S. 3492 — Essential Caregivers Act of 2025

This section states congressional findings regarding nursing home residents during the COVID-19 pandemic, including that approximately 1.3 million individuals resided in nursing homes in 2020 with nearly half diagnosed with Alzheimer's disease or related dementias; that Centers for Medicare & Medicaid Services visitation restrictions contributed to isolation, "failure to thrive," and health declines such as a 31% increase in pressure ulcers, 49% increase in significant weight loss, 40% increase in depression symptoms, and 77.5% increase in antipsychotic prescriptions; and that essential caregivers provide supplemental care and advocacy.

This section requires Medicare skilled nursing facilities to recognize each resident's right to designate (and amend at any time) one or more essential caregivers, including during emergency periods when regular visitation is restricted by federal, state, or local order (or section 1135 waiver). (As background, skilled nursing facilities provide Medicare-covered skilled nursing care and rehabilitation services, primarily to post-acute patients.) Facilities must (1) allow at least one essential caregiver in-person access every day and at any time (with roommate accommodations), subject to an enforceable agreement; (2) limit denials of access to an initial 7 days (or 14 total days with state agency approval) per emergency period, while mandating access for residents in end-of-life care or decline/distress; (3) issue written warnings for noncompliance before denial, followed by a written explanation with appeal rights; and (4) comply with a Secretary-established appeals process (via final rule within two years of enactment) to the state survey agency, which must investigate within two business days (with burden of proof on the facility).