CMS Administrator Seema Verma’s Remarks as Prepared for Delivery: Updates on Healthcare Facility Inspections in light of COVID-19
(As prepared for delivery - March 23, 2020)
The Centers for Medicare & Medicaid Services – or CMS – develops and enforces federal safety standards across the healthcare system. Our network of federal and state inspectors, as well as private accrediting organizations, physically visit each Medicare-participating health care provider to ensure compliance with these standards – including in 15,000 nursing homes.
Nursing homes are unique because they’re not only health care providers – they are permanent homes for over 1.3 million people.
Unfortunately, infection control and prevention has been a longstanding challenge for nursing homes, and one the Trump Administration has been working to address for quite a while. Last April, we unveiled a five-part approach to ensuring safety and quality in nursing homes, which we’re implementing with great success. Crucially, these reforms have better prepared us to respond to emerging threats to nursing home resident safety, such as that which the Coronavirus poses.
They’ve helped us to demonstrate a rapid responsiveness to the changing situation on the ground. On March 4, we redoubled our infection control inspections in nursing homes and advised nursing homes to screen visitors. Then, on March 13, we directed nursing homes restrict visitation even further, to only allow entry to essential staff. And we’ve joined the CDC in a Task Force dedicated to nursing home safety, which meets daily.
With the CDC telling us, as of this week, that at least 146 nursing homes across 27 states have confirmed Coronavirus cases, it’s these kinds of aggressive actions that will see us through this crisis.
As you may know, a nursing home in Kirkland, Washington, was ground zero for the Coronavirus outbreak in America. According to a CDC report, 81 residents, 34 staff, and 14 visitors also became ill. And tragically, 26 people have lost their lives.
Today, we are announcing the results of our investigation, as well as updated coronavirus-specific guidance and tools for our inspectors designed to keep what happened in Kirkland from happening again.
I’d like to thank my colleagues at the CDC, as well as Governor Inslee and his team. We have worked hand-in-glove to get to the bottom of this outbreak.
After a thorough review, inspectors cited the facility for what’s called “immediate jeopardy:” a situation in which patients are in immediate danger. Specifically, the facility failed to identify and manage sick residents, failed to notify the state health department and the state about sickness among residents, and failed to have a backup plan for when their staff doctor became sick.
To alleviate the acute staffing crisis due to staff illness, the Trump Administration deployed over two dozen Public Health Service clinicians to the Kirkland facility to care for the residents. Unfortunately, this situation is not sustainable, as the Public Health Service clinicians can only be onsite for a limited time because their help is needed elsewhere.
Based on the deficiencies found in Kirkland, CMS is following its protocol for such circumstances: On March 18, we notified the facility of our intent to terminate its participation in federal health programs within 23 days unless it remedies the immediate danger to residents. We required the Kirkland facility to provide us a plan to remove those urgent problems. We will be performing an unannounced inspection soon to verify residents are no longer at immediate risk.
We, along with our federal partners like the CDC – which recently published a report about Kirkland – learned key lessons in Kirkland about how Coronavirus works in nursing homes. We’ve used our experiences in Kirkland to develop a new inspection approach. We’re also learning from the newest data about the virus and relying on longstanding principles of infection control.
As previously announced, CMS and our network of inspectors will continue to focus on infection control and situations of immediate jeopardy.
But beginning today, for at least the next three weeks, we will work with the CDC to identify areas the virus is projected to strike next, and target our inspections accordingly. This will allow us to focus inspections on the most urgent situations, so we’re getting the information we need to ensure safety, while not getting in the way of patient care.
This is an extraordinary step designed for extraordinary times. It would not have been possible without President Trump’s emergency declaration, which allows us to deviate from business as usual to meet the unprecedented demands of this outbreak.
CMS’ Federal surveyors will begin conducting these targeted Infection Control surveys using a revised Infection Control protocol specifically adapted to preventing the transmission of coronavirus.
State survey agencies will be using the same guidance as their federal counterparts, but we recognize that some, who will be needed to fulfill state public health duties, will be unable to perform surveys. Others will be limited in what they can carry out due to limited supply of personal protective equipment. That’s why our targeted approach, which focuses resources on areas that need it the most, is so important.
It’s also the reason for the other major innovation in our announcement today: a voluntary self-assessment nursing homes can perform to ensure they meet federal requirements – like screenings for staff, proper staff hygiene, and precautions for limiting spread of contagious illnesses. These are solemn obligations for nursing homes at all times, but their urgent necessity is only sharpened by the coronavirus outbreak.
The plain fact is that, with Coronavirus spreading and personal protective equipment at a premium, some of our state inspectors can be pulled away by their governors to help with other aspects of the Coronavirus response. Our innovative self-assessment tool will supplement our survey work in cases when inspectors aren’t available, or when a facility is experiencing Coronavirus cases and inspectors can’t enter.
Nursing home residents and their families who want to be sure a nursing home is safe should not hesitate to ask staff directly: “what are the results of your CMS self-assessment?”
The loss of life in Kirkland was a tragedy. This new process seeks to ensure that the tragedy is not repeated elsewhere, while giving nursing homes the space and flexibility they need to care for their uniquely vulnerable residents during this emergency.
In closing, I want to emphasize that safeguarding the health and wellbeing of vulnerable Americans is a responsibility that falls on each and every person with a loved one living in one in a nursing home. Unless you absolutely must go into a nursing home, don’t.
We fully appreciate that maintaining distance from beloved mothers and fathers, aunts and uncles, grandfathers and grandmothers cuts against our every natural impulse to be with those we love in anxious times. Nevertheless, we can spare no effort in the protection of these vulnerable Americans. Thank you.
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