July 01, 2024

Warren, Schakowsky Slam Largest Nursing Home Lobbying Groups for “Sabotaging” Biden Administration’s Minimum Nurse Staffing Rules that Improve Quality of Care for Seniors

“There is no justifiable rationale for opposing this rule, but the nursing home industry, instead of acting in the best interests of its residents, is seeking to do so, with no accountability to the residents they serve.”

Text of Letter (PDF)

Washington, D.C. — U.S. Senator Elizabeth Warren (D-Mass.) and U.S. Representative Jan Schakowsky (D-Ill.) sent a letter to two of the largest trade associations representing the nursing home industry — the American Health Care Association (AHCA) and LeadingAge — slamming them for opposing the Centers for Medicare & Medicaid Services’ (CMS’s) final rule that would, for the first time, set a national floor for minimum nurse staffing requirements in Medicare and Medicaid-certified nursing homes, improving quality of care. 

The letter follows a November 2023 report from Senator Warren which found that the CMS policy would result in higher quality ratings, fewer deficiencies in care, and lower levels of patient abuse, and the senator’s May 2024 analysis that found three of the largest public, for-profit nursing home chains handed out nearly $650 million in buybacks, dividends, and CEO salaries since 2018 — excess cash that could otherwise be put toward hiring more nurses and improving care. 

“We are writing regarding the American Health Care Association and the National Center for Assisted Living’s (AHCA/NCAL) and LeadingAge’s shameless attempts to sabotage a long overdue CMS rule that would help millions of seniors living in nursing homes receive better quality care,” wrote Senator Warren and Representative Schakowsky. “Your attempts to reverse this rule make a mockery of your claim that you have an ‘unwavering… dedication to providing quality care solutions for people who are frail, elderly, or living with disabilities,’ and you should put a halt to these misguided efforts.”

The nursing home industry has been fighting tooth and nail against this rule since its inception: in 2023, AHCA spent nearly $4.15 million on lobbying — the most it has ever spent in a single year. AHCA has spent nearly $17 million on lobbying since 2020, and LeadingAge has spent over $750,000 over the same period. After CMS finalized the minimum nurse staffing rule on April 22, 2024, AHCA and LeadingAge announced that the groups were  “exploring all options” to “halt the regulation’s implementation.” Most recently, on May 23, 2024, AHCA, joined by LeadingAge, filed a lawsuit against the U.S. Department of Health and Human Services (HHS) and CMS challenging the rule, and House and Senate Republicans have advanced legislation to prevent it from taking effect. 

“The basis of the nursing home industry’s opposition to this rule appears to be quite simple: greed,” continued Senator Warren and Representative Schakowsky. “Continued industry claims that nursing homes cannot afford to hire more nurses are undermined by a recent investigation by our offices, which found that for-profit nursing homes have been stuffing hundreds of millions of dollars into their pockets with sky-high executive salaries, massive dividends, and large stock buybacks… while claiming they could not afford to meet the rules.”

“There is no justifiable rationale for opposing this rule, but the nursing home industry, instead of acting in the best interests of its residents, is seeking to do so, with no accountability to the residents they serve. You owe Congress and the public an answer for why you are spending millions of dollars on lobbying and campaign contributions in support of policies that would harm the residents living in nursing homes.” concluded the lawmakers. 

Senator Warren has led the fight for stricter oversight of nursing homes and increased transparency: 

  • In May 2024, Senators Warren, Richard Blumenthal (D-Conn.), and Bernie Sanders (I-Vt.), along with U.S. Representatives Lloyd Doggett (D-Texas) and Schakowsky sent letters to three of the largest public, for-profit nursing homes in the country — Brookdale Senior Living, Ensign Group, and National HealthCare Corporation — highlighting the discrepancy between their opposition to a CMS proposal to set minimum staffing levels for nursing homes, and the industry’s massive payouts in buyouts, dividends, and salaries to executives and shareholders, totaling almost $650 million dollars since 2018. 
  • In April 2024, at a hearing of the Senate Special Committee on Aging, Senator Warren highlighted the impact of low staffing levels on quality of care in nursing homes. As of the time of the hearing, CMS was finalizing the rule that would require every nursing home to have a sufficient number of staff on hand to protect and care for residents.  
  • In November 2023, Senators Warren, Blumenthal, and Sanders released a new report: Residents at Risk: Quality of Care Problems in Understaffed Nursing Homes and the Need for a New Federal Nursing Home Staffing Standard. The report revealed that, across a broad range of health outcomes, nursing homes with higher staffing levels that meet the requirements in the CMS proposed rule provide higher quality care than homes with lower staffing levels.
  • In May 2023, at a hearing of the Senate Special Committee on Aging, Senator Warren called out corporate owners of nursing homes, including private equity firms and Real Estate Investment Trusts (REITs), for their failures to protect patient safety and use of complex legal arrangements to avoid regulatory scrutiny.
  • In May 2023, Senators Warren, Chuck Grassley (R-Iowa), and Bob Casey (D-Pa.) and Representatives Lloyd Doggett (D-Texas) and Katie Porter (D-Calif.) sent a bipartisan letter to Health and Human Services (HHS) Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure, calling on CMS to strengthen and finalize its proposed rule to make nursing home ownership more transparent.
  • In December 2022, a Government Accountability Office (GAO) report requested by Senators Warren and Ed Markey (D-Mass.) found increases in both the number and the severity of care deficiencies cited at State Veterans Homes (SVHs) across the nation, citing an increase “from 424 in 2019 to 766 in 2021.”
  • In May 2022, Senator Warren and lawmakers sent a letter to private equity giant KKR for the grossly substandard care and unsafe living conditions in group homes it owned for people with intellectual and developmental disabilities. 
  • In February 2022, testifying before the Senate Budget Committee, Senator Warren called out private equity firms’ predatory practices of buying up distressed companies; stripping workers of benefits, fair pay, and safe working conditions, and reaping billions in profits. She noted that research shows that private equity ownership of nursing homes led to a 10% jump in short-term mortality rates.
  • In August 2021, Senator Warren and lawmakers launched an investigation into private equity ownership of for-profit hospice companies and subsequent reductions in the quality of care.
  • In March 2021, Senator Warren released Genesis’s response to her January 2021 letter and sent a letter to the company, revealing new information that the company CEO - who left the company in near bankruptcy in January 2021 - has been awarded $8 million in salary and bonuses since the start of the pandemic. Senator Warren raised new questions about why the company lavishly rewarded its CEO after more than 2,800 of its residents died of COVID-19 and despite the fact that he left the company in dire financial conditions. 
  • In November 2019, Senators Warren and Sherrod Brown (D-Ohio), and Representative Mark Pocan (D-Wisc.) wrote to four private equity firms that invested in companies providing nursing home care and other long-term care services, citing reports that show private equity investment has played a role in the declining quality of care in nursing homes and requesting information about each firms' management of this sector.