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Update with DHHS Survey Department LeadingAge Nebraska members had the opportunity to meet with DHHS Survey and other partners again this week on our monthly call. Slides from this presentation are available here. Below are a few highlights for Nursing Home members. ICAP Update CDC recently made changes to required testing as well as healthcare staffing requirements for respiratory illness. Dr. Ashraf explained that staff are restricted for a minimum of 3 days for respiratory infections and there is no testing requirement to return to work. PPE utilization should remain the same for COVID as it was previously. For Resident testing, there is no prescribed requirements or frequency for outbreaks. Residents should be tested if they have symptoms and should do a minimum of 10 days isolation for positive cases. Symptom screening of others should be conducted to determine testing needs based on symptoms. Broad based testing is no longer required. Providers are reminded that their policy and procedures can be combined for all respiratory illness, while separating for different protocol for each type of illness. Policy should be based on CDC and/or ICAP guidance. You can view ICAP’s webinar from 10/8/26 and slides for additional guidance. Life Safety Code Doug provided a reminder about not using space heaters. If you are having heating concerns, please contact the State Fire Marshal for short term solutions that are permitted. He also discussed egress exits, including exits off patios and how they should not be locked with a padlock or other means that cannot be removed. Delayed egress are always permitted but those that are not being restricted from the exit should always have access to exit. This may be with a code or other means to allow them to exit. You do not need to post the code on the door, but there needs to be a method that everyone is aware of so they know how to exit. Survey Trends There are two survey trends currently. Notification to the Ombudsman for discharges. Providers are reminded to send a copy of the discharge letter to the ombudsman’s office as they occur. Emergency discharges can be sent on a monthly basis. Providers do not need to do discharge notifications due to death. Second is the issue of informed consent for psychotropic medications. The resident and/or their representative must be informed at admission and for any dose change for psychotropic medications. Update the following call We received the following update regarding the discussion of if this applied to decreases in medications. Here is what was received from Larisa: I just wanted to follow up on the psychotropic medications and the question on decreasing needing informed consent. I have had a few people reach out to me as well on this. So F605 does primarily talk about the increases and changes to different medications. However, we still must look at F552 which is the right to be informed. So, if there was a decrease in the medication the resident/family/POA have the right to be informed in advance of any changes in treatment. F605 also speaks to even with increases and initiation of the medication resident has right to be informed if there is not documentation of that then we would cite F552. I copied the regulation below and highlighted what parts pertain to that. So next question I get is then do they have to have a form. Nor F605 or F552 require a form that is the choice of the facility and their policies, but it is required to be documented somewhere that can be accessible. F552 Planning and Implementing Care. The resident has the right to be informed of, and participate in, his or her treatment, including: The right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition. The right to be informed, in advance, of the care to be furnished and the type of care giver or professional that will furnish care. The right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she prefers. Guidance is: The physician or other practitioner or professional must inform the resident or their representative in advance of treatment risks and benefits, options, and alternatives. The information should be communicated at times it would be most useful to them, such as when they are expressing concerns, raising questions, or when a change in treatment is being proposed . The resident or resident representative has the right to choose the option he or she prefers. Emergency Preparedness and 1135 Waivers Larisa presented on emergency preparedness and requirements of the 1135 waiver. This waiver only goes into effect when there is a federal declaration of an emergency for the area. Providers should include provisions for the 1135 waiver in their emergency preparedness policy. This waiver requires a provider to collaborate and support other emergency processes in their greater community. Providers should network with other healthcare providers as well as their emergency response center in their local area to know and understand emergency plans and how they will be able to contribute to the community in a collaborative way.
