CMS Issues Updates on Immediate Jeopardy

Back in 2019, CMS issued revisions to Appendix Q of the State Operations Manual pertaining to Immediate Jeopardy considerations (on the part of surveyors) and ultimately, citation decisions.  This guidance was relevant for all provider and supplier types participating in Medicare (hospitals, home health, SNFs, etc.). In late October, CMS issued guidance on penalties. What … Read more

Friday Feature: Four Topics to Watch

It has been a busy week and next week is a holiday week (Thanksgiving) so of course, a shortened news and work week. That said, there is a lot going on right now and for followers and readers, I thought sharing my top four topics to watch made sense. Tort Reform: Back in February, the Georgia … Read more

Senior Living Liability Claims Analysis Report

Marsh (largest insurance broker in the world) recently released its 2024 General and Professional Liability Report 2024-General-Professional-Liability-Benchmark-Report-MAR-USA. The report includes data from fifty senior living and long-term care providers comprising 10,300 closed claims with paid indemnity and expense value of $1.87 billion across a ten-year horizon. The ten-year data was used by Marsh to forecast … Read more

Nursing Home Closures Creating Access Issues

With increasing older adult demand for hospital care, an ongoing wave of nursing home closures is creating post-acute access issues. Since 2020, 774 nursing homes have closed, and only seven new facilities opened in 2024. The primary driver for closure is a nationwide shortage of qualified clinical staff, exacerbated by the COVID pandemic.  The pandemic … Read more

Final 2025 SNF Rule – Rate Increase, More Fines

Under the Final 2025 (PPS) rule released last Wednesday, nursing homes are set to receive a 4.2% pay increase in Medicare Part A. Additionally, the facilities will encounter a stricter fines system, with civil monetary penalties being applicable in more situations. The Final Rule is available here: SNF Final Rule 2025 In April I wrote … Read more

Senior Housing and Care M&A at Record Level

Mergers and acquisitions activity in the seniors housing and care sector set a new quarterly record with 183 publicly announced transactions in the second quarter of 2024, as reported by LevinPro LTC. This represents a 21% increase over the 151 transactions from the first quarter of 2024, and a 49% rise compared to the 123 … Read more

Senior Living Occupancy Up: Challenges Remain

According to data released by NIC (National Investment Center) last week, senior living occupancies ticked up in the first quarter. This is a trend that has continued since the pandemic occupancy “crash”.  Other economic data, however, suggest that challenges remain for continued growth, especially within the CCRC/Life Plan sector. The NIC data is here: 2Q24-NIC-MAP-Market-Fundamentals … Read more

The Ensign Group Inc. Case Study: Nursing Home Chains Analysis

In the midst of the Covid-19 pandemic, nursing homes across the United States faced daunting challenges. One such example is The Ensign Group Inc., the second largest for-profit chain in the country. A descriptive case study delves into the financial and quality metrics of this publicly traded U.S. nursing home chain during the age of … Read more

Arbitration Agreements: AZ Atty. General Seeks to End Secrecy Provisions

Arizona’s Attorney General, Kris Mayes, is challenging a major nursing home operator in the state with a new legal initiative aimed at ending the concealment of elder abuse and neglect. In March 2022, a resident with dementia was found face-down at Sun West Choice Health and Rehab. He had a massive bedsore − a telltale … Read more

Private Equity Investment in Nursing Home Sector Generates Regulatory Scrutiny

Private equity investment in the nursing home and assisted living sector (other post-acute as well) continues to be a focus of regulatory activity in Congress.  This is despite private equity investment in the nursing home sector to be involve about 5% of facilities. Home health has seen an increasing investment interest as well from private … Read more