You Asked... We Answered

You Asked: What is meant by a “negative psychosocial outcome”?

We Answered: According to the CMS Psychosocial Outcome Severity Guide, a negative psychosocial outcome refers to changes in a resident’s mood, behavior, emotional well-being, or social engagement that occur as a result of facility noncompliance with a regulatory requirement. Psychosocial outcomes such as sadness, fear, withdrawal, anxiety, humiliation, or depressed mood must be evaluated with the same importance as physical outcomes. Psychosocial outcomes may arise from noncompliance in any regulatory area, and a resident may experience either a negative physical outcome, a negative psychosocial outcome, or both.

Although often associated with situations involving abuse, negative psychosocial outcomes can occur in many other circumstances. For example, surveyors assess for psychosocial harm when reviewing unnecessary medications. Interviews with the resident, family, representative(s), and IDT help determine whether medication side effects contributed to psychosocial decline. Side effects such as sedation, lethargy, agitation, mental status changes, or behavior changes may indicate a negative psychosocial outcome if they:

• affect the resident’s ability to perform activities of daily living or interact with others,
• cause withdrawal or decline from usual social patterns,
• result in decreased engagement in activities, or
• diminish the resident’s ability to think or concentrate.

Additional guidance can be found in the SOM Appendix PP and in the Psychosocial Severity Guide. These documents can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage.

Advocacy in Action Monday: NF Reimbursement, Electronic Monitoring in ALs, and Property Tax Legislation

Join us for the next Advocacy in Action webinar this Monday, December 15, at 10:00 a.m., where you’ll get the latest on legislative activity affecting nursing facility reimbursements, an update on discussions with the Ombudsman’s office regarding electronic monitoring in Assisted Living, and a breakdown of the property tax bills on their way to the governor to be signed.

Annual Lobbying Percentages

LeadingAge and LeadingAge Ohio annually report the lobbying expenditures as a percentage of total expenditures for members’ tax purposes.  Please pass this information along to your organization’s finance representative:

LeadingAge Ohio: 8.35%                        LeadingAge: 1.54%

Shutdown & Errors Delay Member 5-Star Reports

This week, LeadingAge Ohio learned that there would be further delay in its quarterly 5-Star Reports produced in conjunction with LeadingAge New York. According to our colleagues, while CMS has released data in both November and December, the data sets are rife with omissions. In the latest release, six data sets were missing, including MDS quality measures, claims-based quality measures, and health and fire code deficiencies. 

Unfortunately, CMS has shared no set date by which the datasets will be corrected, so at this point we cannot anticipate when reports will be available to members. LeadingAge New York is in touch with CMS about these issues, and ready to produce reports as quickly as possible once corrections are made. 

Questions regarding this issue may be directed to Susan Wallace at swallace@leadingageohio.org or Stephanie DeWees at sdewees@leadingageohio.org.

Stay Connected Snapshot: Upcoming Meetings & Events

There's always something happening at LeadingAge Ohio, view all upcoming events here and mark your calendar today!

• December 15, 10 a.m. - Advocacy in Action
• December 17, 12 p.m. - Housing Happenings Call
• December 18, 1 p.m. - 2025 Reimbursement Collaborative: From Progress to Permanence - Sustaining Results Beyond the Collaborative
• December 18, 2:30 p.m. - 2025 Survey Success Collaborative: Plan of Correction and Past Non-Compliance
• January 8, 2 p.m. - Governance Webinar Series with LeadingAge Virginia
• January 12-30 - 2026 Winter CORE of Knowledge

LeadingAge’s 2025 Year in Review

Policy and Advocacy 

LeadingAge’s national advocacy efforts delivered consequential wins this year. Federal minimum staffing mandates that providers could not meet were reversed; proposals to cap Medicaid funding and eliminate health care–related taxes were stopped; improvements were secured for the Department of Housing and Urban Development’s affordable senior housing preservation program; more than 130 regulatory relief recommendations were submitted; and $915 million in planned cuts to home health were halted.

Member participation reached new heights. Providers completed more than 6,200 advocacy actions—nearly double last year—through alerts, direct messages to Congress, and legislative visits. Engagement with national tools remained strong as members downloaded more than 32,000 resources and registered nearly 5,000 times for networking programs.

2025 Learning Hub, Shared Learning, and Leadership Development

This year saw significant growth in the Learning Hub. Members accessed more than a dozen live online events, more than 25 new OnDemand offerings, and a library that now exceeds 200 resources. New governance materials broadened support for board leadership across the field.

