Maryland, D.C. and Virginia are not mandating COVID-19 tests for the inspectors examining conditions in local nursing homes, public health spokespeople from all three jurisdictions confirmed. The lack of testing for the inspectors, nursing home leaders say, stands in contrast to state and federal testing requirements for nearly anyone entering a nursing home these days.
For the past several months, inspectors were focused on completing federally mandated infection control surveys to evaluate long term care facilities’ responses to the coronavirus pandemic. Some of the inspectors’ findings have resulted in citations and fines for nursing homes found to have inadequate screening, social distancing or sanitizing practices.
Nursing home leaders are worried that inspectors are entering facilities without knowing their COVID-19 status, said Allison Ciborowski, the president of LeadingAge Maryland, a long-term care industry group.
The inspectors work on behalf of the federal government’s Centers for Medicare and Medicaid Services but are employed by state jurisdictions. Ciborowski said CMS hasn’t required or recommended that inspectors be tested. Maryland, Virginia and the District have chosen to follow that lead.
“It’s a concern for our members just because they are really trying to carefully track the spread of the virus,” she told WAMU/DCist. “It seems strange that the agency that is citing nursing homes if they’re not appropriately testing staff is not testing the surveyors that are going in to fight those kinds of things.”
Inspectors may not be required to undergo coronavirus testing, but almost everyone else going in and out of nursing homes is. CMS and state governments regulate how frequently long-term care facilities should be testing staff, residents and regular outside visitors. For much of the summer, CMS required nursing home staff to be tested for COVID-19 every week (in Maryland, weekly testing is still the case).
When inspectors enter facilities, they are expected to comply with temperature checks, answer screening questions, and wear masks, gloves and gowns. Once inside, they walk around the facility, but do not enter sick resident rooms.
Last month, CMS revised its testing guidance, tying the frequency of staff testing to the positivity rate of the county where the nursing home is located. The definition of who counts as staff is still broad: it includes “employees, consultants, contractors, volunteers and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions,” according to the guidance.
Missing from that long cast of characters: inspectors. And while fewer than half of all states are requiring inspectors to get tested despite the omission in CMS guidelines, Maryland, Virginia and D.C. are not.
Spokespeople for the Maryland Department of Health, Virginia Department of Health and D.C. Health pointed to a number of reasons for not requiring tests. Virginia Department of Health spokeswoman Tammie Smith emailed the following list:
- CMS currently has no policy for testing of State Survey Agency staff
- staff wear full personal protective equipment (PPE)
- staff were provided training for donning and doffing PPE
- staff are self monitoring daily
- staff participate in facility screening protocols
- staff have no direct patient/resident contact
- staff are in facilities for a limited amount of time
- staff are practicing social distancing
“Surveyors do not provide direct care and do not enter the rooms of suspected or known COVID-19 positive residents,” said Charlie Gischlar, spokesman for the Maryland Department of Health. DC Health spokeswoman Alison Reeves noted inspectors may get tested for free at the District’s public testing sites, but the agency isn’t requiring them to do so.
Leading Age’s Ciborowski said she hasn’t heard from nursing home leaders who suspect that an inspector may have been infectious while conducting a visit — though if someone is asymptomatic, their illness would likely not show up in a temperature screening or otherwise become immediately obvious. Other states have reported instances of inspectors who were sick with the coronavirus or were extensively exposed to it.
Nursing homes have been the epicenter of the coronavirus outbreak in the region. Nearly half of Virginia’s COVID-19 outbreaks have been linked to long-term care facilities. In D.C., more than 1,000 long-term care residents have been infected. More than 15,000 have caught the disease in Maryland nursing homes and assisted living facilities. (Assisted living facilities don’t undergo the same kind of health inspections as nursing homes.)
Even if local inspectors haven’t been unknowingly sick with the disease, the lack of testing for them is still damaging to morale among nursing home staff, Ciborowski said.
“I don’t think it sends the message that providers and the regulatory agencies are on the same team, when these sets of rules are different,” she said.