Pursuing Quality Long-Term Care

In this episode, Yiqun Chen and Marcus Dillender join us to discuss their revealing study on how nursing homes respond to government inspections. They explain how facilities often make short-term changes—like boosting staff and discharging patients—just to look better during inspections, only to revert immediately afterward. Despite this gaming, inspection ratings still offer meaningful insights into resident outcomes. The conversation covers why some citations lead to real improvements while others don’t; how inspection ratings relate to mortality risk; and what policymakers can do to make oversight more effective and less predictable. This episode offers a candid look at the strengths and blind spots of government monitoring, and what it means for the future of elder care. Guests: Yiqun Chen & Marcus Dillender, economists and authors of the National Bureau of Economic Research (NBER) paper “Government Monitoring of Health Care Quality: Evidence from the Nursing Home Sector”

Join us for part two of a conversation with long-term care residents. In spring 2025, Consumer Voice conducted a nationwide survey of residents to learn what daily life is like in their facilities. The questions ranged from whether residents feel they are treated with dignity and respect to how appealing their meals are, and everything in between. In part two of this podcast, we discuss the survey results and explore key themes with the residents themselves, who serve on Consumer Voice’s Consumer Advisory Council. They share their thoughts and experiences on what it’s like to live in long-term care in 2025 and offer valuable advice on how they advocate for themselves and others.

In spring 2025, Consumer Voice conducted a nationwide survey of long-term care residents to learn what daily life is like in their facilities. The questions ranged from whether residents feel they are treated with dignity and respect to how appealing their meals are, and everything in between. In this two-part podcast, we discuss the survey results and explore key themes with the residents themselves, who serve on Consumer Voice’s Consumer Advisory Council. They share their thoughts and experiences on what it’s like to live in long-term care in 2025 and offer valuable advice on how they advocate for themselves and others. Guests: Maurice Miller, Ray DiFrancisco, Cindy Jones, Margarite Grootjes, and Jeanette Sullivan-Martinez

When something goes wrong in long-term care, do you know what to do? In this episode, we introduce Documenting Resident Concerns in Long-Term Care, a new resource created to help residents and families respond with confidence. From falls and pressure injuries to conflicts with staff, knowing what questions to ask and what details to document can be the key to real solutions. Lori Smetanka and Jocelyn Bogdan of Consumer Voice share practical strategies for gathering information and advocating effectively. This joint project from the National Consumer Voice for Quality Long-Term Care and the National Center on Elder Abuse (NCEA) offers a clear path to stronger advocacy and better care. Guests: Lori Smetanka, Consumer Voice Executive Director, and Jocelyn Bogdan, Consumer Voice Senior Policy Specialist

In this episode, we're joined by three advocates who have worked to raise the personal needs allowance (PNA) and improve the quality of life for nursing home residents in their states. The PNA is a small portion of income that Medicaid nursing home residents can keep each month to cover personal expenses such as clothing, snacks, cell phone bills, and other essentials that make life more comfortable. The federal minimum PNA has not been raised since 1987 and remains just $30 a month, less than one dollar a day. While states can set higher amounts, they currently range from $30 to $200 a month, leaving most residents with only $2 to $3 per day for discretionary spending. Join us as we hear from Bill Lamb, a lifelong advocate in North Carolina, along with resident advocates Ray DiFrancesco of New Jersey, and Jeanette Martinez of Connecticut, as they share their experiences raising the PNA in their states and their advice for others working toward the same goal.

When award-winning filmmaker Susie Singer Carter placed her mother, who was living with dementia, in a five-star nursing home in Los Angeles, she never expected to be dealing with substandard care, inadequate staffing, and chemical restraints. Horrified by what was happening, Susie connected with former federal prosecutor Rick Mountcastle, whose prosecution of Purdue Pharma was featured in the miniseries, Dopesick. Susie and Rick have collaborated on a new documentary, No Country for Old People, to raise awareness about failures in our long-term care system and spur action to promote quality and accountability. On the eve of the release of the documentary, join a conversation with Susie and Rick about what they've learned in this process and what you can do to help change the system. Guests: Guest: Susie Singer Carter, Writer and Director, and Rick Mountcastle, Former Federal Prosecutor

