Inside the OIG’s Latest Focus on Emergency Preparedness for Nursing Homes
The OIG added just one item to its Work Plan in March of 2023 -- but it was a significant item relating to nursing homes.
State Survey Agency Processes for Overseeing Nursing Home Preparedness
The item added in March pertains to the State Survey Agencies (SAs) that oversee how well nursing homes are prepared for challenges and emergencies. OIG expressed concerns due to prior reviews which have highlighted gaps, including gaps related to SA reviews of nursing home adherence to Centers for Medicare & Medicaid Services (CMS) regulations called Conditions of Participation (CoPs).
The OIG’s evaluation will determine:
- What processes SAs use to oversee nursing home emergency preparedness,
- What promising practices, challenges, and/or limitations exist within those processes, and
- How CMS or other U.S. Department of Health and Human Services agencies can best support SAs.
When the OIG reviews state survey agencies’ processes, it is only a matter of time before nursing homes experience the outcomes and recommendations OIG suggests for SAs to act upon.
Prior OIG Reviews
What exactly did prior OIG reviews demonstrate? Let’s take a closer look at the prior reviews mentioned in the Work Plan item to gain deeper insight into their intentions.
Infection Prevention/Control and Emergency Preparedness
In July 2022, the OIG published a report titled “Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness.”
OIG performed this review because eight out of 10 COVID-19 deaths reported in the United States in 2020 were adults aged 65 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. OIG wanted to determine whether selected nursing homes complied with federal requirements for infection prevention and control and emergency preparedness.
OIG found 28 of the 39 nursing homes they reviewed 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:
- Nursing home inadequate internal controls,
- Nursing home inadequate management oversight,
- Nursing home administrative and leadership changes,
- Inadequate communication and training from CMS, and
- Inconsistent and confusing regulations.
Life Safety and Emergency Preparedness
Another report was also issued in July 2022, titled "Audits of Nursing Home Life Safety and Emergency Preparedness in Eight States Identified Noncompliance With Federal Requirements and Opportunities for the Centers for Medicare & Medicaid Services to Improve Resident, Visitor, and Staff Safety.”
OIG performed this audit because many residents of nursing homes have limited or no mobility and are particularly vulnerable in the event of a fire or other emergency. In addition, CMS had issued new life safety and emergency preparedness requirements a few years prior to this report, and OIG wanted to assess nursing homes’ compliance with these newer requirements.
As a result of their audit, OIG identified a total of 2,233 areas of noncompliance with life safety and emergency preparedness requirements at 150 of the 154 nursing homes they visited, including:
- 1,094 areas of noncompliance with life safety requirements, and
- 1,139 areas of noncompliance with emergency preparedness requirements.
According to the OIG, these deficiencies occurred because of several factors, including inadequate oversight by management, staff turnover, inadequate oversight by SAs, and a lack of any requirement for mandatory participation in standardized life safety training programs.
Life Care Centers of America
Lastly, in September 2022, OIG released an audit report summarizing a review of certain nursing homes from Life Care Centers of America (Life Care), titled “Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness.”
The OIG performed these audits for similar reasons cited in the report discussed above relating to infection prevention/control and emergency preparedness.
OIG found that 23 of the 24 nursing homes selected had possible deficiencies. They were careful to point out that actual deficiencies can only be determined following a thorough investigation by trained surveyors. At 22 nursing homes, OIG found 35 instances of possible noncompliance with infection prevention and control requirements related to annual reviews of the Infection Prevention and Control Program, training, designation of a qualified infection preventionist, and Quality Assessment and Assurance Committee meetings.
At 16 nursing homes, they found 20 instances of possible noncompliance related to the annual review of emergency preparedness plans and annual emergency preparedness risk assessments.
Life Care officials attributed the possible noncompliance to:
- Leadership turnover,
- Staff turnover,
- Documentation issues (i.e., information was not documented or documentation was either lost or misplaced),
- Staff members who were unfamiliar with requirements (i.e., requirements stipulating that there is no grace period for infection preventionists to complete specialized training and that emergency preparedness plans needed to be reviewed annually),
- Qualified personnel shortage, and
- challenges related to the COVID-19 public health emergency.
OIG also believes that many of the conditions noted in their report occurred because CMS did not provide nursing homes with communication and training related the new Phase 3 infection control requirements or clarification about the essential components to be integrated into the nursing homes’ emergency plans.
While OIG only added one item to their Work Plan in March 2023, it was a significant one for nursing homes as OIG plans to assess SAs and their oversight of nursing home emergency preparedness. The OIG specifically mentioned gaps that their prior work had identified, as well as three prior OIG audits and their findings.
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