Increasing the frequency of infection-control inspections during the pandemic — and imposing greater fines on facilities with a history of problems curbing the spread of disease — is vital because even the strictest surveys represent a single, point-in-time snapshot, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said last week.
“At the end of the day, the ultimate responsibility, really, for the health and safety of residents is on the nursing home,” Verma said during a phone press conference. “The role of the state and the federal government — we set regulations, we do inspections.”
The administrator was responding to a question about some nursing homes that experienced widespread outbreaks of COVID-19 despite receiving deficiency-free surveys even during the pandemic, a conclusion that prompted one New York lawmaker to question the efficacy of the inspections.
“It’s very shocking that at the apex of this pandemic, our inspectors went in and reported that that there’s nothing out of the ordinary when it’s clear that the infection rate had spread,” state assemblyman Ron Kim told local news outlet The City, which initially reported the survey results.
Just 3% of the more than 5,700 surveys conducted since the start of the pandemic revealed infection-control citations, prompting the Center for Medicare Advocacy to call the results “not credible.”
“It is simply not plausible, during the pandemic, when at least 32,000 residents have died of COVID-19 and large proportions of deaths from COVID-19 nationwide are residents and staff, that facilities have no problems in their infection prevention and control practices,” the Washington, D.C.-based advocacy group said in a Friday release. “Problems cannot be fixed going forward if they aren’t even identified and acknowledged.”
Under normal circumstances, state surveyors only visit individual facilities on behalf of CMS about once per year, or in response to a specific complaint. New federal guidelines released last week now require all states to perform a targeted infection-control survey or risk losing some CARES Act funding, while instituting mandatory follow-up inspections after new outbreaks are reported.
Fines for infection-control violations will also escalate based on a property’s previous history of such citations, rising all the way to $20,000 per instance in certain circumstances.
Verma pointed to limitations, however, in the inspection system.
“When you go into the nursing home, the staff know that they’re being observed — particularly on that day. They go in, and they’re looking for things, and they may not see it in that particular visit,” Verma said. “But when the inspector leaves the nursing home, things can change.”
Those things could include insufficient hand-washing and lax attitudes around separating COVID-positive residents from those without the virus, according to Verma. Early inspection reports from the pandemic months have shown “sporadic non-compliance” in those areas, as well as appropriate use of personal protective equipment (PPE), federal officials had indicated in mid-May.
“It just could be at that particular day, [surveyors] didn’t observe anything, and they showed that they had the appropriate policies and procedures in place,” she said. “But when something actually happens — does the staff follow those policies and procedures? May have happened on that particular day, may not happen every day.”
That said, Verma and other CMS officials have taken pains to praise the majority of facilities that have prevented infections, and also emphasized that the presence of COVID-19 in a given facility’s Nursing Home Compare data may not necessarily indicate any wrongdoing; in fact, many facilities voluntarily took such patients to provide specialized COVID care.
“The vast majority of nursing homes across this country didn’t have significant numbers of cases — or didn’t even have any cases, or any deaths in their nursing homes, and I think it speaks to the nursing homes that were more focused on the federal guidelines and the recommendations, and did a good job with implementing those,” she said.