The COVID-19 pandemic has resulted in a vast majority of nursing homes nationwide not being assessed to ensure they meet federal quality and safety requirements, a new HHS study found.
State agencies, acting on behalf of CMS, are mandated to complete on-site inspections at least every 15 months, but CMS suspended those inspections between March and August of 2020 to reduce the risk of surveyor transmission.
Despite states being able to resume surveys toward the end of 2020, the pause resulted in a significant backlog. In an analysis of CMS data, HHS found that 10,913 of 15,295 nursing facilities—71%—had gone at least 16 months without a standard survey as of May 31, 2021.
Backlogs ranged from 22% of nursing homes in New Mexico not being surveyed to 96% in Connecticut.
Another issue is that the federal government prioritized surveys focused on infection control during the pandemic, conducting nearly 40,000 more in 2020 than in the prior two years, according to the American Health Care Association and National Center for Assisted Living.
“We were facing a global emergency where front-line staff needed to focus all their energy on protecting our most vulnerable,” AHCA/NCAL said in a statement.
Although it was understandable earlier on in the pandemic to shift to infection control surveys, Joyce Greenleaf, HHS’ regional inspector general in Boston, said the backlog is now alarming as families cannot be sure if their loved ones are safe in nursing homes or if quality requirements are being upheld.
HHS’ December 2020 report found that states also faced backlogs of nursing home surveys earlier on in the pandemic, with 8% of nursing homes having gone at least 16 months without a standard survey as of June 2020.
Infection control surveys are only required to happen at 20% of nursing homes based on states’ discretion, said Danielle Fletcher, HHS deputy regional inspector general in Boston, and mostly collect data that identifies facility and community risks.
“It’s not a substitute for a comprehensive survey that covers a lot of territory,” Fletcher said. “[Standard surveys are] CMS’ main tool to ensure minimum standards are met.”
The COVID-19 pandemic is continuing to hit this sector hard, with 94% of nursing homes experiencing staff shortages and nearly 75% saying that their workforce situation has worsened in the past year, according to an AHCA/NCAL survey.
The group also found that 66% of nursing home providers expected to potentially close in 2021 due to small profit margins, losses and cost increases in areas such as staffing.
More than 78% of nursing facility residents and 56% of staff are currently vaccinated according to Medicare data, although large disparities in vaccination rates exist between states.