The OIG collected data from 100 for-profit nursing homes between October 2022 and June 2024. The agency found that seven facilities did not have a designated infection preventionist on staff at some point during the audit period. Meanwhile, 17 did have infection preventionists on staff, but they had not completed mandatory training before starting their jobs.
The Centers for Medicare and Medicaid Services mandates that skilled nursing facilities employ such specialists as part of requirements that nursing homes prevent, identify, report and control infections.
From that sample, the OIG estimated that about one-fourth of for-profit nursing homes may not have complied with federal requirements during the audit period. The shortfall could put residents and staff at increased risk of infections and contagious diseases, according to the OIG.
Related: Nursing homes blast higher staffing minimums
CMS has cited less than 1% of nonprofit and for-profit nursing homes this year for violating the infection preventionist requirements, according to the agency's Quality and Certification Oversight Reports website.
Industry trade groups and nursing home officials attribute noncompliance to difficulties with recruitment and retention, ownership changes, and struggles accessing training in a timely manner, the OIG report said.
“Complying with infection preventionist requirements can be challenging in times of high turnover or workforce shortages," said Jodi Eyigor, director of nursing home quality and policy at LeadingAge, a trade group representing nonprofit long-term care providers.
"It’s not just about filling the role. Nursing homes must ensure that the role is filled by a staff member with the right qualifications and who has completed the extensive training required to fill the role," Eyigor said.
Despite pervasive staffing challenges, it is still important for nursing homes to designate qualified and trained infection preventionists to create safe, high-quality environments for residents and staff, Eyigor said.
Nursing homes should take advantage of CMS’ free online infection preventionist training for multiple workers to ensure more than one employee can fill the role if there is turnover, Eyigor said.
Lack of federal support and resources is the main obstacle to the ongoing training of infection prevention specialists, said Holly Harmon, senior vice president of quality, regulatory and clinical services at the American Health Care Association/National Center for Assisted Living, a nursing home trade group. Harmon disputed the OIG's estimates of how many nursing homes don't comply with requirements.
"We need targeted investments to ensure nursing homes can recruit, retain and develop these specialized professionals and continue to protect residents," Harmon said.
Nursing home leaders have also argued workforce shortages would make it difficult for operators to meet the minimums outlined in CMS' nursing home staffing mandate, thus limiting patient access.
Nearly 800 nursing homes shut down since February 2020 and 20% closed a unit, wing or floor due to labor shortages, the AHCA reported this month.
