Orlando, Florida — Federal nursing home regulators are moving toward a more targeted inspection model, with about 10% of skilled nursing facilities expected to qualify for shorter, risk-based surveys instead of the standard full recertification review. Final criteria are expected to land mid-to-late summer 2026.
That’s according to Evan Shulman, director of the division of nursing homes at the Centers for Medicare and Medicaid Services, who laid out the plan at the American Association of Post-Acute Care Nursing (AAPACN) conference in Orlando this week.
The model is already in a pilot phase. Qualifying facilities will likely need strong star ratings and a clean record on schizophrenia audits — two signs that a facility isn’t hiding problems. But Shulman was clear: if surveyors walk in and see something concerning, a targeted survey can escalate into a full one on the spot.
What Surveyors Are Actually Citing
Shulman also shared what’s showing up most often as citation hot spots tied to the federal staffing campaign — and the number one wasn’t what the room expected.
Elopements topped the list. Most AAPACN members predicted falls would be the leading citation, but it’s wandering residents — and the failures that allow them to leave undetected — that are driving the most enforcement activity. Misuse of hoyer lifts and other transfer equipment came in second, followed by choking incidents at number three.
The staffing campaign itself is also evolving. Certified nursing aides are now explicitly included, with the effort focused on streamlining the pipeline to bring more CNAs into the field. Going forward, campaign resources will be directed toward facilities struggling most to hire — particularly those in rural areas and those with the steepest staffing shortfalls. That narrowing of focus could be significant for facilities in underserved regions, where the gap between staffing mandates and available workers has been widest.
The more than $200 million in funding now behind the staffing campaign includes loan repayment of up to $40,000 for four-year nursing programs — though Amy Stewart, AAPACN’s chief nursing officer, noted that amount won’t stretch far given today’s tuition costs. Two-year programs are facing long waits due to a shortage of nursing instructors.
Stewart highlighted apprenticeship programs as a faster path forward. “Those apprentice programs are going to be the quickest, easiest way for us to get nurses and CNAs,” she said. “They can get some college credit while they work as a CNA or work as a licensed practical nurse, or toward their registered nursing degree.”
AI on Both Sides of the Inspection
Shulman addressed the rapid rise of AI in skilled nursing — on both sides of the regulatory relationship. CMS is exploring greater use of AI in its own operations, while facilities are increasingly deploying AI-powered tools for staffing, documentation, and care management.
Stewart said the AI conversation was one of the more substantive moments of the conference. “Top of mind for providers is, if you work with a number of AI vendors, you run the risk of a HIPAA breach or a security breach with any of those vendors,” she said. Data security — not just efficiency — is shaping how nursing homes think about which tools they adopt.
Shulman also addressed the ongoing friction between surveyors and facility leaders, noting that a mediation resource exists and is available to both operators and surveyors when disputes arise during the inspection process.
For nursing homes that have been bracing for another grueling standard recertification cycle, the risk-based survey model represents a meaningful shift — one that rewards facilities with strong track records. But with elopements driving more citations than expected, operators that assume a good star rating means smooth sailing may want to look more carefully at their wandering prevention protocols before summer arrives.