Shared learning efforts continued with two cohorts of the Dementia Inclusion Series, helping organizations advance more inclusive environments for people living with dementia. Leadership programs welcomed the nineteenth Leadership Academy class, more than a dozen first-time CEOs through the Fellowship Program, and two cohorts in the six-week Next Level Leadership Series.

2025 LTSS Center Research, Advocacy, and Thought Leadership

The LeadingAge LTSS Center advanced key priorities across research, workforce, and public policy. Work with the Moving Forward Nursing Home Quality Coalition and 23 Geriatric Workforce Enhancement Programs supported development of registered apprenticeship models for certified nursing assistants. Five new DC Fellows joined the LTSS Center to expand research capacity.

The Center documented early feasibility of LDcare to support long-distance caregivers of people living with dementia and provided analysis on how Medicaid reductions could affect beneficiaries. LTSS Center Co-Director Robyn Stone shared U.S. affordable housing best practices at the Seoul Senior Forum. The Leaders of Color Network continued its growth, reaching 862 members—up 33 percent from last year.

JCARR Sends Aging Rule to CSI for Further Review

The Joint Committee on Agency Rule Review voted unanimously this week to refer a proposed Ohio Department of Aging rule to the Common Sense Initiative for a business impact analysis. The draft rule, 173-2-08, would require area agencies on aging to secure departmental approval before entering commercial arrangements with private entities.

Area agencies testified that the rule could slow or deter partnerships that help expand services for older Ohioans. Kelsey Bergfeld of the Ohio Association of Area Agencies on Aging said the approval process would add bureaucracy without improving accountability, noting that federal guidance encourages leveraging private resources rather than restricting them. Nan Cahall of the Council on Aging of Southwestern Ohio added that her agency contracts with hundreds of small businesses each year, and delays could jeopardize service delivery.

The Ohio Department of Aging argued that federal law already requires state oversight of these commercial relationships and said a state-level policy is now needed under updated federal rules. Department staff also noted that the January 1 deadline for finalizing the rule is self-imposed.

Following testimony, committee members expressed uncertainty about the rule’s reach and supported directing it to CSI. Representatives Beryl Brown Piccolantonio and Latyna Humphrey later said the proposal could burden area agencies and create delays in essential services. 

AGE is now accepting comments on the already-filed rule and the related application form here. Interested parties are free to review these items, then submit comments to rules@age.ohio.gov no later than December 18, 2025 at 11:59 p.m..

LeadingAge Ohio will continue to monitor the rulemaking process and assess its implications for providers across the state’s aging network.

BGSU Launches Six-Year National Study on Changing Aging Patterns

Bowling Green State University (BGSU) is embarking on a major six-year research initiative examining how America’s rapidly aging population is reshaping families, long-term care, and the broader supports older adults rely upon. The project—funded by the National Institutes of Health—is a collaboration between BGSU, The Ohio State University, and Purdue University, combining expertise in sociology, economics, and demography.

The study aims to understand how life decisions made decades earlier reverberate into older adulthood. Researchers will draw on large national surveys and census data to explore shifting family structures, caregiving patterns, and the implications for an aging population in which more than 10,000 baby boomers turn 65 every day.

LeadingAge Ohio will continue to follow this research as findings emerge and share insights relevant to providers, policymakers, and partners across the aging-services continuum.

McKnight’s Blasts CMS, States for Withholding Funds

This week, McKnight’s Long-term Care criticized state CMP programs for “hoarding” cash while penalty payments continue to rise. Despite new guidance in September, the pace of funding has been sluggish, with receipts far outpacing disbursements in many states. 

The article noted that many states allocate minimal staff to the administration of these funds, and CMS sets limits both on individual nursing homes as well as the types of things that can be funded, largely excluding technology investments that could meaningfully improve the quality of care. McKnight’s echoes grumblings nationwide about the slow pace of investments, with states and CMS often pointing to one another in blame. 

According to guidance issued earlier this year, Ohio had $16.9 million in its CMP fund.

Survey Tip of the Week: Bowel Management

Deficiencies related to bowel programs often stem from inconsistent implementation, gaps in reassessment, or failure to anticipate predictable side effects, especially with opioid use. Under §483.25 Quality of Care, residents have the right to receive treatment and services to maintain or improve normal bowel function. Surveyors will expect facilities to demonstrate that bowel management programs are based on comprehensive assessments, are consistently implemented as written, and are reviewed and revised when the resident’s condition, medications, or responses change. This includes ensuring that interventions such as increased fiber, adequate fluids, bowel medications, toileting schedules, and hygiene assistance are delivered reliably and documented appropriately.

