Dozens of state health surveyors have been visiting nursing homes in recent months to ensure infection control standards are followed during the coronavirus pandemic, at times fining the facilities for insufficient testing of staff and residents.
Those surveyors, however, are not required to be tested for COVID-19, the illness caused by the virus, raising concerns at the facilities that are filled with vulnerable seniors.
“We have long advocated for the state to require the testing of health care inspectors, the same way they require testing of those who provide the health care,” said Joseph DeMattos Jr., president of the Health Facilities Association of Maryland, which represents some of the centers.
“They are going to multiple centers,” he said, “at the same time we are telling operators to discourage employees from working at more than one center.”
Nursing home and assisted living residents represent more than half of the deaths in Maryland from the virus. There have been more than than 15,000 cases and more than 2,100 deaths among residents and staff of nursing and assisted living facilities.
State officials have worked with nursing homes and other senior living facilities to ensure they follow proper federal guidelines for residents' safety. While state inspections were delayed until late April due to a lack of sufficient protective gear in the early weeks of the pandemic, all of Maryland’s 226 nursing facilities have since been inspected.
More than 50 facilities were fined for violating state and federal rules requiring weekly testing of residents and staff, according to records through Sept. 4 provided to The Baltimore Sun from the state Department of Health. A handful have been fined more than once.
Most fines were $250, but the dollar amounts rose into tens of thousands of dollars for more serious issues. A handful were fined hundreds of thousands, but those facilities had other infection control issues. Several facilities with larger fines have disputed the surveyors' findings.
Charles Gischlar, a health department spokesman, confirmed the surveyors are not tested by the state.
The U.S. Centers for Medicare and Medicaid Services “does not require COVID-19 testing of state surveyors,” Gischlar said, referring to the federal agency that provides funding to many nursing homes and requires the infection control standards. That agency recently further relaxed nursing home visitation guidelines.
The state currently employs 56 surveyors for nursing homes, including 17 surveyors completing their first year of training who must be certified before working independently, according to Gischlar.
He said the Office of Health Care Quality, the health agency that conducts the inspections, follows rules for everyone entering the nursing facilities.
“Like all Maryland state employees, OHCQ surveyors are screened upon entry to the office,” he said. "Additionally, surveyors comply with the screening requirements of facilities when they go on site for surveys.”
The department would not disclose whether any surveyors had self-reported positive tests, citing “patient confidentiality.” The numbers of residents and staff who test positive, however, are counted on a public state website.
Del. Karen Lewis Young, a Frederick County Democrat who sponsored a patients' bill of rights law that passed last year, said the state has shown a lack of balance at long-term care facilities when it comes to regulations.
On one hand, she said, the state has restricted visits from families of residents throughout the pandemic, and the isolation has been exceedingly hard for many seniors, perhaps more so those with dementia.
On the other, she said, those conducting inspections can come and go from several facilities with documented cases and not be tested even as officials enforce testing for staff.
DeMattos noted that the state stopped paying for testing for nursing home residents and staff in mid-August. While the $40 to $100 cost of tests is largely covered by public and private insurance for residents, payments for staff tests are coming out of the facilities' budgets or grants.
Young pointed out that many people with COVID-19 infections are asymptomatic and will not be effectively screened out at the gate.
“The reality is most of the cases getting into long-term care facilities, assisted living facilities and nursing homes, are coming from the outside, from people who work there," Young said. “The staff is tested weekly, so anyone else coming in should be tested as well. This is so contradictory.”
The surveyors, she said, could be putting residents at risk, as well as themselves.
Young said she already planned to pass on a list of “best practices” she has compiled based on her research to the state health department, and she plans to ask why the department is not testing the surveyors.
“If they are going to have stricter rules for long-term care facilities than virtually all other businesses and establishments," she said, "then their own employees ought to be held to the same standards.”