Nearly 40 years ago, after repeated reports, articles, and studies highlighting dismal conditions in nursing homes, Congress passed the comprehensive Nursing Home Reform Act, raising the standard of care and expectations for residents of nursing homes across the country. While we are still advocating for the promise of the law to be experienced by all residents, the importance of implementing the provisions is as necessary today as they were when the law was passed. Listen to our discussion about the passage of the Nursing Home Reform Act, its critical provisions, and what additional advocacy is needed to realize its full promise for all residents. Guest: Toby Edelman, Senior Policy Attorney, Center for Medicare Advocacy

When a loved one enters long-term care, family members often find themselves stepping into a new and unexpected role: advocate. In this episode, Andrea DuBrow and Heather Tunis share their personal journeys from concerned family members to dedicated advocates for their loved ones in long-term care settings. Join us as we explore the vital role of family councils, the power of effective leadership, and the importance of advocacy in ensuring quality care. We also discuss strategies for building respectful and productive partnerships with staff and management, offering essential tips to help family members navigate the challenges of advocacy with confidence and purpose. Whether you're just beginning your advocacy journey or looking to strengthen your approach, this conversation provides invaluable guidance and information. Guests: Andrea DuBrow, Former Caregiver, Consumer Voice Leadership Council Member, Social Worker, Public Health Educator and Advocate; Heather Tunis, Family Care Manager, Management Consultant/Executive Coach, Long-Term Care Family Advocate

Consumer Voice’s Public Policy Director, Sam Brooks, talks with Dr. Norma Coe, a professor of Medical Ethics and Health Policy at Perleman School of Medicine, whose research on the minimum staffing rule in nursing homes found that the rule would save 13,000 resident lives annually. Sam and Dr. Coe will discuss the rule, its impact on residents, and the current barriers to its implementation. Guest: Dr. Norma Coe, Professor of Medical Ethics and Health Policy at Perleman School of Medicine

Currently, the reconciliation process is underway in Congress. At stake are hundreds of billions of dollars in cuts to Medicaid, which would permanently alter the Medicaid program and have long-lasting and devastating impacts on tens of millions of Americans nationwide. In this episode, Consumer Voice’s Public Policy Director, Sam Brooks, will discuss the reconciliation process with Nicole Jorwic and Gelila Selassie and what it will mean for Medicaid recipients, including nursing home residents and other consumers of long-term care supports and services. Additionally, this episode includes a call to action and lays out what you can do to help stop these catastrophic cuts to this essential healthcare program.

Although federal law and regulation prohibit the use of third party guarantees, some nursing homes may still attempt to get you to sign documents making you financially responsible for a nursing home stay. Join us for a conversation with experts Anna Anderson and Eric Carlson as they guide you through what you can do if a nursing home tries to hold you financially liable for someone else's nursing home stay. Guest: Eric Carlson, Director, Long-Term Services and Supports Advocacy, Justice in Aging; Anna Anderson, Staff Attorney, National Consumer Law Center

During this time of year nursing homes can expect to see an increase in people visiting their loved ones. This increase puts everyone at a higher risk of catching a cold or respiratory illnesses. Join us for a conversation as we dive into the latest CDC guidance on respiratory illnesses, including COVID-19, for nursing home residents. We are joined by Dr. Erika Wallender from the CDC, and Lori Walsh, Consumer Voice Policy and Program Specialist, to discuss practical steps in reducing infection risks and best practices for staying safe during this upcoming respiratory season. We also remind residents and their families of their rights and protections while navigating life in a nursing home.

Election season is an exciting time that offers a renewed opportunity to shape public policy. For many long-term care residents, voting is a patriotic duty that has been respected and exercised over the course of their lifetime. Residents of long-term care have the same right to vote as everyone else. Join us for a conversation with Gwen Orlowski, Executive Director of Disability Rights New Jersey to discuss how residents and their families can ensure their voices are heard in the upcoming elections.

Guardianship is a tool intended to support individuals who have lost the capacity to make decisions for themselves. However, guardianship is an extreme step and can have a devastating impact on a person's well-being. In this episode, we will discuss guardianship over residents of long-term care facilities, less restrictive alternatives, and strategies for supporting residents under guardianship. Guests: Alison Hirschel, Director of the Michigan Elder Justice Initiative, and Emily Miller, Managing Attorney of the Crime Victims Legal Assistance Project of the Michigan Advocacy Program

