Federal lawmakers and long-term care advocates are questioning whether a new approach to nursing home inspections could leave vulnerable residents at greater risk.
A new federal nursing home inspection process is raising concerns among long-term care advocates who fear that reduced oversight could compromise resident safety and quality of care.
On October 26, 2026, U.S. Senators Elizabeth Warren and Mazie Hirono, joined by Senators Kirsten Gillibrand and Richard Blumenthal, sent a letter to the Centers for Medicare & Medicaid Services (CMS) questioning the agency's implementation of its new Risk-Based Survey (RBS) process.
The letter highlights concerns shared by advocates across the country: When nursing home inspections become shorter and less comprehensive, important warning signs of inadequate care may go unnoticed.
What Is the New Risk-Based Survey Process?
Beginning September 8, 2026, CMS implemented a new inspection approach allowing certain nursing homes to undergo abbreviated surveys rather than the traditional comprehensive inspection process.
Under the new system, qualifying facilities may receive inspections involving:
Smaller survey teams
Fewer residents selected for review
Fewer areas of care examined
Reduced inspection activities
CMS identifies eligible nursing homes based on criteria that include overall quality ratings, staffing ratings, and recent inspection histories.
While the approach is intended to focus inspection resources according to facility risk, advocates are questioning whether the criteria accurately identify facilities where reduced oversight is appropriate.
Why Are Advocates Concerned?
According to the senators' letter, nearly 1,700 nursing homes nationwide qualify for the abbreviated inspection process, potentially affecting approximately 114,300 residents.
An analysis by the National Consumer Voice for Quality Long-Term Care identified several concerning findings among eligible facilities:
27 nursing homes had displayed a resident abuse indicator on Medicare's Care Compare website since September 2025.
478 facilities had already gone more than a year without a standard inspection as of September 1, 2026.
73 facilities had experienced one or more payment denials within the previous four years related to noncompliance with federal requirements.
These findings raise questions about whether existing ratings and inspection histories provide a complete picture of the care residents actually receive.
The senators also questioned the reliability of facility performance over time, citing research indicating that approximately half of the newly eligible facilities would not have qualified for the program one year earlier.
What Does the Gold Trophy Mean?
Families researching nursing homes on Medicare's Care Compare website may notice a gold trophy icon displayed alongside certain facilities.
Under the new program, this symbol identifies nursing homes eligible for abbreviated Risk-Based Surveys.
Importantly, the gold trophy does not guarantee that a facility is free from care concerns or that residents will consistently receive high-quality care.
Advocates worry that families may interpret the symbol as an award for excellence without understanding its connection to the reduced inspection process.
Families should continue evaluating nursing homes through multiple sources, including inspection histories, staffing information, resident experiences, and conversations with their local Long-Term Care Ombudsman Program.
Why Thorough Inspections Matter
Nursing home inspections are an essential safeguard for residents.
Comprehensive inspections help identify concerns involving medication management, nutrition, infection prevention, staffing, personal care, resident dignity, and other important aspects of daily life.
For residents who may have difficulty communicating their concerns or advocating independently, these inspections provide an important layer of protection.
In their letter, the senators requested additional information from CMS about how the abbreviated inspection process will identify potential harm, how outcomes will be monitored, and what safeguards will be used if facilities fail to maintain appropriate standards.
CMS was asked to respond by November 9, 2026.
What Can Families and Community Members Do?
Families, caregivers, and community members play an important role in protecting the rights and well-being of nursing home residents.
If you have a loved one living in a nursing home, consider taking these steps:
Review the facility's information. Visit Medicare.gov to review nursing home ratings, inspection histories, and any gold trophy designation.
Stay engaged. Visit regularly, communicate with residents and staff, and pay attention to changes in care or well-being.
Speak up about concerns. If you notice problems involving resident safety, dignity, or quality of care, report them rather than assuming they will be identified during a routine inspection.
Contact your Long-Term Care Ombudsman. Ombudsman programs provide free, confidential assistance to residents and help address concerns about their care and rights.
Our Commitment to Resident Rights Remains Unchanged
At the Long-Term Care Ombudsman Program of Northeast Indiana, our mission is to advocate for the rights and well-being of individuals living in long-term care facilities.
Regardless of changes to federal inspection procedures, every resident deserves to live in an environment where their dignity is respected, their concerns are heard, and their health and safety are protected.
Effective oversight, meaningful accountability, and strong resident advocacy all contribute to quality long-term care.
We encourage families, residents, and community members to stay informed about these changes and reach out whenever concerns arise.
Resident rights should never be overlooked. And every resident deserves a voice.
Have Concerns About a Long-Term Care Facility?
The Long-Term Care Ombudsman Program of Northeast Indiana provides free, confidential advocacy and assistance to residents of long-term care facilities across our nine-county service area.
If you have questions about resident rights or concerns about the care someone is receiving, we are here to help.
Learn more or contact our team at www.longtermcareombudsman.org.
Source: October 26, 2026, letter to CMS Administrator Mehmet Oz from U.S. Senators Elizabeth Warren, Mazie Hirono, Kirsten Gillibrand, and Richard Blumenthal regarding the Risk-Based Survey program.
