Facilities News Spotlight

2023-05-22 Spotlight: Senate Report – Nursing Homes Severely Understaffed

Senate Special Committee on Aging Report: Nursing Home Survey Agencies are Severely Understaffed

As reported by The Consumer Voice, May 19, 2023

Today, the Senate Special Committee on Aging, led by Chairman Bob Casey, released a new report, “Uninspected and Neglected: Nursing Home Agencies are Severely Understaffed, Putting Residents at Risk.”  The report details a nationwide staffing crisis at state survey agencies that is directly impacting the health and well-being of nursing home residents. In addition, the Senate Special Committee on Aging held a hearing on the issue today, at which State Long-Term Care Ombudsman Leah McMahon testified regarding how inadequate staffing at state survey agencies is impacting resident care in Colorado.

The importance of state survey agencies cannot be understated. They are charged with enforcing federal and state regulations to ensure the safety of nursing home residents. Inadequate state surveying activity allows facilities to continue to operate in a manner that harms residents or puts them at risk of harm.

Key findings from the report include:

  • One-third of the 15,000 nursing homes in the United States are behind on their annual surveys, with 11% of homes not having had a survey in over two years.
  • 31 of 52 state survey agencies are experiencing vacancy rates of 20% or higher, with nine survey agencies having vacancy rates over 50%.
  • Low salaries and burnout lead to high staff turnover in state agencies, which results in inexperienced surveyors.
  • Many states have turned to hiring third-party companies to conduct surveying activities and are paying exorbitant fees for their services. The report also calls for increased oversight of these third-party survey companies.

The Committee’s report made several recommendations, including:

  • Increased funding from Congress. Funding for state survey agencies has been flat for years, despite calls for increases from both Presidents Trump and Biden.
  • Congress and state governments should take action to support state surveyors, including providing educational opportunities and mental health support.
  • Congress should increase funding for State Long-Term Care Ombudsman programs. The report relies heavily on input from Ombudsman program representatives and notes their critical role in advocating on behalf of residents and calls for increased funding for these critical programs.

Consumer Voice has long been concerned about inadequate enforcement activities in nursing homes and delays attributable to staffing shortages and has repeatedly called for increased funding for state survey agencies. Consumer Voice is grateful to the Senate Special Committee on Aging and Chairman Casey for drawing attention to this important issue, and we urge Congress, the Centers for Medicare & Medicaid Services (CMS), and state governments to adopt the report’s recommendations.

Elizabeth Warren Raises Concern About ‘Horrendous’ Nusing Home Conditions Caused by Corporate Greed (video)

Forbes Breaking News (via YouTube), May 19, 2023

During a Senate Aging Committee hearing on Thursday, Sen. Elizabeth Warren (D-MA) questioned witnesses about nursing home conditions.

‘System in Crisis’: US Senate Hearing Calls for More Funding, Staffing for Nursing Home Inspections

Skilled Nursing News
By Zahida Siddiq, May 18, 2023

The nursing home inspections system is underfunded and understaffed and needs federal assistance for alleviating inspection backlogs, or residents will remain in peril, experts and legislators said at a U.S. Senate hearing on Thursday.

Officials from the long-term care ombudsman program as well as leaders from state inspections and regulatory bodies were among those who testified before the U.S. Senate Special Committee on Aging, following the release of its investigative report.

“The report paints a picture of a system in crisis,” said Sen. Bob Casey (D-Penn), who blamed a shortage of inspectors and low funding as factors that are jeopardizing the annual nursing home inspections process. “The result is that nursing home residents are being put at risk because of this problem … My fear is that the trail is going cold for too many residents before nursing home inspectors can arrive on the scene.”

“My investigation reveals unacceptable rates of vacancies at state survey agencies, threatening the safety and health of nursing home residents as their complaints collect dust while inspectors struggle to meet the demand,” Casey said.

Inspection backlogs
As a result of fewer inspectors, most states have nursing home inspection backlogs.

The report found 31 states and the District of Columbia had inspection staff vacancy rates above 20% on average, and nine were short-staffed by 50% or more. Meanwhile, the highest vacancy rates were in Kentucky at 83%, Alabama at 80% and Idaho at 71%. .

During the hearing, staffing shortages at nursing homes were also cited by experts as being important for better health outcomes, especially as they relate to mental health concerns of residents. . .

In closing, Sen. Casey compared the current findings to work of the Senate committee on nursing home oversight almost four decades ago, and said, “We heard similar warnings today and these warnings must not be ignored.”

Aside from more funding, Casey recommended adding more transparency to the survey process and scrutiny of independent contractors as well as boosting the health care workforce.

“The [Senate] Aging committee’s oversight in the 1980s paved the way for landmark nursing home reforms that President Reagan signed into law. Today’s hearing and the committee’s investigation provide another opportunity to find common ground to make sure nursing home residents are kept safe and receive the care that they and their families deserve and have a right to expect,” Casey said.

Nursing home oversight ‘a system in crisis,’ Senate committee finds

McKnight’s Long-Term Care News
By Kimberly Marselas, May 19, 2023

Oversight of the nation’s 15,000-plus nursing homes is “in crisis,” with many facilities more than a year overdue for routine inspections and nine states reporting more than half their surveyor positions are unfilled, senators said Thursday as they released a scathing report on the issue.

“Underfunded and understaffed, state agencies have fallen behind on the basic duties that they’re charged with executing on, for example, conducting annual nursing home inspections and responding to resident complaints in a timely manner,” said Sen. Bob Casey (D-PA), chairman of  the Special Committee on Aging. “Nursing home residents are at risk because of this problem.” . .

Casey placed much of the blame on Congress and its willingness to “flatline” funding for oversight, noting that the report should be a wake-up call to increase support for survey and inspection activities around the country. . .

In 2020, Casey secured a one-time, $100 million funding boost for nursing home oversight in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. That is set to expire in September, and 32 states and Puerto Rico reported concern that the loss of those funds will have a negative impact on their ability to complete their work.

In April, Casey and Sen. Ron Wyden (D-OR) urged the Senate Appropriations Committee to add $566 million in funding to CMS’s Survey and Certification program, which was supported in President Biden’s FY 2024 budget proposal.

But after the hearing, the American Health Care Association pushed back against the idea that more enforcement was the best or only way to improve patient care. While the organization shares concerns about the survey backlog, Holly Harmon, AHCA’s senior vice president of quality, regulatory, and clinical services, pointed out that nursing homes are facing the same issues hiring staff that the survey groups do.

Where are the inspectors? How a lack of nursing home oversight is endangering residents

Health Leaders
By USA Today, May 18, 2023

Most states have nursing home inspection backlogs largely because federal oversight funding has stalled. State inspectors are on the frontline of protecting the quality of care for and the rights of more than 1 million Americans who live in nursing homes, either because of aging, illness, or disability, or who have short-term stays for rehabilitation. The report from the U.S. Senate Committee on Aging found 31 states and the District of Columbia had inspection staff vacancy rates above 20% on average; nine were short staffed by half or more. The highest rates were in Kentucky (83%), Alabama (80%) and Idaho (71%).