Health officials say the state is making progress on reducing a significant backlog of nursing home inspections, with more than half of facilities having received an inspection within the last 16 months.
But with some facilities being more than four years behind schedule for an inspection, advocates and lawmakers fear that some of Maryland’s seniors may be languishing in unsafe living conditions while the state works through its backlog.
“How do we hold owners of nursing homes accountable for the care in the places where these folks are staying?” asked Bruce Hartung, president of the Maryland Continuing Care Residents’ Association. “Without inspections, we simply have no idea how these folks are living — and in what conditions they are living.”
At issue is a years-old backlog of state inspections of the state’s 220 nursing homes as required by the U.S. Centers for Medicare and Medicaid Services. The backlog has spanned administrations and was exacerbated by the COVID-19 pandemic.
But Maryland ranks second to last in the nation when it comes to timely inspections of nursing homes, with average inspection lag of 2.44 years compared to the national average of 0.97 years, according to StarPro, which tracks data on nursing homes across the United States. Maryland falls behind only Alabama, which has an average lag of 3 years.
The state Department of Health has been struggling to catch up on those inspections since, with some facilities not receiving an annual inspection for four years or more, according to CMS data, though state officials note that the federal data may lag by a couple months.
Meanwhile, lawmakers and senior advocates worry that seniors could be facing unsafe living conditions without oversight or knowledge of state officials, and they passed legislation this session in hopes of keeping better tabs on the issue.
“These are the most vulnerable people in our population,” said Sen. Benjamin Kramer (D-Montgomery). “And nobody is putting eyes on the nursing home to ensure that these seniors are being properly cared for.”
Lawmakers passed Senate Bill 376, sponsored by Kramer, to boost the reporting requirements on the health department, so it will provide more frequent updates as it works through the inspection backlog.
Under SB376, which is currently on the governor’s desk, the department will need to start providing quarterly reports updating lawmakers on the progress of nursing home inspections throughout the state. The bill also prompts the Office of Health Care Quality to report to local jurisdictions every six months on the progress of inspections in their individual counties.
The nursing home inspection backlog was a hot topic throughout session.
Dr. Nilesh Kalyanaraman, deputy secretary for the health department on public health, told lawmakers that the agency is making progress on the backlog, though he admitted there is still work to be done.
He said during a January briefing on the issue for the Senate Finance Committee that the estimated time to “catch up” on inspections will take about two more years, as the department has needed to train staff to conduct the inspections. Each inspection can take about a week to conduct.
In written testimony on SB376, the health department reported that as of March 31, there were 130 nursing homes out of a total 220, or 59%, that had an annual inspection conducted in the previous 16 months, the maximum time allowed by federal guidelines. That’s an improvement from June, when the rate of annual inspections conducted within 16 months was just 21.2%, according to the department’s testimony.
Hank Greenberg, AARP Maryland state director, said that uninspected nursing homes can result in lower quality of care for seniors, who may not have a strong support system to help advocate for themselves against mistreatment or even abuse.
“This can result in preventable injuries, a decline in overall resident well-being, and really contributes to the fact that their could be abuse and neglect that don’t rise as quickly as they should,” he said. “And keeps people from being able to know that things will be addressed.”
A group of nursing home residents are already suing the Department of Health for neglect they allegedly experienced in living facilities, citing the backlog of nursing home inspections as a contributing factor to their experience.
The plaintiffs have mobility-related disabilities and rely on nursing staff for moving around the facility, eating, and personal hygiene. The lawsuit alleges that residents were often left unattended for extended periods, leaving them isolated from community events or sometimes left in soiled clothing for hours, among other concerns outlined in the lawsuit. The nursing homes cited in the lawsuit had not had an inspection in years, some as far back as 2020, according to the suit filed last year.
SB376 was amended throughout session, and Greenberg and Hartung would have preferred the original version of the bill, which would have allowed counties to sign a memorandum of understanding with the health department to take over on inspections for nursing homes, freeing up state resources to work on the remaining backlog.
The initial version of the bill was based on a previous agreement between Montgomery County and the state that expired in 2021, which allowed the county to keep up with timely inspections. The original language in SB376 would have allowed other counties to request the chance to do the same.
The department opposed that version of the bill, saying it would actually cost the state more money to let counties conduct inspections and would create other complications. Supporters of the legislation disagreed, but the bill went through a series of amendments before it was struck out during conference committee and rewritten to the new reporting requirements.
“When you can’t get the inspections done, what are your alternatives?” Hartung said. “It [reporting requirements] is a step forward … But we know that they’re not getting done, so the question is what kind of teeth will there be in that reporting?”
But both Hartung and Greenberg still believe that the new reporting requirements will help keep tabs on the department as it works through the backlog of nursing home inspections.
“We obviously need that reporting,” Greenberg said. “I’m sure that some of those reports will be responses to complaints that have been alleged … There’s a lack of accountability without these reports that could lead to increased risks of neglect and abuse and most importantly, substandard care.”
Maryland Matters is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Maryland Matters maintains editorial independence. Contact Editor Steve Crane for questions: editor@marylandmatters.org. Follow Maryland Matters on Facebook and X.
