INDIANAPOLIS – A federal report analyzing the lack of in-depth surveillance in nursing homes nationwide during the COVID-19 pandemic has revealed that the list of facilities that have operated for more than a year without continuing recertification inspection to lie down.
The Office of the Inspector General of the US Department of Health and Human Services released a report in late July detailing how states failed to address inspection backlogs – vigorous in-person surveillance visits commonly referred to as “investigations” by regulators. The federal watchdog found that 71% of nursing homes nationwide lingered for more than 16 months without an annual survey.
In April, a draft CNHI report found that 51% of the country’s nursing homes had gone without inspection for at least 18 months – a longer timeframe than the July report which took into account state delays. , predating the pandemic. Since then, the list of facilities overdue for inspection has grown.
“Comprehensive nursing home inspections – standard surveys – are CMS’s main tool in ensuring that nursing homes meet the minimum standards necessary for the safety and well-being of residents,” the report says. “Yet, due to the COVID-19 pandemic, states have conducted far fewer of these standard surveys, which help identify and correct shortcomings. “
In a typical year, the Centers for Medicare and Medicaid Services require states to conduct surveys at least every 15 months to meet federal requirements and maintain Medicare and Medicaid certifications. Intensive multi-day surveys often reveal an assortment of gaps in care and require more operators than other surveillance.
In March 2020, CMS suspended recertification investigations and moved on to infection control investigations, designed to prepare nursing homes for the onslaught of COVID-19 cases. Nursing homes care for some of the most medically vulnerable people in common spaces, making these facilities the most prone to infectious diseases like COVID-19.
As detailed in the CNHI report, these surveys find more problems than infection control surveys, which can take as little as half an hour. In the report, the Newfane Rehab & Health Care Center in western New York had not had a recertification investigation since September 2019. Inspectors visited the facility for a recertification investigation in late June, 21 months afterward. the last.
Inspectors found moderately severe deficiencies in both inspections – the unsafe placement of cords in the 2019 investigation was corrected, but the installation had another electrical issue in 2021, when inspectors discovered exposed wiring.
Infection control investigations between recertification inspections do not prioritize these issues, instead focusing on delays in reporting COVID-19 information.
Newfane, a COVID-19 hotspot in May 2020, reported 31 confirmed deaths from COVID-19 and seven presumed deaths from COVID-19 at the 165-bed facility, according to the New York state statement August 21. Newfane did not respond to requests for comment.
Even with the shift from detail-oriented recertification investigations to infection control investigations, an estimated 133,736 nursing home residents have died from COVID-19, representing more than 20% of all deaths from the disease. COVID-19.
“Almost no surveillance”
CMS had good reason to delay inspections, said Tamara Konetzka, professor of public health at the University of Chicago, noting the need to focus on the spread of COVID-19 and concerns about inspectors bringing the virus into establishing or catching the virus from residents.
“At the same time, it’s worrying not to have inspections, especially when visits have been reduced,” said Konetzka, who studies the US long-term care system. “We know that family members help monitor and ensure proper care… inspections and families therefore work in a complementary fashion. “
The loss of both visits and inspections amounted to “almost no surveillance at all,” Konetzka said.
CMS authorized states to resume in-depth inspections in August 2020, provided they have the necessary resources to do so. As the report shows, few states have managed to catch up with inspection delays.
As of June 2020, 8% of nursing homes had spent at least 16 months without a standard survey. In one year, that backlog has swelled to 71% of nursing homes nationwide, according to the OIG report.
The authors of the report recommend that CMS give states advice on prioritizing the backlog of investigations as well as deadlines for completing those inspections, which CMS told CNHI it was doing in March. However, as the report points out, the problem has worsened since the CNHI report last spring.
“We encourage CMS to take the actions outlined above to implement this recommendation and assist states in ensuring the necessary oversight of nursing homes,” the report concludes.
Due to staff shortages and uncertainty, Konetzka argued that maintaining visits should be a priority as it can be performed safely and allow for some oversight. Resuming inspections should be based on previous nursing home performance, as assessed by CMS Nursing Home Compare, and not on COVID results.
“These are the facilities where we know the quality issues are probably going on and where the lack of monitoring is likely to be the most dangerous,” Konetzka said.