Skilled Nursing Facility Surveys Skyrocket During Pandemic

Skilled nursing facility surveys have skyrocketed over the past year, with some worrying that surveyors have also grown more aggressive.

Federal data indicates that the number of surveys conducted nationwide has risen 132% percent since 2020, leaving some wondering how fairly standards are being applied when COVID-19 is already forcing facilities to contend with staff shortages, aging infrastructure, profit loss, and increased scrutiny over everything from infection protocols to federal loans.

Hedy Rubinger, Partner at Arnall Golden Gregory LLP, told SNN that the law firm has also seen “a dramatic increase” in infection control (IC) surveys.


“One of our clients has experienced IC surveys every two to six weeks for months resulting in more than a dozen IC surveys to date,” Rubinger said. “Even with all of the intense scrutiny, this client has only received one citation which confirms that the number of surveys is unnecessary.”

SNFs were surveyed 73,000 times last month, compared to 30,000 times in April 2020, nursing home data analyzer StarPRO told SNN. This latest data from the Centers for Medicare & Medicaid (CMS) indicates a 132% increase in surveys overall — with a 400% increase in survey points per survey.

Rubinger noted that not only has she seen a rise in the number of surveys, but also more “Immediate Jeopardy” level citations. “The situations I am aware of, all involving vaccinated residents and staff, do not rise to that level and prior to COVID would not typically result in a citation, let alone an Immediate Jeopardy citation,” she said in an interview this week.


While the COVID-19 IC surveys did lead to an uptick in Immediate Jeopardy citations about infection control issues, StarPRO Managing Director Colleen Muncy has concerns that states and individual surveyors may be applying standards unequally.

The average number of IC surveys a SNF received over the past year is 4.5, however some states far exceed that figure, per StarPRO’s data. In California, Massachusetts, and Florida, SNFs received an average of five IC surveys. Texan, Indianian, and Arizonian facilities received six surveys on average. And in Connecticut, SNFs received an average of 12 IC surveys last year.

“No one is saying infection control is not important. It’s applying the standard the same across the board,” said StarPRO’s Colleen Muncy. “Are they really worse homes? Or are they really aggressive surveyors?”

Adding to the situation is the quickly changing regulatory landscape and the fact some states are working to clear a backlog of standard surveys which were initially paused due to COVID-19.

“With respect to infection control alone, the rules and recommendations have changed so frequently that even surveyors have been issuing citations based on outdated information,” said Rubinger, who added she is concerned the backlog could make it harder for state agencies to vet citations.

“Poor operators should be cited, but an overly punitive citation does nothing but demoralize the staff that has worked so hard during the pandemic,” she said.

The case for infection scrutiny is clear in the wake of COVID-19 outbreaks in some nursing facilities across the country, some of which triggered federal investigations. But groups like the American Health Care Association (AHCA) worry the current survey system is treating all facilities like “bad actors” and may be doing more harm than good.

“Rather than helping facilities understand the regulations and how to comply with them, surveyors cite and fine with no additional help,” a AHCA spokesperson told SNN in an email. “This takes precious resources away from the frontlines when we are in the midst of an unprecedented crisis.

The trade group previously noted that COVID-19 highlighted pre-existing IC issues that deserved to be fixed and is currently proposing changes to the survey system to make it more uniform nationwide.

“The public deserves more accurate and current data on how these homes are operating and how the homes’ surveys and inspections [are going.]” said StarPRO’s Muncy. “The facilities deserve to have the standards applied to them consistently.”

Written by Sloane Airey

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