U.S. to Pause Routine Nursing Home Inspections

U.S. to Pause Routine Nursing Home Inspections

Inspectors to Emphasize Controlling Infections, Focus on Facilities at Risk From Coronavirus. 

By: Anna Wilde Mathews and  Jon Kamp – March 23, 2020 12:30 pm ET

Federal regulators said they plan to temporarily halt routine inspections of nursing homes to focus on the most dangerous situations, as coronavirus cases mount in the facilities across the U.S. and serious infractions were found at the hardest-hit location.

Under the changes, regular inspections of nursing homes, home health and hospice companies, among others, will be paused for at least three weeks. During that time, inspectors will emphasize controlling infections, and focus on facilities at risk from the new coronavirus and those with potential issues posing the most peril to residents.

The Centers for Medicare and Medicaid Services is expected to announce the developments Monday. The inspection-policy change will be made under the Trump administration’s recent declaration of a national emergency tied to the new coronavirus.

The move follows a recent inspection of the Life Care Center of Kirkland, a nursing home near Seattle, which is tied so far to 35 coronavirus deaths. CMS said the inspection found three major violations at the facility that put residents in imminent danger, including not quickly identifying and managing sick residents. Life Care said it had faced an unprecedented crisis and has fixed the issues.

“Right now, the biggest threat to our nursing home residents is the coronavirus,” CMS Administrator Seema Verma said in an interview. “We cannot have a repeat situation like we had in Kirkland.”

Nursing homes house the population most vulnerable to the respiratory sickness: older, often frail residents with underlying medical conditions. Many nursing homes have long struggled with infection control, according to federal inspection records and researchers.

As the new coronavirus has spread across the U.S., nursing homes have been heavily—and devastatingly—affected. At least 146 nursing homes in 27 states have at least one infected resident, CMS said, citing data from the Centers for Disease Control and Prevention.

Recent coronavirus outbreaks, including deaths, have hit elder-care facilities in Vermont, Louisiana, Kansas and Florida, among other states. Assisted-living facilities, unlike nursing homes, aren’t under federal regulatory oversight.

Meantime, nursing homes say they are struggling with a lack of personal protective equipment for their workers, and that in some cases they aren’t able to get prompt coronavirus tests for all of their residents and employees who might need them.

Ms. Verma said testing was rolling out more broadly.

Annual inspections are traditionally the nursing-home industry’s main form of oversight, along with special exams responding to complaints. The examinations are generally carried out by state investigators using criteria set at the federal level, and they are required to participate in the Medicare and Medicaid programs.

Yet the virus’s heavy toll on nursing homes has scrambled traditional thinking about oversight. Earlier this month, CMS took a first step toward targeting inspections, by focusing more closely on infection control.

Some nursing-home operators have asked for the agency to dial back regular inspections, saying that they imposed a heavy burden at a time when the facilities are focused on managing the risk of the virus.

Researchers said that pausing routine inspections could reduce important scrutiny on the facilities, but the move is likely worth the cost for now.

“There’s a real reason we have these inspections, they are very important,” said Kathryn Hyer, a professor at the University of South Florida. But, she said, nursing home staff are under strain and “I don’t think that right now they should be worried about preparing for an inspection.”

Deb Murphy, chief executive of the Washington state affiliate of LeadingAge, which represents nonprofit providers of aging services, said inspections are intense, and staff are currently focused on dealing with the coronavirus.

“There’s a lot of stress and strain” when the inspections are going on, Ms. Murphy said. In addition, inspectors are traveling from facility to facility and may unwittingly carry the virus, putting staff and residents at risk, she said.

Under CMS’s new policy change, there will still be inspections related to complaints and reported incidents that appear to rise to the highest level of concern, known as immediate jeopardy.

Inspectors, who generally work for states under the direction of CMS, will also do infection-control examinations of facilities identified with the CDC as being at risk from coronavirus.

And CMS will offer nursing homes a checklist to assess their own infection-control practices.

The agency isn’t blocking one practice that the CDC said may have made several nursing homes in the Seattle area more vulnerable to the spreading outbreak: staff members who work at more than one nursing home.

The federal regulator previously told nursing homes to identify staffers who work at more than one facility and screen and restrict access if needed to ensure they don’t infect residents. The agency has also told nursing homes to restrict visitors and cancel communal activities, such as dining.

The inspection of Life Care, by federal and state inspectors and concluding on March 16, found that the facility had put patients in imminent danger in three ways, according to CMS.

Aside from not rapidly identifying and managing sick residents, CMS said, Life Care didn’t promptly notify the state about its growing respiratory infection rate, and failed to have an adequate backup plan once its main clinician became sick.

CMS has informed Life Care Center of Kirkland that it will be terminated from Medicare and Medicaid if it doesn’t take corrective actions, Ms. Verma said. If terminated, the nursing home couldn’t bill the programs.

The facility is partly being staffed by the federal government currently, she said.

Life Care spokesman Tim Killian said the company is “disappointed that CMS hasn’t taken into consideration the entirely unprecedented nature of this event at our facility.” He said the facility was prepared for a disaster, but “it’s unrealistic to expect any nursing home to be able to manage this on our own within the framework of a normal disaster response plan.” He said the facility couldn’t get coronavirus test kits until March 5, and “we did not have the capability to diagnose and manage Covid patients because we did not have test kits.”

He said the facility has already corrected the issues cited by the regulator, which were the result of the crisis.

Write to Anna Wilde Mathews at anna.mathews@wsj.com and Jon Kamp at jon.kamp@wsj.com




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