Update with DHHS Survey Department LeadingAge Nebraska members had the opportunity to meet with DHHS Survey and other partners again this week on our monthly call. Slides from this presentation are available here . Below are a few highlights for Assisted Living members. ICAP Update CDC recently made changes to required testing as well as healthcare staffing requirements for respiratory illness. Dr. Ashraf explained that staff are restricted for a minimum of 3 days for respiratory infections and there is no testing requirement to return to work. PPE utilization should remain the same for COVID as it was previously. For Resident testing, there is no prescribed requirements or frequency for outbreaks. Residents should be tested if they have symptoms and should do a minimum of 10 days isolation for positive cases. Symptom screening of others should be conducted to determine testing needs based on symptoms. Broad based testing is no longer required. Providers are reminded that their policy and procedures can be combined for all respiratory illness, while separating for different protocol for each type of illness. Policy should be based on CDC and/or ICAP guidance. You can view ICAP’s webinar from 10/8/26 and slides for additional guidance. Life Safety Code Doug provided a reminder about not using space heaters. If you are having heating concerns, please contact the State Fire Marshal for short term solutions that are permitted. He also discussed egress exits, including exits off patios and how they should not be locked with a padlock or other means that cannot be removed. Delayed egress are always permitted but those that are not being restricted from the exit should always have access to exit. This may be with a code or other means to allow them to exit. You do not need to post the code on the door, but there needs to be a method that everyone is aware of so they know how to exit. Survey Trends There are no survey trends specific to Assisted Living providers. Emergency Preparedness: Larisa reviewed information regarding emergency preparedness requirements for Assisted Living Providers. See slides for additional information.  Here is your Life Plan Community Weekly Recap .
CDC Releases Updated Return-to-Work Guidance. The Centers for Disease Control & Prevention (CDC) has released updated guidance outlining recommendations for work restriction for healthcare personnel related to respiratory viruses. LeadingAge has vigorously advocated for such guidance for years. The guidance replaces the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 previously used for work restrictions for healthcare personnel exposed to or infected with COVID-19. The new guidance is based on recommendations from CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), approved during the Committee’s last meeting in November 2024 before it was disbanded in March 2025. The new guidance applies to respiratory illnesses “not addressed elsewhere” in CDC guidance, including flu, respiratory syncytial virus (RSV), and COVID-19. According to this guidance, asymptomatic healthcare personnel who have been exposed to a respiratory illness do not need to be restricted from work but should wear source control from the day of first exposure through at least the fifth day after exposure. Healthcare personnel with a suspected or confirmed viral respiratory infection should be restricted from work until all four conditions are met: At least three days have passed since symptom onset (or first positive test, for asymptomatic infections), The individual is fever-free for at least 24 hours without the use of fever-reducing medications, Symptoms are improving, and The individual feels well enough to return to work. Testing to determine the specific respiratory illness is not required; however, CDC recommends following guidance specific to the respiratory pathogen should the individual opt for testing. LeadingAge is very pleased to see this updated guidance after years of advocacy and urges CDC to similarly update transmission-based precautions for healthcare settings and retire outdated guidance for SARS-CoV-2 infections among patients in healthcare settings, including residents in nursing homes. Provider can see the 10/8/26 presentation from ICAP with a summary of the requirements for health care providers regarding respiratory illness. Infection Control Guidance: Measles. With measles cases being reported across the U.S., LeadingAge members should be prepared to identify and address this highly contagious illness. Stay on top of case prevalence in your local area and coordinate with your local public health for guidance. The Centers for Disease Control & Prevention (CDC) also has resources available to help. Check out Healthcare Providers: Stay Alert for Measles and Measles Preparedness and Response in Healthcare Settings to get started.
Workforce Bill Aimed at Direct Care Workers Introduced On October 1, House Committee on Education and Workforce Ranking Member Bobby Scott (D-VA), along with Representatives Adelita Grijalva (D-AZ) and Susie Lee (D-NV), introduced the Direct CARE Opportunity Act of 2026. This legislation is intended to strengthen the direct care workforce through federal investment in recruitment, retention, training, and career advancement initiatives. The proposal builds on concepts that have circulated in previous congresses and reflects ongoing concerns about growing demand for direct care workers and persistent workforce shortages across aging and disability services. The bill’s central concept is the establishment of a grant program administered by the Department of Labor, in coordination with the Department of Health and Human Services, to support strategies for recruiting, retaining, and advancing direct care workers. Grants would be awarded for a minimum of five years to support workforce development initiatives such as education and training programs, apprenticeships, supportive services, and other efforts designed to strengthen the direct care workforce. Potential applicants for such grants would include states, workforce