Agencies That Inspect Nursing Homes Face Staffing Crisis

The Senate Special Committee on Aging has released a report exposing an understaffing problem among the survey agencies across the nation that are responsible for overseeing nursing home inspections. The staffing crises at these agencies, according to the report, has led to an increase in the number of regulation violations and ultimately is making long-term care facilities unreasonably dangerous for their residents.

Today, more than 1.1 million individuals live in about 15,000 nursing homes nationwide. Yet as many as one in nine of these facilities have not had an annual inspection in the past two years – in large part due to staffing shortages. In its report, committee members make several recommendations to Congress for addressing this shortage – including decreasing burnout among agency staff, increasing staff salary, and lowering the overall turnover rate among inspection staff.  

What Do State Survey Agencies Do?

State survey agencies contract with a state Medicaid agency to inspect long-term care facilities and ensure they are meeting federal standards for medical care, are fully prepared for emergencies, are keeping residents safe, and more. These agencies create inspection reports that detail a facility’s performance and document violations of state statutes and regulations. Such reports are intended to be conducted on an annual basis.

State survey agencies must have adequate staff to carry out these tasks, however. Enforcing federal and state regulations helps protect nursing home residents from unreasonable risk of harm. If these agencies do not have the workforce they need to operate efficiently, the older adults that call these care facilities home may continue to endure a substandard quality of care as a result.  

Key Findings

According to the report:

• Most state survey agencies have severe vacancy rates. Thirty-one of 52 state survey agencies have staff vacancy rates of 20 percent or higher; nine agencies have a vacancy rate of 50 percent.
• Nearly one-third of the 15,000 nursing homes across the United States are behind on annual surveys.
• Eleven percent of nursing homes nationwide have not had an annual survey completed in two years.
• Many states currently rely on third-party companies to survey their long-term care facilities, which comes at a significant expense.

Recommendations for Addressing the Nationwide State Agency Staffing Shortage

There are several causes for the high staff turnover in the industry, among them low salaries and burnout.

The committee recommended the following to address such issues while increasing the efficiency of state survey agencies:

• Increase funding to the Office of the Inspector General (OIG) for the Department of Health and Human Services. (The OIG seeks to provide oversight and improve the efficiency of HHS programs such as Medicare and Medicaid.)
• Expand funding for state long-term care ombudsman programs, which serve as crucial advocates for nursing home residents.
• Boost funding for nursing educational programs.
• Invest further in state and federal funding for inspection activities.
• Strengthen the process for reviewing inspection results by requiring survey agencies to verify any deficiencies cited in their inspection reports.
• Provide more robust mental health resources for the health care workforce.
• Relax hiring requirements for inspection staff and hire professionals from disciplines besides nursing.
• Review current duties of inspection staff and eliminate tasks not related to inspection.
• Have the Centers for Medicare and Medicaid Services (CMS) track and publicly report the capacity of survey agencies to effectively perform oversight of nursing homes.
• Track survey agencies’ use of contractors to ensure the quality of oversight by these third-party inspectors.

Investing in Survey Agencies Ensures Better Oversight for Care of Older Americans

Fixing dangerous and unregulated long-term care facilities is not an issue that can be ignored, particularly given that the population of older adults will exponentially increase over the next several decades. By 2040, older Americans are projected to number 80.8 million – and 94.7 million by 2060.

“The people working at survey agencies are dedicated professionals who endure long hours conducting emotionally taxing work, often for relatively low pay, each of whom wants to see patient care and safety improved,” the report states. “Ensuring that every nursing home patient receives high-quality care demands that the nation provide these public servants with the resources necessary to properly oversee facilities.”

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