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Leadership During Crisis?

Published on June 26th, 2020

Under normal circumstances, state surveyors only visit individual facilities on behalf of CMS about once per year, or perhaps in response to a specific credible complaint. However, new federal guidelines released require all states to perform a “targeted” infection-control survey or risk losing some CARES Act funding, while instituting mandatory follow-up inspections after new outbreaks are reported.

Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said “At the end of the day, the ultimate responsibility, really, for the health and safety of residents is on the nursing home,” during a phone press conference. “The role of the state and the federal government — we set regulations, we do inspections.”

Verma was answering a question about nursing homes with outbreaks of COVID-19 despite receiving deficiency-free surveys even during the pandemic, a conclusion that questions the integrity and efficacy of the inspections.

Just 3% of the more than 5,700 surveys conducted since the start of the pandemic revealed infection-control citations, prompting the Center for Medicare Advocacy to call the results “not credible.”  Especially since 84% of all facilities have had at least one deficiency related to infection control in the last five years! Deficiencies include insufficient hand-washing and lax attitudes around separating COVID-positive residents from those without the virus, as well as appropriate use of personal protective equipment (PPE).

It is simply not plausible, during the pandemic, when at least 32,000 residents have died of COVID-19 and large proportions of deaths from COVID-19 nationwide are residents and staff, that facilities have no problems in their infection prevention and control practices,” the advocacy group said. “Problems cannot be fixed going forward if they aren’t even identified and acknowledged.”

Verma pointed to limitations, however, in the inspection system.

When you go into the nursing home, the staff know that they’re being observed — particularly on that day. They go in, and they’re looking for things, and they may not see it in that particular visit,” Verma said. “But when the inspector leaves the nursing home, things can change.”

It just could be at that particular day, [surveyors] didn’t observe anything, and they showed that they had the appropriate policies and procedures in place,” she said. “But when something actually happens — does the staff follow those policies and procedures? May have happened on that particular day, may not happen every day.”

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