boards, labor organizations, nonprofit organizations with expertise in aging or disability services, institutions of higher education, tribal organizations, and other entities capable of developing and implementing direct care workforce strategies. The bill is largely agnostic on care setting and specifically identifies personal care aides, direct support professionals, home health aides, and nursing assistants among the workers it is intended to support. LeadingAge appreciates efforts to bolster this workforce and the congressional recognition of the critical role these workers play in caring for older adults and supporting families. Investments like those envisioned in this bill can help attract workers to aging services careers and create opportunities for advancement within the field. At the same time, temporary grant programs alone cannot resolve the structural difficulties facing these occupations. Workforce challenges are closely tied to longstanding reimbursement constraints posed by our federal health programs that limit providers' ability to offer sustainable wage growth and benefits. While proposals like the Direct CARE Opportunity Act can serve as an important part of the solution, long-term workforce stability will also require attention to the underlying financing systems that support aging services providers and the workers they employ. DHS proposed $70,000 fee on student workers open for comment: As indicated earlier this week, DHS has proposed a rule that would charge schools $70,000 before recommending international students on an F-1 visa for Optional Practical Training (OPT), and $30,000 for each later OPT period, citing fraud concerns and the protection of U.S. workers. OPT allows foreign students to work during and after a course of study. Schools could pass the cost on to students or employers. For aging services, the concern is international graduates of U.S. nursing and allied health programs who use OPT to move into their first U.S. jobs. The proposed rule is now published in the Federal Register and open for comment, with a close date of November 9, 2026. For more information and employer recommended steps see our full article here . Here is your weekly Workforce Weekly Recap
CMS Releases Guidance on Direct Care Worker Reporting Requirements for HCBS On October 9, the Centers for Medicare and Medicaid Services (CMS) released both a State Medicaid Director Letter (SMDL) and Technical Specifications to states. The guidance relates to provisions from the Medicaid Access Rule which required states, among other requirements, to collect data and report to CMS on wages and benefits paid to direct care workers providing homemaker, home health, and personal care services. States must be prepared for the reporting requirement beginning July 9, 2028 and the reporting of readiness to CMS by July 9, 2027. With that in mind, CMS issued the SMDL and technical specifications to help states establish their infrastructure for collecting data and reporting to CMS. The 80/20 wage pass through requirement remains in the Access Rule with an effective date of July 9. 2030. It is unknown at this time if this section of the rule could be eliminated prior to implementation. The SMDL contains useful examples to help states consider how to establish reporting infrastructure and rate attribution, along with reminders that IT system upgrades are available for enhanced federal funding. Check Out the Treasure Trove of Resources on the GUIDE Dementia Care Model. Following recent meetings with the Center for Medicare and Medicaid Innovation staff for the Guiding an Improved Dementia Experience (GUIDE) model, CMMI staff shared a number of resources including a series of fact sheets, operational guidance, training materials and more on the model that members who are both GUIDE participants and providers of GUIDE services likely will find useful in navigating the latest changes. These resources can be found here , including more information about how to comply with the updated policies around Residential Care Communities . Additionally, keep up to date on any GUIDE model developments through our GUIDE model serial post. CMMI GUIDE staff will also be joining the October 22 LeadingAge Adult Day Network at 1 p.m. ET to discuss the opportunities for adult day providers in the model and to answer members’ questions about the model. If you are interested in joining this discussion, reach out to Georgia Goodman at ggoodman@leadingage.org for details on how to join. Also, stay tuned for more details for GUIDE participants and providers to participate in a November discussion with CMMI GUIDE staff on the Residential Care Community changes and challenges, and how to meet the needs for respite care under the model.
LeadingAge Takes Housing to the Hill. With the debate over federal housing funding and policy heating up ahead of the mid-term elections, LeadingAge national’s affordable housing policy experts and housing provider members from around the U.S. visited congressional offices on October 6, 2026, to elevate and explain affordable senior housing communities’ most pressing issues. Discussions focused on sharing member experiences with congressional committee staff from both parties, including the House Financial Services Committee and the Senate Committee on Banking, Housing, and Urban Affairs, which oversee policy for federal housing programs, as well as the Senate Committee on Appropriations, which oversees funding for housing programs. Led by LeadingAge’s housing policy team, the group of ten mission-driven housing organizations also met with the office of Senator Reed (D-RI), a key champion of affordable senior housing programs, and the office of Congresswoman Goodlander (D-NH-02), who helps lead bipartisan efforts to speed up affordable housing production. Conversations centered on five priorities outlined in LeadingAge’s housing policy agenda: expanding rental assistance for older adults; improving preservation programs for existing affordable senior housing; strengthening development tools to create new units