The Office of Inspector General (OIG) conducted an audit and found that selected nursing homes may not have complied with federal requirements for infection prevention and control and emergency preparedness. Specifically, 28 of 39 nursing homes they audited had possible deficiencies. They found 48 instances at 25 nursing homes of possible noncompliance with infection prevention and control requirements and 18 instances at 18 nursing homes of possible noncompliance with emergency preparedness requirements related to all-hazards risk assessments and strategies to address emerging infectious diseases. The nursing homes attributed the possible noncompliance to: (1) nursing home inadequate internal controls, (2) nursing home inadequate management oversight, (3) nursing home administrative and leadership changes, (4) inadequate communication and training from the Centers for Medicare & Medicaid Services (CMS), and (5) inconsistent and confusing regulations.
The Centers for Disease Control and Prevention (CDC) indicate that individuals who are aged 65 and older or nursing home residents are at a higher risk for severe illness from COVID-19. In addition, 8 out of 10 COVID-19 deaths reported in the United States in 2020 were adults aged 65 years and older. COVID-19 is especially dangerous for the more than 1.3 million residents who live in the 15,446 Medicare and Medicaid certified nursing homes nationwide.
The OIG’s objective in conducting the audit was to determine whether selected nursing homes complied with federal requirements for infection prevention and control and emergency preparedness. They analyzed state survey agency (SSA) data on Medicare.gov for the most recent standard surveys and the previous 12 months of complaint reports. They identified 6,830 nursing homes that were cited for infection prevention and control program deficiencies, and Medicare.gov indicated that 39 nursing homes had not provided a plan of correction for the deficiencies as of March 26, 2020. They contacted the 39 nursing homes and requested that they provide the OIG with infection prevention and control and emergency preparedness program documents that were in effect from January 1, 2019, through May 31, 2020.
The OIG recommends that CMS: (1) instruct SSAs to follow up with the 28 nursing homes that they have identified with potential infection prevention and control and emergency preparedness deficiencies to ensure that they have taken corrective actions; (2) issue updated phase 3 interpretive guidance as soon as feasible; (3) provide training to SSAs on the updated phase 3 interpretive guidance as soon as feasible; and (4) consider updating the regulation to make clear that nursing homes must include emerging infectious diseases as a risk on their facility- and community-based all-hazards risk assessments.
CMS agreed with the OIG’s first three recommendations and described corrective actions it had taken or planned to take, such as ensuring that SSAs follow up with the nursing homes, issuing phase 3 interpretive guidance, and providing training related to the phase 3 interpretive guidance. CMS stated that it had intended to release the phase 3 interpretive guidance during the second quarter of 2020. However, prior to issuing the guidance, the COVID-19 public health emergency (PHE) was declared, and CMS immediately redirected resources to address patient safety needs related to the PHE. Regarding the OIG’s fourth recommendation, CMS stated that it would consider this recommendation in future rulemaking and said that it has taken considerable steps to make clear that nursing homes should include emerging infectious diseases as an identified risk on their facility- and community-based all-hazards risk assessments.
Read the full report here: https://oig.hhs.gov/oas/reports/region1/12000005.pdf.
Issue:
Facilities’ infection control policies and procedures, when implemented correctly, slow the spread of COVID-19 and other communicable diseases. If infection control policies and procedures are not followed per requirements, this may be seen as placing residents in immediate jeopardy for harm and provision of substandard quality of care, which may result in citations and monetary penalties. Emerging infectious diseases should be included as a risk factor in facility emergency preparedness plans. It is critical that facilities review their emergency preparedness plan periodically so it can be implemented promptly should any emergency arise.
Discussion Points:
- Review policies and procedures for infection prevention and control. Ensure that policies are up-to-date with the most recent CDC and CMS infection control guidelines, including listing emerging infectious diseases in the facility’s emergency preparedness plan. Review your emergency preparedness plan and update as necessary. Make sure the plan is available to staff so they can easily access the guidelines for the various components should an emergency occur.
- Train all staff to follow the facility’s policies and procedures for infection prevention and control. Train all staff on your emergency preparedness plan. Conduct drills for the various disaster response plans to ensure staff competency with each. Document that these trainings and drills occurred, and file the signed documents in each employee’s education file.
- Periodically audit to ensure that all staff members are following infection control policies and procedures correctly. Provide additional education if necessary. Audit staff to ensure that they are aware of their roles during an emergency per your emergency preparedness plan.
