H.R. 6766 — Essential Caregivers Act of 2025

This section states seven congressional findings concerning nursing home residents during the COVID-19 pandemic, including the high prevalence of dementia (nearly half of 1.3 million residents in 2020), visitation and access restrictions despite Nursing Home Reform Act rights, health declines from isolation (e.g., 31% rise in pressure ulcers, 49% in significant weight loss, 40% in depression, 77.5% in antipsychotic prescriptions), staff shortages, and the supportive role of essential caregivers.

This section amends resident rights requirements for Medicare skilled nursing facilities (SNFs)—post-acute care institutions certified under Medicare—to establish a new subparagraph requiring recognition of each resident's right to designate (and amend at any time) an essential caregiver with in-person access at all times, including during emergency periods (e.g., public health orders or section 1135 waivers) when regular visitation is restricted. (1) During such emergency periods, SNFs must allow at least one essential caregiver daily and at any time (with roommate accommodations), enforce related agreements, and deny access only for an initial period of up to 7 days or an additional 7 days (with state agency approval, for a 14-day maximum), except for residents in end-of-life care or decline/distress (as defined by the Secretary). (2) For residents unable to designate due to cognitive or mental disability, the resident representative (per 42 C.F.R. § 483.5) may designate. (3) SNFs must issue written warnings for noncompliance with agreements before denial, provide written explanations within 24 hours of denial (with appeal options), and bear the burden of proof in appeals. (4) Not later than two years after enactment, the Secretary must issue a final rule establishing an appeals process under which state survey agencies receive and investigate denials within two business days.