Two examples from Appendix PP illustrate how seemingly small inconsistencies can result in deficiencies:

• Missed Bowel Regimen with Opioids: A hospice resident on a pain management program using opioids experienced avoidable discomfort because the facility did not consistently implement the bowel management plan outlined in the coordinated care plan. Even episodic minimal discomfort due to predictable opioid-related constipation can rise to Level 2 severity when interventions are not followed as planned.
• Inconsistent Fiber/Hygiene Support for Fecal Incontinence: Another resident, alert and aware of her care needs, reported intermittent fecal incontinence and relied on a bowel program involving extra fiber and increased liquids. Changes in dietary service led to missed fiber supplements, and inconsistent staff assistance with hygiene caused the resident to stop attending activities she enjoyed. Surveyors cited the facility for failing to provide appropriate treatment and services—evidence of the significant impact on the resident’s dignity, social engagement, and psychosocial well-being.

Surveyors will also interview residents and staff to determine whether bowel management practices are understood and consistently implemented. They may review bowel records, MARs, care plans, and monitoring documentation to confirm that ordered interventions are followed and that reassessments occur when constipation persists or worsens. If concerns arise, surveyors will evaluate whether the facility’s policies, procedures, and staff training clearly outline expectations for bowel programs, monitoring, and timely response to changes in condition.

CMS Suspends Nursing Home Medicare Revalidation

The Centers for Medicare and Medicaid Services will pause its off-cycle skilled nursing facility provider enrollment revalidation indefinitely, according to reporting from Skilled Nursing News’ article on the suspension. The process, announced in 2024, required facilities to submit updated ownership, management, and related-party information through a revised Form CMS-855A.

Associations had raised concerns about the pace and complexity of the requirement. LeadingAge’s Jodi Eyigor noted that CMS still intends to collect ownership information during routine revalidations and urged the agency to use the pause to improve guidance and oversight of Medicare Administrative Contractors.

Why it matters

• The pause prevents potential enrollment or billing disruptions for facilities that had not yet completed the off-cycle paperwork.
• Many providers had been managing repeated requests for additional documentation, often with limited direction from Medicare Administrative Contractors.
• CMS has not changed underlying disclosure rules. Facilities must still respond to any outstanding requests and maintain accurate ownership data.

Bottom line for Ohio providers

• Watch for the formal CMS announcement outlining expectations during the pause.
• Continue responding to any information requests already issued by Medicare Administrative Contractors.
• Ensure ownership and managerial records remain current so they can be submitted promptly once CMS provides revised instructions.
• Contact your Medicare Administrative Contractor if system issues affect your ability to meet a response deadline.

LPC Member Network Meeting

The Life Plan Community (LPC) Member Network will meet on Thursday, December 18, at 2 p.m. ET to Members who have not received an invitation for the LPC Member Network call should email Dee Pekruhn at dpekruhn@leadingage.org to be added to the distribution list.

BHI Senior Living Honors the Legacy of Gerald “Jerry” Mansbach

BHI Senior Living is sharing the story of Gerald “Jerry” Mansbach, a World War II veteran, devoted family member, and resident of The Barrington of Carmel. His life was recently profiled by Talegate, offering a vivid look at a man whose curiosity, discipline, and steady humor enriched every community he joined.

Jerry grew up in Fort Wayne and later built a four-decade career with Merrill Lynch. Beyond his professional life, he spent more than 50 years constructing detailed World War II model ships—a pursuit that reflected both craftsmanship and respect for history. The feature captures his warmth and perspective, offering a meaningful look at a resident whose experiences span generations.

BHI Senior Living notes that stories like Jerry’s continue to inspire its campuses and remind us of the depth and diversity of the lives lived within our organizations. His narrative highlights the power of community, lifelong learning, and the many paths that lead residents to senior living.

The full video profile is available on YouTube and can be viewed here.

Governance Webinar Series Begins in January

The next Governance Webinar Series begins January 8, 2026. The four-part series, held each Thursday in January from 2 to 3 p.m., is designed for executives, leadership teams, and board members interested in examining the partnership between leadership and the board for long-term sustainability and organizational strength.

Sessions include Recruiting for Mission, Onboarding for Impact on January 8; Inspiring Why: Engaging Boards in Meaningful Philanthropy on January 15; Ready by Choice, Not by Chance: Strategic Affiliation Planning on January 22; and Governing in the Age of AI: Legal Considerations for Aging Services on January 29.

Member registration is $119 per person. Full details and registration are available here.