Complications for brand spanking new nursing dwelling employees? CMS and GAO agree on new necessities wanted for an infection prevention professionals
First came the federal requirement that every nursing home must have an infection prevention specialist on staff. Now a government watchdog says minimum training requirements should be set for these vital clinicians – and the primary regulator of care homes agrees.
The Government Accountability Office on Wednesday made three recommendations to the Centers for Medicare & Medicaid Services to improve infection control practices in nursing homes. CMS agreed to the IP training but was less enthusiastic about two other proposals.
In a major report on the physical and mental health of nursing home residents during the pandemic, one of GAO’s key findings was that infection control needed to be improved, including establishing specific standards for the recently mandated position of infection preventer.
CMS agreed, but only said it would “consider” a recommendation to collect human resource data for infection prevention to determine if current human resource needs are sufficient.
The agency asked GAO to withdraw its third recommendation in its entirety: CMS should provide additional guidance in the State Operations Manual for determining the scope and severity of deficiencies related to infection prevention and control.
Any change in training or role definition could be critical, noted Amy Stewart, vice president of education and certification strategy for the American Association of Post-Acute Care Nursing.
Despite recent updates to infection prevention regulations, many facilities still struggle to understand the expectation and who can fill that role, Stewart told McKnight’s Long-Term Care News on Wednesday. She said it’s important to look at a provider’s assessment data to better understand each facility’s unique infection prevention and control needs.
GAO makes no staffing suggestions in the report, said John Dicken, GAO director of health care for public health and private markets.
“The GAO report does not recommend specific staffing requirements, but more information about staffing for this role in nursing homes might help reflect on whether that staffing is adequate and how it might vary between homes with different characteristics of facilities, residents, and staff ‘ he told McKnight’s Long-Term Care News.
Who is an Infection Control Specialist?
The requirements for the infection prevention professional state that the person must be employed at least part-time in the facility. In addition, one or more people can take on the role.
“It could be added to someone else’s job responsibilities. However, facility leaders must ensure that the individual taking on this role has adequate time to complete the required tasks,” Stewart said. “I’ve seen several cases where DNS or DON got the job.
“It may be possible if the facility has a low census that allows that person to focus time and effort on infection prevention and control tasks,” she added. “If the facility has a high census or high volume of infections that need to be tracked and a plan to lower that trend through infection control education, the DNS may not have enough time in its schedule to do so.”
Because of this, Stewart said, facilities would benefit from having more than one person trained in infection prevention and control. She pointed out that CMS offers free online training for infection prevention.
An American Health Care Association/National Center for Assisted Living Infection Prevention Officer training course has specifically trained thousands of individuals to effectively implement and manage an infection prevention and control program at their respective centers. The group said in an email to McKnight that it “will continue to advocate for meaningful resources and policies that benefit the safety and well-being of our residents.”
The Association for Professionals in Infection Control and Epidemiology commended GAO for its e-recommendations in a statement emailed to McKnight’s.
“Too often this role is understaffed or inappropriately filled by someone who is expected to serve as an infection prevention expert and a full-time nurse with other important responsibilities. More than half of infection prevention professionals in nursing homes have no specific training and less than 10% are certified. The COVID-19 pandemic has shown us the outcome of how people in long-term care are treated like second-class citizens in terms of infectious disease risk. It is time we took the expectations of patient care in long-term care to the hospital level.”
General deterioration in health
The report was part of a mandate from the CARES Act, which gives GAO oversight of the federal pandemic response. GAO reviewed documents from CMS and the Centers for Disease Control and Prevention and analyzed the health records of CMS residents from 2018 to 2021. It also interviewed CMS, CDC, state survey agencies, and nursing home officials from eight states, who based on various factors such as geographic origin were selected location.
Broadly speaking, GAO analysis of CMS data reported by nursing homes showed that seven of the eight key indicators of patient mental and physical health declined at least slightly in 2020, the first year of the pandemic, compared to previous years.
“I’m not surprised at the worsening of depression and weight loss during the pandemic,” Stewart said. “Many residents suffered from social isolation due to the restrictions imposed by the pandemic. Fear of spreading COVID-19 to vulnerable residents led to visitor restrictions that were beyond the control of facility leaders.”