Operators Applaud State’s Efforts To Drastically Reduce Nursing Home Survey Backlog Via Third Parties

Survey backlogs have caused headaches for nursing homes, and Delaware is one state that is using third party contractors to successfully drastically reduce the backlog in a move that is being applauded by nursing home operators.

Delaware contracted with Healthcare Management Solutions to help clear its backlog of nursing home and assisted living surveys, doubling the number of annual surveys completed compared to 2021.

The state also completed 151 more intake investigations compared to 2021, according to the state Division of Health Care Quality Director Corinna Getchell, who testified before the Delaware Joint Finance Committee. Getchell’s comments were detailed in a Delaware online story.

Only seven of Delaware’s 81 long-term care facilities still are overdue for a survey, she said, and two are being handled currently.

The Delaware Health Care Facilities Association (DHCFA) told Skilled Nursing News that operators are pleased with the work of third party contractors in making progress with the survey backlog.

“Contract surveyors have helped to alleviate the backlog caused by hiring challenges within the state agency,” Cheryl Heiks, executive director for DHCFA said in an email to SNN. “Our providers have found them to be professional and well prepared to move efficiently and thoroughly through the process.”

Meanwhile, in other states such as Arizona, where legislative efforts were underway for use of third party surveyors last year, operators pushed back the initiative at the time.

However, Delaware has shown that it can be done successfully.

Since they aren’t state employees, Heiks said they can concentrate on the survey instead of being called away for a meeting or scheduled time off, which can delay the process.

SImilar to other states, Delaware has struggled with hiring and retaining surveyor staff due to low salaries, the report found.; iIt’s a trend extending back at least a year. Getchell’s division has asked repeatedly in recent years for more funding, but has been denied by the governor’s office, according to the Delaware Online report.

On a federal level, many states including Delaware had a backlog of surveys because of a lack of federal funding. Assisted living facilities weren’t included since they don’t fall under federal oversight, the report said.

Currently, Delaware has seven vacant positions out of 70, including one investigator and six surveyors. The surveyor training process usually takes about a year, leaving a gap between new staff being hired and being able to survey nursing homes independently.

Meanwhile, the state has contracted with Healthcare Management Solutions to complete state surveys for $800,000. Contractors have assisted with other surveys and trained staff in areas where the state Division of Care Quality lacked training resources, Getchell told Delaware Online.

It appears that the state’s efforts to reduce the backlog really kicked into high gear in March of last year, with outstanding surveys reduced by 40.5%, from 1,474 complaints at the time to 877 currently, the report found.

The state’s choice to hire contractors was spurred by a Delaware Online and The News Journal investigation last year, which found the state had failed to in the past decade investigate complaints of abuse, neglect and falls at long-term care facilities. The report was followed by a congressional investigation into the issues nationwide.

On top of that, the Centers for Medicare & Medicaid Services (CMS) opted to test out a new survey process as a way to alleviate extra administrative burdens for nursing home staff and tackle survey backlogs.

“Facilities are struggling with staffing at all levels and the survey process is a time intensive process for the staff. Processes and procedures that allow it to move effectively for both parties will allow for more time for resident care,” added Heiks.

The News Journal found that assisted living complaints had overall been investigated less than nursing homes – between 2013 and 2021, nursing homes in the state had an average investigation rate of 49% while assisted living averaged 22%.

Delaware nursing homes did receive an increase to Medicaid reimbursement rates, but funding has yet to be dispersed and it’s unclear the added funding would cover pay hikes for existing staff. Facilities must also follow state-implemented minimum staffing ratios of 3.28 hours per resident per day, carried out by certified nursing aides, licensed practical nurses, registered nurses, or other direct caregivers.