Untested for Covid-19, Nursing-Home Inspectors Move Through Facilities

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By Anna Wilde Matthews, Wall Street Journal, August 14 2020

More than half the states, including Texas, Pennsylvania and Ohio, don’t require their own inspectors to be tested for Covid-19 before entering nursing homes, despite concerns that asymptomatic visitors could pose a risk to residents.

The federal government said in June that states needed to complete special infection control-focused examinations of the approximately 15,000 federally certified nursing homes by late August, or risk losing some funding. But the Centers for Medicare and Medicaid Services, or CMS, the agency that oversees nursing-home inspections, didn’t require states to test workers who perform site visits.

The Wall Street Journal contacted health regulators in all 50 states to ask about testing requirements for nursing-home inspectors, known as surveyors. At least 26 states don’t require regular testing, though some, including New Hampshire and New Jersey, said they offer it on a voluntary basis. Others, such as South Carolina, Washington and Idaho, are developing new testing programs for inspectors.

“With the increased spread of the virus in Idaho, and surveyors being in and out of nursing homes, it is the responsible thing to do,” said Niki Forbing-Orr, a spokeswoman for the Idaho Department of Health and Welfare. The state knows of two surveyors who have previously tested positive for the virus, she said.

To keep the new coronavirus out, nursing homes since March have been locked down to most visitors.

“All surveyors should be tested because they could potentially bring Covid in,” said Patricia Stone, a professor at the Columbia University School of Nursing. “They’re going from potentially one hot spot to another, and there’s so much community spread.”

Since much of the country began to reopen at the end of May, nursing homes reported an additional 82,209 Covid-19 cases, according to a Journal analysis of the most recent weekly CMS data. The data also show nearly 10,000 nursing-home residents died of the virus from June 1 to Aug. 2, the last day covered in the data.

The Journal’s analysis of the federal data included only nursing homes whose data consistently cleared the government’s data-quality checks and excluded some additional nursing homes that reported more Covid-19-linked deaths than total deaths in any week.

More states, including California, Tennessee and Colorado, are adding testing mandates for those who perform nursing-home surveys. Some state officials say tests are needed to protect the elderly residents.

“It was a no-brainer,” said David Morgan, a spokesman for the New Mexico Department of Health. “People in nursing homes and long-term care facilities are our most vulnerable populations.” In New Mexico, inspectors must be tested monthly, and before they visit a facility.

Some of the states that aren’t regularly testing inspectors, including Texas and Georgia, have seen significant spread of the coronavirus among their populations, and recent cases in nursing homes, according to federal data. The Texas Health and Human Services Commission and the Georgia Department of Community Health both said they were adhering to federal guidance.

“The surveyors are in the facility for a limited period of time, have the appropriate [personal protective equipment] to ensure their safety as well as the safety of the residents and staff,” said Melanie Amato, a spokeswoman for the Ohio Department of Health.

A spokesman for the Pennsylvania Department of Health said the state is working to ensure that inspectors who need testing, or have Covid-19 symptoms, have access to it.

Seema Verma, the CMS administrator, said inspectors wear full personal protective equipment, following recommendations from the Centers for Disease Control and Prevention, and go through nursing homes’ screening protocols. “They’re protected, and the people that they’re around are protected,” she said.

The agency “continues to look at this issue and work with the CDC to evaluate appropriate testing protocols given the activities and potential exposure in a given area,” a CMS spokeswoman said.

The CDC didn’t respond to a request for comment.

Protective equipment might not be enough to prevent spread of the virus from inspectors who might not know they are infected, researchers said. “Of course they should be tested,” said Tamara Konetzka, a professor of health-services research at the University of Chicago. “Surveyors by definition need to be in the facility and observing things . . . . PPE is not foolproof.”

Christopher Weaver contributed to this article.