for older adults with low incomes; investing in Service Coordination and place based supportive services throughout affordable senior housing; and modernizing existing programs serving older adults. The group of advocates represented housing communities from Massachusetts to Ohio to California, through both large and small housing portfolios. Over several hours in both the House and Senate, LeadingAge members described their experience with federal housing programs, including the importance of the Department of Housing and Urban Development’s (HUD) Section 202 Supportive Housing for the Elderly program; their challenges with infeasible domestic procurement requirements through the Build America, Buy America (BABA) Act; and such ongoing concerns as the need for greater rental assistance funding and how Section 202 can be most effectively combined with the Low-Income Housing Tax Credit (LIHTC). The congressional staff appeared deeply engaged in conversations of members’ experiences; many asked detailed follow-up questions and requested input on potential solutions, including legislative approaches championed by LeadingAge. The meetings underscored the value of member participation in federal advocacy. Collaborative efforts like these visits are vital to our work on the Hill because they help elected officials understand the real-life impact of policy. But being in D.C. is not the only avenue for engagement: members can also take action to urge Congress to enact full funding for housing programs serving older adults in fiscal year 2027, and get connected with LeadingAge’s work on affordable housing for older adults. Read more here . LeadingAge Joins Coalition Calling for CRA Protections. In response to proposed changes to the Community Reinvestment Act (CRA) that would harm affordable housing investment, LeadingAge joined a coalition of housing and lending organizations to fight back. The Community Reinvestment Act, enacted in 1977, requires banks to reinvest part of their earnings back into their communities; because investment yields on affordable housing communities are often more moderate than other forms of investment, it takes requirements like those under the CRA to drive affordable housing investment specifically. In fact, the CRA currently drives roughly 80% of equity investments in the Low Income Housing Tax Credit (LIHTC) each year, which is the primary tool nationwide for developing new moderately affordable housing units. However, CRA changes proposed by the Office of the Comptroller of the Currency (OCC) and the Federal Deposit Insurance Corporation (FDIC) could alter the CRA’s definitions and requirements detailing which banks are required to reinvest, potentially reducing the pool of CRA-impacted large banks by 60%, reflecting billions of dollars of current investment in housing. LeadingAge, along with other steering committee members of the ACTION Campaign – a national grassroots coalition of more than 2,400 organizations and businesses focused on protecting, expanding, and strengthening the Low-Income Housing Tax Credit – called the consequences of the proposed changes “damaging” and urged the OCC and FDIC to leave the thresholds as they current stand under the CRA rule. The coalition letter reads: “For nearly half a century, the CRA has driven banks to extend private capital financing to local communities they serve, combating the legacy of redlining, promoting equitable lending, and facilitating reinvestment in low- and moderate-income places and people. CRA has spurred lending and investments in homeownership, small businesses, healthcare, childcare, and other community needs, but nowhere is its impact more pronounced than in the effect CRA has had on the production of affordable rental housing through the [Low Income Housing Tax Credit] program.” LeadingAge will continue to push for the highest possible levels of investment in affordable housing programs serving older adults. Here is your weekly Affordable Housing Weekly Recap.
LeadingAge and Hospice Advocates Meet with OMB and DEA on Final Teleprescribing Rule
HUD Begins Scoring NSPIRE Affirmative Requirements. On September 29, the Department of Housing and Urban Development (HUD) published a notice seeking public input on changes to the way housing inspections are scored at HUD-assisted properties. Titled “National Standards for the Physical Inspection of Real Estate,” the notice makes three revisions to the NSPIRE Scoring Notice for public comment, including to initiate scoring for newly inspected standards beginning October 1, as well as two minor technical corrections to previously published methodologies related to determining sample size for inspections. The NSPIRE Scoring Notice does not apply to the Housing Choice Voucher and Project-Based Voucher programs and does not revise the inspection frequencies established under the applicable program regulations. Comments are due to HUD by November 30, and LeadingAge will work with our membership to submit our feedback. For example, LeadingAge previously worked with HUD to delay scoring for the affirmative standards and applauds HUD for providing a grace period for providers, who were still required to fix any deficiencies that were not scored; however, the agency published the notice to end the grace period in certain scoring just a day prior to the change taking effect; LeadingAge calls on HUD to provide more timely information in the future. Here is your weekly Affordable Housing Weekly Recap.
CMMI GUIDE staff will also be joining the October 22 LeadingAge Adult Day Network at 1 p.m. ET to discuss the opportunities for adult day providers in the model and to answer members’ questions about the model. If you are interested in joining this discussion, reach out to Georgia Goodman at ggoodman@leadingage.org for details on how to join. Also, stay tuned for more details for GUIDE participants and providers to participate in a November discussion with CMMI GUIDE staff on the Residential Care Community changes and challenges, and how to meet the needs for respite care under the model.
