OIG Estimates 1 In 4 For-Profit Nursing Homes Not Complying With Infection Control Staffing Rules

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Dive Brief:

• About 1 in 4 for-profit nursing homes across the country are likely not complying with federal regulations surrounding infection control staff, increasing health and safety risks for residents and workers, according to an estimate by the HHS’ Office of Inspector General.
• In a report analyzing a sample of 100 facilities, 17 potentially didn’t follow rules that require an infection preventionist — a staffer responsible for managing the nursing home’s infection prevention and control policies — to complete specialized training before taking the job.
• Seven nursing homes potentially failed to designate an infection preventionist entirely, the OIG said.

Dive Insight: 

More than 1.3 million people live in nursing homes nationwide, according to the OIG’s report. These patients are more susceptible to infections, given they’re often elderly or medically fragile and live in close proximity to other residents and staff.

For example, COVID-19 tore through nursing homes during the early days of the pandemic, killing patients at an outsized rate and overwhelming facilities. More than 172,000 residents have died of the coronavirus, and millions have been infected, according to data from the CMS. 

To improve safety and quality in long-term care facilities, the CMS in 2016 implemented new standards that required nursing homes to establish an infection prevention and control program and designate at least one person who would be responsible for that plan.

The program had to include a system for preventing, identifying and controlling infections, an antibiotic stewardship program, and a plan for recording incidents and taking corrective actions. 

The infection preventionist was required to work at least part-time and to complete specialized training in infection prevention and control. 

But some nursing homes failed to fully comply with these rules, according to the OIG report. Six nursing homes in the sample didn’t have a designated infection preventionist for part of the audit period, which ranged from 30 to 311 days for five of those facilities. One nursing home didn’t have a preventionist for any part of the study period. 

Officials at the nursing homes said they failed to comply with the infection staffing rules due to challenges hiring and retaining qualified workers, as well as significant changes in ownership, administrators or infection prevention staff. 

They also reported problems accessing statewide in-person or online training and problems completing the training in a timely manner due to work demands or changing regulatory requirements. 

Staffing has become a significant challenge for nursing homes. Before the pandemic in 2018, 23% of nursing homes used temporary agency staff, accounting for about 3% of all direct care nursing hours. But in 2022, nearly half of nursing homes used agency workers, making up 11% of all direct care nursing hours, according to a study published earlier this year in Health Affairs. 

The Biden administration published a regulation this spring that would require facilities to provide 3.48 hours of care per resident per day — with at least 0.55 hours coming from registered nurses — in a bid to improve health outcomes for residents and decrease staff turnover.

But facilities argued implementing the rule would be impossible given nursing shortages. This month, Texas sued the Biden administration over the regulation, arguing high costs from putting the rule in place would force nursing homes to shut down across the state.