U.S. Senator Calls For More Frequent Inspections of Poor Performing Nursing Homes

Poor performing nursing homes were often cited for Insufficient care during the COVID-19 pandemic, which led to high rates of infection and deaths among residents and staff.

As part of a continuing effort to prevent incidents of nursing home abuse and neglect that continue to plague certain facilities nationwide, a powerful U.S. Senator is calling for federal regulators to step up inspections for nursing homes that are known to be problematic.

U.S. Senator Bob Casey, chair of the U.S. Senate Special Committee on Aging, wrote a letter (PDF) to U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure on May 9, calling for an increase in inspections of what are known as Special Focus Facilities (SFF); those nursing homes and long-term care facilities which have been rated poorly by CMS, saying many of them are not being surveyed as frequently as required by law.

Nursing homes that have received the SFF designation must be surveyed every six months, while those which score more highly only need to be inspected every 15 months. However, according to the Casey’s letter, CMS has failed to conduct surveys of problem nursing homes in the timely manner outlined by the law.

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Specifically, the letter states the Aging Committee has identified 15 nursing homes, representing 22% of the 63 facilities currently registered in the SFF program, which have gone six months or longer without a standard inspection. Four facilities have gone at least seven months without inspections, and three facilities have gone eight months, the letter notes.

Casey states one SFF nursing home in Missouri went more than 11 months without a survey or inspection, and once finally inspected in July 2021, twenty deficiencies were cited, which Casey states is more than twice the state and national average. The deficiencies included failing to document resident falls and failing to provide timely blood cancer medication to a resident.

“Conducting regular standard surveys of SFF participants is an important means of ensuring safety, accountability and compliance with Federal law,” Casey states in his letter. “The statutory survey requirements coupled with CMS’s publicly identifying SFF participants and SFF candidates help residents and their families make better informed choices about their care.”

The letter also included a series of questions related to the rates of graduating SFF facilities, along with a request for an explanation as to how CMS will take steps to bolster the program and the timeline on which it intends to do so.

With more than 1.4 million residents in over 15,500 Medicare and Medicaid-certified nursing homes throughout the United States, significant attention has been placed on nursing home neglect incidents caused by understaffing, staffing turnover rates and lack of infectious disease protocols throughout the course of the COVID-19 pandemic.

Nursing home staffing levels plummeted during the pandemic, due to employees succumbing to Covid-19 or becoming burn-out attempting to provide care for their residents with a greatly decreased staff. Many nursing home workers, seeing the sharp rise in workload without accompanying increase in pay, simply quit for other, higher-paying jobs, leaving those who stayed pulling multiple shifts to try and make up for the staffing deficiency.

In February, the White House issued a press release proposing a series of reform policies that are designed to ensure patients receive better quality of care through improved staffing requirements.

The release cited a recent survey by the Government Accountability Office, which found 82% of nursing homes lack suitable infection control and prevention protocols, which has directly contributed to more than 200,000 nursing home resident and staffing deaths recorded throughout the course of the pandemic. The White House indicates that if decisive action is not taken now, the nation’s most vulnerable population could be subject to ever-worsening conditions.


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