Centers for Medicare & Medicaid Services (“CMS”) wants surveyors to add extra attention and increase oversight in nursing homes regarding the quality of care and quality of life for residents.

On November 12, 2021, the Quality, Safety & Oversight Group at CMS issued a memorandum entitled “Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes” (“CMS Survey Memo”) that announced the renewed CMS efforts to increase oversight in nursing homes. The CMS Survey Memo also announced adjustments to focus infection control surveys and the backlog of recertification surveys.

Resident Health and Safety Concerns

CMS stated that, due to the limitations of oversight during the public health emergency and changes in how some nursing homes may have operated, it is very concerned about how residents’ health and safety have been impacted. CMS is specifically concerned about:

  • Increased weight loss;
  • Pressure ulcers;
  • Abuse or neglect; and
  • Other quality of care and quality of life issues.

Three Quality of Life and Quality of Care Focus Areas

CMS Survey Memo instructs surveyors to specifically review and focus additional attention on the following three areas:

1) Surveying for Nurse Competency

CMS cautions surveyors that it did not waive 42 CFR § 483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.

CMS Survey Memo alerts surveyors to pay additional attention to compliance with the requirements for nursing services at 42 CFR § 483.35, which states, “The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with the facility assessment required at §483.70(e).”

An important component of competency is the ability to identify and address a resident’s change in condition. CMS asserts that these competencies are critical in order to identify potential issues early, so interventions can be applied to prevent a condition from worsening or becoming acute. According to CMS, without these competencies, residents may experience a decline in health status, function or need to be transferred to a hospital.

The citation for nurse competency is F-Tag 726, which was cited 445 times in calendar year 2020 and 351 times so far in calendar year 2021.

2) Inappropriate Use of Antipsychotic Medications

CMS red-flagged the inappropriate use of antipsychotic medications as an area of concern related to quality of care. Under 42 CFR § 483.45(d), nursing homes are required to ensure that each resident’s drug regimen is free from unnecessary drugs. CMS Survey Memo calls for surveyors to continue to focus their efforts on identifying the inappropriate use of antipsychotic medications and emphasize non-pharmacologic approaches and person-centered care practices.

3) Quality of Care Areas: Unplanned weight loss, loss of function/mobility, depression, abuse/neglect or pressure ulcers

CMS directs that surveyors should assess other care areas where residents’ health and safety may be at increased risk, such as unplanned weight loss, loss of function/mobility, depression, abuse/neglect or pressure ulcers. It calls for surveyors to use the appropriate critical element pathways to thoroughly investigate these areas to ensure any non-compliance is identified and subsequently corrected.

Effective Date

These surveyor changes are effective immediately.

Practical Takeaways

  • Nursing homes need to train and refocus efforts on staff’s ability to identify and address a resident’s change in condition.
  • Nursing homes should audit and monitor the use of antipsychotic medications.
  • Nursing homes need to quickly address and work to prevent unplanned weight loss, loss of function/mobility, depression, abuse/neglect or pressure ulcers.