In a column published by McKnight’s in December 2023, “Revamping CMS Survey Data Integration Amid Regulatory Lag in Nursing Home Oversight,” I urged the Centers for Medicare & Medicaid Services to critically assess the impact of surveyor staffing shortages on the Five-Star Health Inspection domain calculation.
Many nursing homes have not had an annual recertification survey in well over a year, with the average delay being 578 days. Since the Five-Star rating largely depends on surveys, these delays mean that consumers, residents and providers are not receiving current and relevant information. At Zimmet Healthcare Services Group, we monitor these statistics closely, and frankly, not much has changed since COVID.
To more fully understand how these survey delays impact consumer information, we broadened our analysis to include the Special Focus Facility (SFF) program and the abuse icon.
CMS explains to consumers that it created the SFF initiative to address nursing homes with a “yo-yo” compliance history — those that rarely address underlying systemic problems, causing repeated cycles of serious deficiencies. A nursing home designated as an SFF is supposed to be surveyed twice as frequently, or every six months, as required under several sections of the Social Security Act.
This is not happening. On average, nursing homes designated as SFFs wait 304 days between surveys. Removing two of the highest outlier states, Maryland and Idaho, brings the average to 252 days.
In 2019, CMS put a similar consumer protection in place with the “abuse icon.” CMS’s memo to state survey agency directors states that this icon aims to “make it easier for consumers to identify facilities with instances of non-compliance related to abuse.” Facilities where residents were found to be harmed (scope/severity of G or higher) on the most recent standard survey or a complaint survey within the past 12 months are flagged with the abuse icon.
Facilities where residents were found to be potentially harmed (scope/severity of D or higher) on the most recent standard survey or a complaint survey within the past 12 months, and on the second most recent standard or complaint survey in the 12 months before that, are also flagged. Nursing homes with the abuse icon have annual surveys that are 575 days apart on average.
Both the SFF designation and the abuse icon appear on CareCompare.gov. An SFF designation will replace the facility’s Five-Star ratings with a yellow warning sign. Nursing homes that receive the abuse icon have their Health Inspection rating capped at a maximum of 2 stars, and a red hand will appear.
The survey agency delays, as reported by the majority staff of the U.S. Senate Special Committee on Aging in their report “Uninspected and Neglected” (and discussed in my December article), have implications for both consumers and providers. Consumers need accurate information to make informed placement decisions. Providers need to focus on today’s priorities, not on outdated data.
CMS, I am asking again: Please critically assess the impact of surveyor staffing shortages on the nursing home industry, both in terms of quality of care and integrity of consumer information.
Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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