Regulatory Delays Hurt Care

Long Overdue

The Centers for Medicare & Medicaid Services’ August data shows state inspectors are overdue on monitoring 4,500 nursing homes for annual standard surveys. Ridiculous. 71% of nursing homes had gone at least 16 months without a standard survey. The time between surveys ballooned during the pandemic.

Sen. Bob Casey Jr. (D-PA) is demanding state survey agencies report data on delays, unsafe staffing and challenges in the inspection process.  Casey has been an outspoken advocate for improved nursing home care and regulatory oversight.

Casey said the inspection workforce left the field in extensive numbers since the pandemic’s start. Down by as much as 50% in some states because surveyors are “drained by physically and emotionally demanding work. Casey wrote:

“State surveyors are the eyes and ears ensuring quality care is delivered.  Given their critical role, I am requesting information related to your agency’s staffing needs as the U.S. Senate Special Committee on Aging seeks to better understand the scope and severity of staffing shortages affecting state survey agencies’ ability to carry out their work.” 

Special Focus Facility

During the pandemic, Casey helped secure an additional $100 million of funding for survey and certification activities. However, Casey warned CMS to improve enforcement practices, noting that one in five nursing homes in the Special Focus Facility program were overdue for inspections. The interval for those facilities should be every six months.

“When their work is repeatedly delayed and interrupted, nursing home residents lose an important backstop looking out for their safety and wellbeing. I’m seeking information from state agencies across the U.S. to get a clearer picture of how far the issue of staffing shortages goes and how it may affect nursing home quality.”

Delayed surveys limit the opportunity to fix problems and improve quality of care. Consumers need oversight and current information on performance metrics. Casey’s letter pointed out that state survey agency officials report challenges with hiring and retaining surveyors.

Casey seeks specifics on turnover; the reasons workers are leaving; and nursing shortages. He is requesting information about pay increases, schedule changes or other incentives, as well as how surveyor salaries compare to those for registered nurses in other positions in a given state. I hope he can make the necessary changes to improve the quality of care.