Updated September 2025: We have updated the article to include the latest 2025 CMS regulatory revisions, including revised surveyor guidance (Appendix PP), new Five Star rating methodology, expanded staff role definitions, strengthened infection prevention requirements, reduced psychotropic medication protocols, and updates to privacy, accessibility, and assistive technology trends.
Understanding Nursing Home Requirements in 2025
Understanding the intricate landscape of nursing home requirements is crucial, especially for facilities seeking participation in Medicare and Medicaid programs. At the heart of these requirements is compliance with 42 CFR Part 483, a regulation that facilities must meet to receive payment from these federal programs. According to the Centers for Medicare & Medicaid Services (CMS), adherence to these standards not only ensures payment eligibility but also safeguards the well-being of nursing home residents.
Navigating the Regulatory Environment
Navigating the regulatory environment of nursing homes involves a firm grasp of key federal regulations and compliance standards. The framework, provided by 42 CFR Part 483, outlines essential guidelines for both skilled nursing facilities (SNFs) and nursing facilities (NFs). According to CMS Guidance for Laws & Regulations, these stipulations are vital for Medicare and Medicaid-certified institutions, emphasizing the necessity of regular surveys and inspections to uphold quality care.
Survey and inspection processes play a pivotal role in maintaining compliance. State surveys, often conducted without prior notice, ensure that facilities meet established standards, as CMS Guidance highlights, helping protect residents from substandard care and fostering an environment of accountability. Differing from routine inspections, these comprehensive evaluations take into account various factors, such as resident feedback, to ensure a holistic review of compliance.
2025 CMS Regulatory Updates
Beginning in 2025, CMS introduces significant new compliance standards and protocols that reshape how nursing facilities operate. Newly revised surveyor guidance (Appendix PP, effective April 28, 2025) strengthens expectations for medication management—especially regarding psychotropic medications—emphasizing resident involvement in treatment decisions, restricting unnecessary drug use, and consolidating enforcement on medications administered for staff convenience. Updates also include clarified duties for medical directors, enhanced infection control protocols, and new requirements for functional status assessments aligned with Minimum Data Set (MDS) Section GG, supporting the development of individualized mobility and care plans. There is now expanded focus on clearly defined nursing roles, enhanced assessment practices for falls, pressure ulcers, hydration, and weight loss, and reinforced policy adherence through medical director oversight. These changes are outlined in the CMS 2025 Surveyor Guidance Update and further highlighted by Navigating the 2025 CMS Updates.
The Five Star quality rating system has also changed, with the methodology now considering only the two most recent surveys instead of three, effective July 2025. COVID-19 vaccination information has been removed from public nursing home profiles to reflect a post-pandemic environment. Additionally, CMS is expanding public reporting on the performance of nursing home chains to promote transparency and facilitate informed decision-making. These regulatory enhancements underscore CMS’s ongoing commitment to advancing resident care, safety, and quality assurance. To remain compliant, facilities must update their protocols, conduct comprehensive staff training, and prioritize rigorous functional and medication assessments in daily practice. Expanded Quality Assurance Performance Improvement (QAPI) integration is now a central focus to support leadership and regulatory compliance.
Recent regulatory memos further highlight the emphasis on reducing psychotropic medication use through alternative behavioral support and environmental modifications, indicating a trend toward more ergonomic, person-centered rehabilitation and the adoption of inclusive assistive devices for residents with reduced mobility. Infection control requirements have increased, with new CMS guidelines—in particular, QSO-24-08-NH and subsequent 2025 updates—mandating enhanced barrier precautions to guard against multidrug-resistant organisms (MDROs), which is crucial for resident safety and when integrating mobility and hygiene-related technologies. Facility design clarifications also now permit newer or newly certified nursing homes (post-November 2016 approvals) to achieve updated accessibility and privacy requirements—such as single-occupancy rooms—without mandatory extensive renovations, supporting both modern care delivery and resident dignity.
