By Carlos Alfaro and Darcy Costello
Read the full-series, Discharging Trouble
COLLEGE PARK – As complaints rise throughout the nursing home system in Maryland, state nursing home regulators have a persistent staffing problem and are struggling to keep up.
By the end of 2015, about one in every five positions were unfilled at the Office of Health Care Quality, which is crucial to the regulation and inspection of health care facilities such as hospitals and nursing homes, according to a 2017 fiscal year budget analysis conducted for the Maryland General Assembly. That vacancy level is nearly double from the previous year.
The staffing problems are hindering proper oversight, according to an analysis of the Office of Health Care Quality’s 2017 fiscal year budget. The agency “has faced chronic staffing shortages over the past few years due to the combination of an increased workload, a structural deficiency in positions allotted for survey and inspection activities, and chronic vacancies among surveyor positions,” according to the state legislative analysis.
The OHCQ’s staffing problems are, at the very least, slowing down the agency’s reviews of nursing homes and other entities. A staffing turnover rate of 7.6 percent “impinges on the Office of Health Care Quality’s (OHCQ) ability to fulfill its statutory responsibilities,” according to its budget for the 2016 fiscal year. The update released earlier this year, for the 2017 fiscal year, paints a bleaker picture, saying that “OHCQ indicates it will do little to improve its staffing situation.”
The agency’s response time missed a federal goal set by the Department of Health & Human Services of starting an investigation within 10 days of a complaint alleging actual harm, according to the budget analysis. In 2015 – the most recent year available – it took an average of 34 days to initiate an onsite investigation, which the agency attributed to a hiring freeze, according to the budget analysis.
Alice Hedt, former Maryland state long term care ombudsman, said the vacancies are a concern. “This shortage of one out of five positions not being filled — it’s obviously going to impact their work,” Hedt said.
Christopher Garrett, spokesman for the Maryland Department of Health and Mental Hygiene, said OHCQ made “significant progress” in doing more with less through regulatory efficiency and effectiveness in the past three years. He defended the agency’s budget, saying “staffing at all levels of government could be viewed subjectively.”
“What matters is that OHCQ remains committed to performing the required surveys to hold providers accountable for maintaining appropriate levels of care to Marylanders,” Garrett wrote in an email. The Office of Health Care Quality received 1,083 complaints about nursing homes in the 2015 calendar year. Of those complaints, 122 related to admissions, discharges and transfers.
These staffing concerns come as Maryland’s elderly population continues to grow. In 2010, some 19 percent of the state’s population of 5.7 million was age 60 or older, and this age group will rise to 26 percent by 2030. According to data collected by The Henry J. Kaiser Family Foundation, there were 25,513 residents in certified nursing facilities in Maryland in 2014, up from 24,178 residents in 2013.
The budget documents show the agency also had trouble surveying assisted living facilities. In 2015, the agency surveyed 70 percent of assisted living facilities, fewer than its goal of 80 percent. There were 1,482 licensed assisted living sites in 2015, and the number is expected to grow to slightly over 1,500 in 2016.
Problems with oversight might lead to a rise in unlicensed facilities that can gamble on operating without fear of being caught, according to one expert.
“A lot of these assisted living providers are popping up, and they recognize that it’s difficult and that OHCQ has pretty limited recourses to be able to conduct surveys on a very regular basis with them,” said Anne Hurley, former project director for Long-Term Care Assistance Project at Maryland Legal Aid.
Still, the budget documents paint a more stark picture, saying the Office of Health Care Quality “has faced chronic staffing shortages over the past few years” due to increased workload and shortage of inspectors and surveyors.
The staffing woes are not expected to go down any time soon. The agency’s workforce is old enough that within five years, 51 percent of the workforce will be eligible for retirement. Age is not the only factor in the agency’s staffing problems: Similar opportunities in the private sector pay more than the agency, according to Maryland Delegate Kirill Reznik.
“We have a hard time filling those roles because the individuals who are qualified for those positions can make significantly more money in the private sector,” said Reznik, a Democrat from Montgomery County who chairs the health and human resources subcommittee that oversees the Office of Health Care Quality.
Reznik says that the agency is “losing people to the private sector, companies that the office is supposed to inspect.” Across-the-board vacancies are nothing new to the agency that has about 202 positions overall. The agency is down 52 surveyor positions in the 2016 fiscal year. The deficiency peaked in the 2013 fiscal year with 107 vacancies in the last 12 years.
The agency’s staffing shortage also affects the amount of federal funding it receives. Vacancies in its fiscal department make it harder for the agency to apply for federal funds, and it risks losing federal funds if it can’t meet federal rules, according to the budget analysis. At the state level, the agency’s budget is generally consistent. The agency has a $20.3 million budget allowance for the 2017 fiscal year, a 1.4 percent increase from the prior year.