As the nursing home industry continues to recover from the last several years of the pandemic, annual inspections have fallen by the wayside.
According to federal data from mid-February, about 4,500 of the nation’s 15,000 nursing homes were overdue for an inspection. More than 1,500 of those facilities were last inspected before the public health emergency was declared, according to a report published in Newsweek.
That translates to about 30% of active providers with overdue recertification surveys, a problem that began when annual inspections were paused due to increasing Covid cases. The Centers for Medicare & Medicaid Services (CMS) directed health departments to resume annual inspections in November 2021.
California led states in the number of late surveys at 566; Ohio came in second with 392 late surveys, followed by New York with 293 late surveys and Missouri at 264.
Data was compiled from the CMS’ CASPER system. Nursing homes are required by federal law to undergo an inspection at least every 15 months. CMS contracts with state health departments to oversee the industry.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is concerned with the backlog, and supports efforts to resolve and improve upon the survey process.
“Coming out of the pandemic, this situation also presents an opportunity to reconsider the status quo. The current survey and enforcement system has been shown to be inconsistent and ineffective,” AHCA/NCAL said in a statement.
One of the association’s major reform proposals includes improving the oversight process to focus more on resident satisfaction, rather than “simply looking for ways to penalize providers.”
“We need to focus on the science of quality improvement by recognizing good faith efforts, leveraging continuous learning, and effectively remedying identified issues,” added AHCA/NCAL in its statement. “We believe this could reduce burnout among both surveyors and nursing home staff.”
Fellow association LeadingAge pointed to decades of Medicaid underfunding, leaving the country’s nursing homes in need of an overhaul – including the inspection process.
“State survey agencies are frequently short staffed and turnover is often rampant, which contributes to infrequent inspections,” LeadingAge said in a statement. “Regular inspections are an important component of quality care; quality care is top priority. That’s why we continue to urge that a state’s nursing home Medicaid reimbursement levels and the funding of its survey agency must be part of the annual CMS approval process for state Medicaid plans.”
States health department officials say they can’t retain or recruit enough surveyors to catch up, according to the Newsweek article. Officials blame a mixture of burnout, retirements, lackluster salaries and lingering Covid fears for the lag.
Kentucky, for one, reported less than 1 in 5 surveyor positions were filled as of October, according to the article.
“The shortage of state surveyors is indicative of a larger workforce crisis facing the entire long term care profession. We need a concerted, supportive effort to help recruit more individuals to serve our nation’s seniors,” AHCA/NCAL said in its statement.
Findings come on the heels of federal entities calling for significant changes to industry oversight through inspections. –The Department of Health and Human Services Office of Inspector General (OIG) issued a report in January showing that more than 1,300 nursing homes had Covid-19 infection rates of more than 75% during surges in 2020.
Surveys didn’t identify infection control issues, the report found. However, OIG suggested CMS build on previous probes into the industry and re-examine or revise nursing staff requirements completely.
Surveys are also closely tied to the federal Five-Star Quality Rating System, which likely means that the number of stars consumers see on Care Compare could be outdated along with inspections.
Some states like Arizona are taking matters into their own hands, with legislators seeking to have surveys outsourced to third parties. Arizona’s move would fully privatize the process for the state, a first for the industry. States have been known to strike contracts with private companies in the past to outsource work, but not entirely privatize the process.
The legislation wouldn’t serve the state, David Voepel, executive director for the Arizona Health Care Association told Skilled Nursing News in a previous interview; the advocate group is against the proposed bill. The move would double inspections, requiring the third parties to conduct at least two every year.
Companies featured in this article:
AHCA/NCAL, Arizona Health Care Association, LeadingAge, Newsweek
