How A Federal Shutdown Weakens Nursing Home Oversight And What It Means For Residents

We examine how the federal shutdown disrupts nursing home oversight, why CMS triaged surveys to emergencies, and the risks created by fewer inspectors and furloughed staff. We share steps facilities can take to protect residents, drawing lessons from the OIG’s pandemic report.

• status of the shutdown and date context 
• CMS priorities for complaint investigations and revisits 
• suspension of recertification and initial surveys 
• state surveyor staffing gaps and missed annual surveys 
• risks from reduced oversight, abuse and neglect concerns 
• lessons from the June 2024 OIG report 
• contingency planning for monitoring, QAPI and communication 
• expectations for future cause-and-effect reporting

Please feel free to reach out to Verity Consulting at VerityTeam.com if you'd like further assistance with your healthcare compliance needs

Chapters

• 0:10 Welcome And Disclaimers
• 0:46 Setting The Scene: Shutdown Status
• 1:05 Why Nursing Homes Are At Risk
• 2:44 What CMS Will And Won’t Do
• 4:20 Staffing Shortages And Missed Surveys
• 6:19 Lessons From OIG And The Pandemic
• 8:32 Contingency Planning And Next Steps
• 10:15 Closing Thoughts And How To Reach Us

Transcript

SPEAKER_01: 0:10

Hello, I will be your host. My name is Deanna Fi. I am a registered nurse and healthcare analyst. Let's get started.

SPEAKER_00: 0:20

The views or opinions expressed in this podcast are for informational purposes only, not intended as legal or professional advice, and may not represent those of Verity Consulting. Although we make strong efforts to make sure our information is accurate at the time the podcast episode was recorded, Verity Consulting cannot guarantee that all information in this podcast is always correct, complete, or up to date. All information in this podcast is subject to change without notice.

