Andy Beshear CABINET FOR HEALTH AND FAMILY SERVICES Eric Friedlander

GOVERNOR
OFFICE OF INSPECTO R GENERAL
SECRETARY

275 East Main Street, 5E-A Adam Mather

Frankfort, Kentucky 406 21 INSPECTOR GENERAL

Phone: (502) 56 4-7963

Fax: (502) 564 -6546

To: Bob Casey, Chairman

U.S. Senate Special Committee on Aging

From: Belinda Beard, BS, RN Director

Division of Health Care

The Division of Health Care (DHC) is the Kentucky State agency that provides oversight of the Long-Term
Care (LTC) survey activities. The LTC scope of activities includes, but is not limited to, recertification
surveys, complaint investigations, enforcement, and Informal Dispute Resolution processes. The
aforementioned activities may also include enforcement processes if harm is identified and cited. These
activities require numerous administrative tasks for CMS data submission and aggregation for quality
review. The DHC has a working relationship with several state agencies as it relates to the LTC survey
process, such as the Ombudsman Office, the Attorney General’s Office, and the Division of Community
Based Services, which adds another layer of LTC work activities.

The DHC struggles to meet the above-mentioned federal workload priorities, while trying to maintain an
adequate and effective workforce. Due to the pandemic, Kentucky has lost 67% of our DHC staff. This
significant staffing shortage prevents us from meeting our CMS survey timeframes. Kentucky struggles
with recruitment and retention for many reasons due to our inability to be market competitive. Review
of the surrounding state agencies and private sector pay rates revealed Kentucky state surveyor salaries
are below market rates by $21,000 dollars per year. CMS and state budgeted monies would need to
increase significantly to allow DHC to raise salaries to meet the market rates. Although Kentucky gave
our state employees an 8% percent pay raise this year, salaries are still below market rate at an average
of $53,906.16 a year.

Exit interviews reveal numerous staff left DHC for better paying positions; some accepted positions with
salaries in the six-figure range. Several staff reported burn out, stating the extended travel and over
time was too burdensome for their health and family life. A few elected to retire early, and others left
out of concern for the potential exposure to COVID-19 while performing surveys.

Sixty-seven percent of our workforce have two years or less of surveying experience, which affects the
quantity and quality of our work product. So training is crucial for these staff, however, at this time,
Kentucky’s five trainer positions are vacant. Although we continue to post positions and conduct
interviews routinely, once candidates are offered the position, they decline citing the low pay. This leads
to our need to re-post more positions, review more applications, and conduct more interviews than we

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have ever had to do before and adds significantly to our daily workload. This also takes time away from
our CMS work duties.

In addition to the DHC’s staffing shortage, our complaint workload and the required percentage of
infection control surveys have increased over the last three years. This increase in workload has
contributed to our inability to effectively address our complaint backlog, and ability to conduct
recertification surveys. Although we have contracted with a surveying agency, they are also experiencing
staffing constraints due to their numerous contracts with other state agencies, preventing them from
meeting our CMS contractual agreement. Working with the contracting company has also caused
additional workload for the state agency related to the quality assurance (QA) of their work product. We
find that our QA process identifies additional information and work that is needed on the part of the
contracting company. This extra work causes delays in our submission of the work product to CMS.

The Kentucky State Agency respectfully suggests that CMS relax the requirement that LTC surveys be
conducted on consecutive days, in order to allow staff a break on the weekends and holidays. In
addition, we suggest that consideration of complaints in the backlog queue, that are over one year old,
be allowed to be taken on the next recertification survey or not surveyed at all due to age. Our
investigations of these have revealed that most facility employees cannot remember the event or the
resident when the complaint is that old, making it nearly impossible to investigate.

The DHC appreciates the Committee’s inquiry and the opportunity to share our struggles with the
Special Committee on Aging.

My Kindest Regards,

Belinda Beard, BS, RN

Division Director