Nursing Home Administrator Experiences Navigating the Changing Regulatory Environment During the COVID-19 Pandemic

Throughout the COVID-19 pandemic, the Centers for Medicare and Medicaid Services and state health agencies implemented numerous regulations for nursing homes addressing infection control and data reporting. This study explores interviews (n = 156) with administrators of 40 nursing homes across the U.S. between July 2020 and December 2021 to better understand their experiences with governmental agencies amid shifting regulatory standards, frequent inspections, and possible enforcement actions. Administrators highlighted confusion due to the evolving and sometimes conflicting guidance between state and federal agencies, although some states offered valuable COVID-19-specific assistance. They also described challenges in understanding and implementing new, frequently changing requirements, resulting in potential inspection deficiencies. Although enforcement actions, including financial penalties, are intended to deter noncompliance, administrators expressed concerns about added resource strain. Recommendations included increasing collaboration and data collection between regulatory agencies; reducing administrative burden during outbreaks and incorporating feedback from centers during regulatory changes; and increasing reimbursement to support compliance. Continued changes to oversight, including increased penalization and risk-based survey prioritization, should be evaluated to determine differential impacts on nursing home operations and resident care.