Current Trends and Challenges in Nursing Homes
The nursing home sector is currently navigating several trends and challenges, including occupancy rates, funding, and workforce dynamics. As of recent data, occupancy rates in nursing homes are seeing modest increases, with major markets experiencing slight rises. This is juxtaposed with a 4.2% increase in Medicare payments to SNFs for the fiscal year 2025, according to the National Investment Center (NIC).
Despite these financial shifts, nursing homes continue to grapple with workforce shortages and the resulting strain on service delivery. These challenges are expected to intensify due to external policy impacts—most notably, the One Big Beautiful Bill Act (OBBB) signed in July 2025, which is anticipated to increase care complexity in nursing homes as rural hospital closures accelerate and workforce demands heighten. Addressing these challenges, including compliance with new surveyor and reporting guidance, is among the primary policy priorities for 2025, as highlighted by the American Health Care Association (AHCA) and recent regulatory memoranda. The sector’s focus remains firmly on ensuring resident-centered care while adapting to regulatory changes and increasing operational pressures.
Common Questions About Nursing Home Admission and Care
For those considering admission to nursing homes, understanding the nursing home requirements is paramount. Questions often arise regarding federal regulations, the role of staff, and measures ensuring compliance and safety. According to CMS Guidance, inspections, a critical component of regulatory oversight, are designed to validate compliance and highlight areas needing attention.
Addressing common concerns, each facility is guided by the responsibilities of its medical director and staff to deliver consistent, quality care. Their roles are pivotal in implementing and maintaining rigorous standards that protect residents. With the 2025 CMS updates, this includes a reinforced focus on appropriate medication management with resident consent, thorough assessment after significant health status changes, strengthened infection prevention practices—especially concerning multidrug-resistant organisms—and the use of updated tools for evaluating self-care and mobility (such as the MDS Section GG). Practical scenarios like ensuring proper medication protocols, minimizing psychotropic drug use by utilizing supportive ergonomic and behavioral interventions, and addressing evolving rehabilitation needs highlight the complexity of maintaining regulatory compliance while delivering personalized care.
Exploring Alternatives to Nursing Homes
The potential for remaining independent in one’s own home is a desirable option for many older adults. Products like VELA Chairs facilitate this autonomy by addressing common mobility and safety concerns. Features such as a central brake enhance security, while electric height adjustability and ease of movement in a seated position afford significant support throughout daily tasks. By reducing falls and conserving energy, these chairs help seniors maintain a greater degree of freedom and dignity. Though not the only solution available, VELA Independence Chairs stand as a proven, practical choice that can delay the transition to a nursing home by improving life at home. They provide meaningful assistance in cooking, cleaning, and relaxing, underscoring the importance of such mobility aids in the continuum of care.
- Centers for Medicare & Medicaid Services (CMS) – Quality, Safety, and Oversight memorandum QSO-25-NH (June 18, 2025) on Five Star rating changes and chain data publication.
- CMS updated nursing home surveyor guidance effective April 28, 2025, in Appendix PP (State Operations Manual) including psychotropic medication and resident care policies.
- CMS Nursing Home Requirements and Survey Protocols official page (July 31, 2025 update).
- Analysis on impacts of One Big Beautiful Bill Act (OBBB) on Skilled Nursing Facilities by Holland & Knight (July 2025).
- Constellation Quality Health’s summary of 2025 CMS updates focusing on nursing services, Payroll Based Journal, and QAPI integration (February 2025).
- Hall Render – “Nursing Home Update: CMS Extends Implementation Date of Surveyor Guidance” (March 2025) [link]
- Health Industry Washington Watch – “Recent Legislative and Regulatory Updates for Long-Term Care Facilities” (July 2025) [link]
- The Consumer Voice – “Summary of CMS’s Revised Guidance for Nursing Home Surveyors” (January 2025/April 2025) [link]
- AHCA/NCAL – “CMS Makes Updates to Nursing Home Care Compare and Five Star” (June/July 2025) [link], “CMS Posts Updated Appendix PP Regulations” (May 2025) [link]
- PALTmed – “CMS Announces Key Revisions to Nursing Home Surveyor Guidance” (November 2024, updates through 2025) [link]