Under significant industry pressure, the Trump administration is reducing its use of fines against nursing homes that harm patients or put them at risk for serious injury.
The American Health Care Association, the industry's main trade group, has complained that under Obama inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.
"It is critical that we have relief," Mark Parkinson, the group's president, wrote in a letter to then-President-elect Donald Trump in December 2016.
Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said providers are ultimately concerned that burdensome regulations hinder quality care for patients.
"Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn't increase the quality of care they provide," Goodrich said.
But the administration's new guidelines discourage applying fines even in some situations that have resulted in patient deaths. Advocates see this as harmful, particularly with what seems to be a widespread patient care problem:
Since 2013, nearly 6,500 nursing homes — 4 out of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.
Trump issued an 18 month grace period for nursing homes that violate a set of eight new rules in November. Those cited will not incur a penalty and are expected to use that time to improve operations.
Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors "are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards." He said while the motivation for tough regulation was understandable, "the fines don't make it easier to hire people and doesn't make it easier to stay in business."