PITTSBURGH (TNS) — Building on his prior work to improve the federal government’s program that aims to improve the nation’s worst nursing homes, U.S. Sen. Bob Casey on Monday sent the Centers for Medicare and Medicaid Services a letter expressing “concern” that homes aren’t being inspected frequently enough, fearing that the lack of attention could lead to harm for fragile residents.
”Conducting regular standard surveys of SFF participants is an important means of ensuring safety, accountability and compliance with Federal law,” Casey, D- Pa., wrote in a six-page letter sent to CMS Administrator Chiquita Brooks-Lasure that contained examples documenting the problems with participants in the Special Focus Facility program.
”Nursing homes that go long periods between standard surveys can accumulate deficiencies in the absence of regular oversight,” he wrote.
Members in the SFF program — which is limited to just 88 homes — are selected because they have been identified by inspectors as homes that “substantially fail” to meet CMS’s requirements over multiple inspections. Initially, they are placed in a “candidates” list for the SFF, which has over 400 participants.
Once they are moved to the official SFF program, the homes are supposed to have standard survey inspections at least every six months — instead of every 15 months for non-SFF nursing homes — so CMS can keep closer tabs on them.
But one Missouri nursing home in the SFF program went 11 months between surveys, and when it finally was inspected in July 2021, inspectors documented 20 deficiencies — more than twice the state and national average for deficiencies found during inspections — including failing to document residents’ falls, Casey wrote in his letter to CMS.
Another home in Minnesota — which already had a pattern of inspectors finding abuse and neglect deficiencies — was not inspected for 10 months by the time it was inspected in June 2021, when it was again cited for not reporting suspected abuse and neglect cases.
Overall, an analysis by the staff of the U.S. Senate Aging Committee, which Casey chairs, found that among the 63 nursing homes in the SFF program in February, 15 of them — or 22% — had gone six months or longer without being inspected.
The homes were spread among 14 states, but none was in Pennsylvania, which has four homes in the SFF program, including Brighton Rehabilitation and Wellness Center in Beaver County.
The other three homes in the SFF program in Pennsylvania are Glen Brook Rehabilitation and Healthcare Center in Berwick; Laurelwood Care Center in Johnstown; and Squirrel Hills Wellness and Rehabilitation Center in Pittsburgh.
All four Pennsylvania homes were listed as having shown “improvement” in their most recent standard surveys. If their next standard survey continues to show improvement, the homes can “graduate” from the SFF program.
Looking back to prior SFF program lists, the Senate Aging Committee analysis found some homes went much longer without being inspected in the past. One Floridahome went 12 months between standard surveys, while homes in California and Georgia went 10 months.
”The inspection data and persistent deficiencies, coupled with the [ Office of Inspector General’s] recent reports, leave me concerned about the timeliness, consistency and effectiveness of SFF program oversight and the wellbeing of residents in those facilities,” Casey wrote.
He asked CMS to respond by answering a series of questions about the problem, including addressing what the OIG identified as the “root cause” of delays in nursing homes inspections: staffing shortages and staff turnover at state health agencies that do the inspections.
”What, if any, information can CMS share about the scope of staffing shortages at state survey agencies, and the extent to which it contributes to delays in nursing home surveys? What is CMS doing to address these chronic problems? What strategies, if any, has CMS considered to improve survey agency staffing? What types of technical assistance does CMS provide to states to assist them in conducting timely and effective oversight of SFFs and SFF candidates?” Casey wrote, in part, asking CMS to respond to these and other questions by June 6.
Casey — along with his Senate colleague from Pennsylvania, Republican Pat Toomey — has been concerned about the SFF program for years.
He and Mr. Toomey in 2019 cajoled CMS to — for the first time — make public the previously secret SFF candidates’ list.
”When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings,” Mr. Toomey said at the time.
During the height of the pandemic, the two senators teamed up again to try to get CMS to do more from nursing homes struggling with the spread of COVID-19.
More recently, in March 2021, the duo reintroduced legislation to enhance the SFF program by making more oversight and additional resources available to all of the more than 400 candidate facilities, too, not just the much smaller official list of up to 88 homes. They had previously introduced the bill in November 2020.
That bill has been referred to the Senate Finance Committee, of which Casey is a member.