Retaliation, and the fear of retaliation, can prevent residents and family members from raising their concerns about care and safety. It also has a chilling effect on the reporting of abuse or neglect in long-term care facilities, leaving many living in fear and without relief from harm. Retaliation can range from very subtle to obvious actions and it may be difficult to determine whether staff are retaliating or if a resident’s needs are not being met for another reason, such as understaffing. Retaliation is never acceptable; it is a violation of the resident's rights. In this episode, join us for a conversation with an Ombudsman, a long-term care resident, and a gerontologist as we discuss how to identify retaliation, action steps to take when it does occur, and how to advocate to prevent retaliation from happening in the future. Guests: Tasha Erskine-Jackson, Regional Ombudsman, Connecticut Aging and Disability Services; Jeanette Martinez, Connecticut Long-Term Care Resident; and Eilon Caspi, Gerontologist and Dementia Behavior Specialist

In April 2024, a new federal rule requiring minimum staffing levels in nursing homes was released. This rule is an important step toward improving quality conditions in nursing homes and ensuring that residents receive the care they need. Listen in on a discussion between Consumer Voice's Lori Smetanka and Sam Brooks, who talk about the importance of the rule, what it says, and how we can start thinking about using it in advocating for quality care.

The Centers for Medicare and Medicaid Service’s (CMS) new minimum staffing standard requires facilities to provide 3.48 hours of care per resident per day. That translates into three hours and 29 minutes of care over 24 hours for each resident. This number is lower than what Consumer Voice and other consumer advocates, nursing professionals, and nursing home residents have been advocating for, for years. This number is lower than what studies have shown, for decades, will keep nursing home residents safe, but it will still raise staffing levels at many facilities. In this episode, you will hear an important conversation between four nursing home residents about their personal experiences with understaffing, their thoughts on the new minimum staffing standard released by CMS, and their plans for advocating for themselves and others moving forward. The residents in this conversation are all part of Consumer Voice’s Consumer Advisory Council and we are grateful they made the time to share their thoughts with us. Special Guests: • Maurice Miller; Long-Term Care Resident in Maryland • Sharon Wallace, Long-Term Care Resident in New York • Cindy Napolitan Long-Term Care Resident in Texas • Margarite Grootjes, Long-Term Care Resident in Ohio

Every April, organizations across the country take the time to celebrate and thank their volunteers. Volunteers are the backbone of many Long-term Care Ombudsman Programs (LTCOP). With the help of volunteers, the Ombudsman program can have a regular presence in facilities and stay in touch with residents. Volunteers lend their time, talent, and voice to make a difference in their communities and the LTCOP could not be its best without the volunteers who help carry out the mission of advocating for long-term care residents. In this episode, the National Ombudsman Resource Center (NORC) talks to a certified volunteer from New Jersey about her experience and dedicated advocacy. The Administration for Community Living (ACL) also joins to honor the over 4,000 people who serve as Long-Term Care Ombudsman volunteers. These specially trained volunteers visit nursing homes and residential care communities to advocate with and for the residents living there. By visiting on a regular basis, volunteers get to know residents and gain their trust to better assist them in resolving issues or complaints to help ensure they receive quality long-term care. Guests: Beverley Laubert, National Ombudsman Program Coordinator, Office of Long-Term Care Ombudsman Programs, Administration for Community Living; Pat Murphy, Certified Volunteer Advocate, New Jersey Long-Term Care Ombudsman Program

Since the pandemic began, there has been significant efforts by advocates to create better laws and regulations to protect nursing home residents. The pandemic and its devastating impact on nursing home residents has resulted in many states passing new laws or creating new regulations regarding a variety of areas, including staffing, transparency, and the nursing home workforce. On this episode, you will hear from two advocates that have been successful in getting new laws and regulations passed and promulgated. Tony Chicotel, Senior Staff Attorney at California Advocates for Nursing Home Reform and Pam Walz, Supervising Attorney at Community Legal Services in Philadelphia, will discuss recent legislative and regulatory victories and how they helped ensure they were implemented.

Often the conversation about addressing the chronic poor care that exists in far too many of today's nursing homes is framed around new laws or regulations. Yet, there are steps that can be taken now - using existing federal and state legal authority - to improve care and conditions in our country's nursing homes. In our conversation, we will discuss four levers of opportunity for increasing quality and accountability in nursing homes with the author of "Using What We Have: How Existing Legal Authorities Can Help Fix America's Nursing Home Crisis." Special Guest: Nina Kohn, J.D., the Solomon Center Distinguished Scholar in Elder Law at Yale Law School, the David M. Levy Professor of Law at Syracuse University College of Law, and a leading authority in elder law and the civil rights of older persons.