SPEAKER_01: 0:46

Welcome to Vital Compliance Insights. Today I want to touch upon what's happening in our country right now. As of today, I'm recording this podcast November 10th, 2025. And we're still in the throes of a federal government shutdown in the United States. And I really want to touch upon how does that affect nursing homes? Because that's really the area of my greatest concern right now. So, okay, just for those who maybe aren't up on things, October 1st, 2025, that was the effective date that the federal government stopped funding certain programs. And they decided, okay, there are discretionary federal fundings that will end. We do know Medicare Medicaid, which is a funding source for nursing homes, most many nursing homes, they have mandatory funding requirements. So that's good. However, there are going to be other disruptions as a result of the federal funding cuts. And so what I want to do is just touch a little bit about, touch upon that a little bit. So the real big problem, the effect here, is with funding cuts to the federal programs, it's not just dollars to federal programs, the regional offices, et cetera, central office, Medicare, Medicaid, but it's people, it's the the people, there have been federal workers have been furloughed. Health and Human Services, CMS. They did develop some contingency plans, but uh certainly many federal employees were furloughed. So there again, that's fewer resources, and fewer people are available to assist state survey agencies across the United States, those agencies that have interactions with the federal agencies that govern or have oversight for them. So there's just a lot of ripple effect. You know, you throw the pebble in the water, and the ripples, they really do extend out. And sometimes it's not always clear on what's going to be affected, affected entirely. Now, CMS and Health and Human Services did indicate that they would focus on complaint investigations, those that are alleging serious concerns of incidents of harm, immediate jeopardies. So CMS and HHS said, basically, don't worry, we're going to continue to focus on those. Well, we will do revisit surveys, particularly for those providers that are at risk for having their termination in the Medicare Medicaid program. But other than that, CMS and HHS said we're not going to do the recertification surveys. We're not going to do the initial surveys. We're really going to focus, we're not going to focus on those less serious complaints. And so really, for the most part, federal surveys have been suspended, with the exception of the ones I've just indicated. So what does that mean? Okay, what does that mean? Who's really where is the oversight? Things are a little uncertain about the level of oversight that can reasonably be achieved with fewer resources. And like I said, a lot of federal workers have been furloughed. Now we know it's well documented, state survey agencies are very short-staffed with their own surveyors getting out there. So it's been very difficult for them just to meet their minimum thresholds in some cases. I was reading recently where the CMS released some data of the approximately 2,300 nursing home facilities in the United States. About over 16% have not had their annual surveys in the past 18 months. So you're looking at about what 400 or so nursing homes haven't had an annual survey. So that means there's no eyes, there are no eyes, rather, in the building looking around to identify quality of care concerns. There's just an overall lack of monitoring and oversight. And that can be a real problem. We can certainly talk about that. But certainly there are going to be immediate concerns, but there's going to be some longer, longer lasting. And what I mean by that, we're just furthering the delays for systems that are already struggling. We know in Maryland there was a class action lawsuit. There is a class action lawsuit against the Maryland Department of Health related to survey delays and how that's been translated into substandard care because of the lack of oversight. But there again, the Maryland Department of Health is so understaffed. They're having a difficult time conducting surveys, period. So we know there's already a lot of fragility in a system, nursing home oversight systems, and now we've had funding cuts and resource cuts at the federal level, but that trickles down to the state agencies. Let's not forget, and I did reference this in a previous podcast, the OIG report that came out June 26, 2024. I'll put that on our Verity team website. The OIG article, lessons learned during the pandemic, can help improve care in nursing homes. So that report really certainly talks about just the overall failure, system failures related to the spread of infection, infection related to COVID-19 in nursing homes and how that had a devastating effect on resident care. But there were so many other things that failed here, just overall lack of oversight, a lack of having the eyes in the buildings to see what's going on with residents. Certainly you could read the article, but it talks a lot about the increase in incidence of resident abuse and neglect. So hopefully that article would point out that we need to be aware that it's times like this with government shutdowns when there are fewer resources, fewer people, boots on the ground, looking, seeing, checking things out, that puts residents at even greater risk in our nursing homes. So, with that said, though, I am grateful that we have learned a lot from our pandemic and that I think people have improved systems, there has been system improvement in nursing homes to manage infection control rates. But insofar as the government shutdown, with this situation, the federal government has limited resources to enforce. Are state agencies able to meet their requirements to monitor? Well, there's just fewer resources to do it, period, not only at the state, but at the federal level. There will be some cause and effect reporting coming out about how this shutdown, the government shutdown, has affected levels of services in nursing homes. And so we should expect to hear some of those reports coming out anytime now. Certainly, nursing homes need to look at contingency plans. How can we meet our needs? What kinds of things can we do to make sure our residents have a voice to speak up and express their concerns about care? Are there services that are having any kind of disruption in our operations of our nursing homes? I was reading some articles where state agencies have reached out to federal agencies for assistance and they're saying, in so many words, we'll get to you when we can. We are very short-staffed, so bear with us, because we have had so many uh cuts in uh federal employees being furloughed. So I think we will have to stay tuned for the cause and effect as to how this trickles down and ripples out. I just do hope we have learned some very valuable lessons about the lack of oversight in nursing homes. And I recognize the federal, the federal government has to make some cuts and changes in programming where they can with limited funding. But on the other hand, I just hope we don't go backwards where the residents and benefits beneficiaries are the most at risk. And so with that, I think I'll wrap up and just say I'm hoping this shutdown ends soon. It's today, November 10th, 2025, and uh we have no official uh ending yet since our October 1st shutdown date. So we'll have good thoughts and hope that things will improve. Thanks for listening. If you have any comments or if you have any need for any assistance from VerityTeam.com, please reach out to Verity Team.com. Thank you. Thank you for listening. Your time is appreciated. We hope you enjoyed this episode of Vital Compliance Insights and found this to be informative. Please feel free to reach out to Verity Consulting at VerityTeam.com if you'd like further assistance with your healthcare compliance needs. Stay tuned for the next episode.