Nursing home staff are at their wits end, leaving their beloved profession in droves, disheartened by CMS and the state health department’s callous approach to finding fault instead of supporting, engaging and educating staff during this difficult time in all of health care. 

While nursing homes have been and are doing their best to ensure the safety of both their residents and staff with staffing challenges, PPE shortages, and working to figure out how to conduct visits with loved ones and not potentially introduce COVID-19 into the facility from their community at large, CMS and the Trump administration have been proudly bragging about the millions of dollars in fines and the increased pressure they've burdened facilities with.

What CMS and the Trump administration haven't highlighted is their failure to provide comprehensive COVID-19 mitigation and prevention guidance and equipment to nursing homes timely. 

Ultimately, CMS failed to provide education and training until August 25, 2020 after they had already levied millions in dollars in fines to nursing homes without providing comprehensive or consistent guidance or ensuring the tools (access to PPE, training, and testing) needed to combat the virus in the most vulnerable patients was readily available. That’s like getting fined for fighting a large wildfire you didn’t get the training or equipment to do the job.

Minor errors cited during an onslaught of infection control surveys, demanding perfection, unrealistic expectations and failing to focus on systemic deficient practice against a virus that no one has been able to control, is adding extra and unnecessary stress to a workforce that is already pushed to the limits. Staff spend weeks catering to surveyors, retrieving paper work and evidence of their efforts instead of filling in for their sick staff and/or focusing on patient care. 

Although, CMS has publicly claimed Patients Over Paperwork, the reality is that these frivolous citations and their penalties have caused undue burden during a time when staff are grieving patients and coworkers that they loved and lost, while trying to cover staff shortages due to COVID-related illnesses.

Hospitals haven’t been held to the same expectations in regards to COVID-19 infections/deaths.  The entire world has had to make changes due to the unmitigated spread of COVID-19 but nursing homes are one of the only industries who are being demonized because they are unable to stop it.  

During this entire pandemic, CMS and the state health departments continue to use heavy-handed fines, denial of payments, denial of admissions as punishment for failing to keep COVID out of nursing homes in an impossible situation, without acknowledging their own failure to ensure access to appropriate PPE, education and support.  In some communities this approach by CMS has bedlocked hospitals leaving patients no where to go once they no longer need that acute hospital based care but still need rehab. 

Blame should not be placed on the shoulders of those caring for the nation’s elderly and at risk adults for a virus that is out of anyone’s control, without adequate support and equipment.  Staff are tired.

We request the following: 

• All COVID-related infection control citations from the beginning of the pandemic be reviewed by an independent, non-government agency to ensure there were systemic failures identified and cited and not just one-time observations or minor deficient practice cited at higher scope and severity than what is normally identified/cited in normal surveys. Any citations flagged for review will be delivered to CMS with the explicit expectation to remove the non-systemic failure, reduce the scope and severity of the citation if appropriate or delete it altogether along with any associated penalties. 
• All COVID-related infection control citations during the pandemic that did not meet Immediate Jeopardy level have all associated penalties removed if compliance was achieved on the first revisit. 
• All COVID-related infection control citations prior to 9/25/20 have no scope and severity and do not impact facility CMS 5-star scoring but are used as guidance to improve care delivery.   
• Facilities dealing with an active outbreak will only be surveyed once during the outbreak to minimize COVID exposure to the surveyors and ensure staff are available for care delivery versus survey management.  
  • Surveyors will be required to contact county health department officials while onsite and with a facility representative to ensure continuity of messages. 
  • Another survey can be completed after the outbreak has been resolved as a lookback. 
• Facilities will not be cited for inconsistencies between county, state and Federal interpretations of guidance for testing, accepting admissions, and COVID mitigation and prevention strategies.  Any citations of this nature will be reviewed and deleted from public record.

See full document with resources: Stop CMS from unfairly punishing nursing homes and work collaboratively