Medicare orders more weekend inspections at thinly staffed nursing homes

Nursing homes with lower-than-average weekend staffing will face more frequent weekend inspections by state survey agencies checking up on quality of care and resident safety, the CMS announced Friday.

The CMS notified state survey agencies it will use payroll-based staffing data to identify facilities with reduced weekend staffing, and require the agencies to conduct at least 50% of off-hours surveys of those facilities on weekends, starting immediately.

That percentage is up sharply from the previously required 10% of surveys performed on weekends or during non-business hours.

The action grows out of research showing that nursing homes with higher nurse staffing levels tend to have fewer resident hospitalizations. The CMS said that while most facilities have somewhat fewer staff on weekends, certain facilities have significantly lower weekend staffing. Some report days with no RNs on-site.

"We're deeply concerned about potential inadequacies in staffing … and the impact this can have on patient care," CMS Administrator Seema Verma said in a written statement. The new policy will strengthen oversight of resident health and safety and help ensure accurate public reporting, she added.

The CMS has been under congressional pressure to increase its oversight of nursing home quality and safety following reports by Kaiser Health News and other news organizations of abuse, neglect and substandard care at facilities across the country.

The intensified weekend inspections at selected nursing homes are part of a broader range of CMS regulatory actions aimed at improving quality and safety. It is revising Medicare payments to skilled-nursing facilities based on how often residents are hospitalized within 30 days of discharge, with penalties for poorer performers and bonuses for better performers.

Last month, the CMS announced it will develop new training materials for nursing home professionals to help them reduce adverse events, improve dementia care, and strengthen staffing quality. That three-year effort is funded by civil monetary penalties the CMS has collected from facilities for noncompliance with regulations.

It also announced it is developing a rule to allow the imposition of civil monetary penalties of up to $200,000 against nursing home staff who fail to report abuse of residents or other illegal activities.

Late last year, however, the CMS placed a controversial 18-month moratorium on several key parts of an Obama administration regulation that would have imposed civil monetary penalties, payment denials or termination from Medicare on nursing homes if they did not comply with certain requirements.

Those requirements included having adequate staff on-site, such as staff to provide behavioral health services.

The nursing home industry criticized the CMS' move to increase weekend inspections at selected facilities, arguing the agency should focus on addressing the national workforce shortage rather than taking a punitive approach.

"Unfortunately, Friday's action by CMS will enforce policies that make it even more difficult to meet regulatory requirements and hire staff," said David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association.

But patient advocates said the action is needed to push state survey agencies to properly enforce the rules for protecting resident safety.