Verma Praises Nursing Home Staff for ‘Amazing Job,’ But Surveys Find Lingering Infection Control Problems

Leaders at the Centers for Medicare & Medicaid Services (CMS) on Wednesday praised nursing home administrators and staffers for their work during the COVID-19 pandemic, while also highlighting some nagging infection-control issues observed during the first major batch of post-coronavirus surveys.

State surveyors have visited about 6,800 nursing homes, or 44% of the nation’s total, since CMS reoriented its inspection practices around infection control in March, director of CMS’s nursing home division Evan Shulman said on a weekly update call with industry stakeholders.

While Shulman emphasized that operators have demonstrated solid work during the pandemic, three major areas of “sporadic noncompliance” still remain: hand hygiene, proper use of personal protective equipment (PPE), and cohorting.

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As CMS has in the past, the officials clarified that PPE violations were not related to shortages, which many operators have experienced across the country, but rather improper use — including incorrectly donning and doffing masks and gowns.

Similarly, issues with cohorting did not stem from facilities that did not have the space or logistical capabilities to separate COVID-positive residents from negative ones, but instead mistakes such as improper signage, or staffers failing to wash hands or change PPE when moving from the positive zone to the negative.

Lauren Reinertsen, director of CMS’s Northeast Division of Survey & Certification, asserted that such problems can be fixed with a combination of observation and management.

“It’s not easy to do these important tasks, but we do hope that some of the items that I mentioned might be taken into consideration as you continue your good work in infection control,” Reinertsen said.

Shulman also encouraged operators to enroll in the Centers for Disease Control & Prevention’s (CDC) National Healthcare Safety Network database, a prerequisite for compliance with new federal COVID-19 reporting requirements.

Operators must begin submitting data by Sunday, though fines for noncompliance will not kick in until early June; while thousands have already set up accounts within the NHSN, Shulman said that uptake is not yet complete.

“We still need thousands more to enroll. Thousands have also started to report, and we still need thousands more to report,” Shulman said.

CMS administrator Seema Verma kicked off the stakeholder call by thanking operators for their cooperation with the infection-control surveys.

“These are truly unprecedented times, and you all have done an amazing job,” Verma said. “This has been an incredibly difficult time for you and your staff. It’s been difficult to keep people safe. The number of deaths has been hard on your staff.”

The administrator asserted that CMS’s COVID-19 oversight efforts were designed to be collaborative with the industry, underscoring her close working relationship with American Health Care Association (AHCA) CEO Mark Parkinson and describing the surveys as “problem-solving.”

“We hope the work that we’ve been doing with the nursing homes represents a partnership,” Verma said. “These are challenging times; we’re all learning new things about the virus.”

She also noted that the work around nursing home compliance will not be over anytime soon; more information about applying for spots on the the previously announced Coronavirus Commission for Safety and Quality in Nursing Homes is forthcoming this week, according to Verma.

“This is going to be an ongoing battle,” she said. “We know coronavirus, unfortunately, isn’t going anywhere for a while, and while we are seeing reductions in cases all across the country, it’s something that we’re going to have to continue to be vigilant on.”