Nursing Home Infection Control Surveys on the Decline

Focused infection control (FIC) surveys appear to be on the decline at a time when some in the skilled nursing industry still remain concerned over the nature of the relationship with surveyors throughout the COVID-19 pandemic.

FIC surveys were conducted 756 times in June of this year compared to 8,896 times in June 2020 — a 91.5% decrease year-over-year, according to data provided by nursing home data analyzer StarPRO.

The latest data from the Centers for Medicare & Medicaid Services (CMS) is part of a larger trend. FIC surveys fell below the number of standard surveys in June 2021 for the first time since last March when CMS suspended all non-emergency survey work and refocused its efforts on compliance with the agency’s infection control policies.

Chart courtesy of StarPRO, data from the Centers for Medicare & Medicaid Services (CMS)

In June there were 761 standard surveys conducted and 756 FIC surveys conducted, compared to one year earlier when there were 594 standard surveys and 8,896 FIC surveys.

There was however a spike in FIC surveys conducted from July to August — 597 compared to 1,022 respectively. This could possibly be attributed to an increase in surveyors as a result of the emergency of the delta variant, according to Spencer Blackman, director of product for StarPRO.

The outcomes of these FIC surveys are also trending downward. Aside from a recent spike in August, similarly to the number of surveys, the number of deficiencies found on each infection control survey has been falling.


Jason Lundy, a shareholder in the Chicago office of national law firm Polsinelli, told Skilled Nursing News that because CMS put a pause on non-emergency survey work he’s seen several examples where facilities are cited for a past incident that has since been resolved.

This opens up the possibility that civil monetary penalties (CMPs) “can run longer and larger.”

“They’re supposed to be remedial to get things fixed, not punitive just to raise revenue for the government or to put a penalty or a black mark on a facility,” Lundy said. “If something has already been addressed by the time the surveyor reviews it, there’s not much remedial purpose to additional citations or penalties.”

Blackman said that the general trend “could be the new normal” for these types of surveys going forward.

“We’ve sort of long thought that, along with COVID and the flu being a big thing in nursing homes as well, that infection control could be just a regular part of life going forward for the adults,” Blackman said. “If they’re going to be done at the same frequency as a standard or a complaint survey that might be the new normal.”

Even though FIC surveys appear to be declining, states are not keeping up with the pace of standard surveys. States would need to conduct around 1,300 surveys each month in order to meet CMS’ goal of each home having a standard survey every 12 months, Blackman said.

CMS reported 844 new standard surveys in the month of September, according to StarPRO’s data.

Out of 15,295 nursing homes nationally, 10,913, or 71%, have gone at least 16 months without a standard survey as of May 31, according to an updated report filed by the U.S. Department of Health and Human Services Office of Inspector General.

“I think earlier in the pandemic they could have said that they couldn’t get into the homes or that they were busy focusing on the infection control surveys, but now that those have leveled off, I really feel like there’s sort of less of an excuse as to why they can’t get in there and perform those standard surveys,” Blackman said.

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