26 States Do Not Mandate COVID-19 Testing for Nursing Home Inspectors: Report

The majority of states do not require nursing home surveyors to receive regular COVID-19 tests, even as case counts rise and family members remain barred from visiting in many areas, an investigation by the Wall Street Journal found.

Twenty-six states did not have mandates for routine COVID-19 testing of inspectors, the WSJ report determined, with significant variations between states: New Hampshire and New Jersey have a voluntary testing program, for instance, while others are in the process of creating formal testing requirements.

Individual State Survey Agencies (SSAs) are responsible for inspecting nursing homes on behalf of the federal government. Since March, the Centers for Medicare & Medicaid Services (CMS) has instructed SSAs to focus primarily on infection-control violations, which were common problems even before the start of the pandemic.


CMS last week announced that SSAs had completed 99.2% of mandatory targeted infection-control inspections, finding triple the typical number of citations; all told, the federal government touted $15 million in COVID-related fines against nursing homes since the start of the pandemic.

“This is not just a testing issue or a supply issue, and our deep concern is that even in nursing homes that are doing testing on a regular basis, that we are still seeing significant spread — and so even with our commitment to do more testing, to ensure you have the supplies that you need, our concern is that that’s not going to necessarily completely address the problem,” CMS administrator Seema Verma said on a Thursday conference call with nursing home leaders and other CMS officials.

But the fact that many of these surveyors have not been subject to the same testing requirements as nursing home staff raised alarm among experts who weighed in on the WSJ’s results.


“Of course they should be tested,” University of Chicago researcher R. Tamara Konetzka told the Journal. “Surveyors by definition need to be in the facility and observing things…PPE is not foolproof.”

The WSJ story came on the heels of a Los Angeles Times report in late July alleging that California inspectors were sent into nursing homes without COVID-19 tests. Seven Golden State surveyors have tested positive for the novel coronavirus, the Journal found.

Verma told the WSJ that surveyors follow Centers for Disease Control and Prevention (CDC) guidelines regarding the use of personal protective equipment, and additionally must undergo screening at each nursing home.

“They’re protected, and the people that they’re around are protected,” Verma said.

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