A powerful US senator is bringing in additional firepower in his quest to fix what he sees as major issues with state surveys of nursing homes. It’s an effort that had one leading advocate channeling Alanis Morrissette.

Bob Casey (pictured) (D-PA) added Senate Finance Committee Chairman Ron Wyden (D-OR) and Budget Committee Ranking Member Chuck Grassley (R-IA) to the fight with a letter Thursday to the Centers for Medicare & Medicaid Services asking the agency to “take immediate steps to strengthen the Nation’s nursing home oversight system.” 

The letter comes two months after Casey, chairman of the Senate Committee on Aging, held a hearing and issued a report that detailed severe deficiencies with state survey agencies. The 2,000-page report, “Uninspected and Neglected: Nursing Home Inspection Agencies are Severely Understaffed, Putting Residents at Risk” found that 1 of every 9 nursing homes in the US had not had an annual survey in two years, and that 32 state agencies had vacancy rates of 20% or higher among facility surveyors. Surveys are supposed to take place roughly every 16 months.

“Many states have turned to using costly contractors to bridge these gaps, raising concerns about efficiency, effectiveness, and conflicts of interest,” the senators’ letter said. “CMS has an integral role to play in addressing many of the current failures of the nursing home oversight system, especially to improve monitoring and reporting on the capacity of state survey agencies to carry out statutorily required inspections in mandated timeframes.”

The letter makes two specific requests of CMS to “regularly collect” information from state survey agencies about staffing levels and report on state agencies’ ability to conduct appropriate oversight of nursing homes. 

Zach Shamberg, president and CEO of Pennsylvania Health Care Association, struck out at the letter as though it were rain on a wedding day. 

“As singer and songwriter, Alanis Morrissette said, ‘Isn’t it ironic…don’t you think?’,” Shamberg said to McKnight’s Long-Term Care News in an email. “Senator Casey and the Biden administration have been in dogged pursuit of a federal staffing requirement for nursing facilities at the same time our country has become immersed in a workforce crisis. Both long-term care providers and regulatory agencies are vying for workers, yet the only support offered has been to oversight, rather than to care.”

A spokeswoman for CMS acknowledged receipt of the letter Thursday and said the agency “remains committed to improving safety and quality of care for all nursing home residents.” 

“The President’s FY 2024 Budget includes a request for needed resources to strengthen nursing home oversight, as annual funding for survey and certification activities has remained flat for over eight years while complaints have increased,” the agency said in a statement to McKnight’s.

During the May 18 hearing, the board president for the Association of Health Facility Survey Agencies testified that “Immediate Jeopardy” complaints had risen 102% since 2015. Shelly Williamson, who is also the administrator of long-term care regulation for the state of Missouri, said there has been no additional national funding to support the increase in required inspections. 

Stephen B. Hanse, president and CEO of the New York State Health Facilities Association, told McKnight’s on Thursday that Congress, CMS and providers need to be partners on these matters.  

“After nuclear power, nursing homes are arguably the most regulated industry in our nation,” Hanse said. “As such, skilled nursing providers are subject to extensive and extremely transparent federal, state and local health department oversight and reporting requirements. It is vital that Congress, CMS and nursing home providers work together in partnership to enact beneficial solutions that ensure the continued provision of essential long-term care services. Solutions that include, among other things, addressing the long-term care workforce crisis and chronic underfunding of Medicaid.”

In response to Casey’s latest missive, the American Health Care Association reissued its statement from the May 18 hearing that said the shortage of surveyors is “indicative” of the LTC sector workforce crisis. 

“We need a concerted, supportive effort to help recruit more individuals to serve our nation’s seniors, and we have proposed a comprehensive set of policies that would help grow and strengthen the nursing home workforce,” read the statement, which was attributed to Holly Harmon, the association’s senior vice president of Quality, Regulatory and Clinical Services.