Why Oregon’s nursing home inspection unit is understaffed, overburdened

Since 2020, Oregon’s nursing home inspection team has been budgeted for 47 positions but has never been staffed at that level, a fundamental cause of its stubborn complaint backlog and inspection delays, state officials said.

Its average vacancy rate during that period was 25%. Officials blame the vacancies on high turnover, lengthy training to certify new inspectors and uncompetitive pay.

From January 2019 through November 2024, for example, the unit hired about 38 surveyors. But 27 surveyors resigned from the survey unit in the same timeframe, agency officials said.

Of the 38 surveyors on staff as of November, eight had been hired within the last eight months. Once hired, it takes nine months for a surveyor to be trained and pass the minimum qualification test, and up to six months more before they can be fully independent in the survey process.

Corissa Neufeldt, deputy director of safety and regulatory oversight for the Department of Human Services’ Office of Aging and People with Disabilities, said the agency can’t ask the Legislature for additional positions when it can’t fill the slots it has.

Since she was hired in 2023, she said the agency has been advocating for higher nurse surveyor compensation and it plans to seek approval to negotiate higher salaries from the state board that administers collective bargaining with unionized workers.

“If we can get our existing positions filled, then we will be in a better position to meet the CMS priority requirements of timely recertification of facilities as well as timely response to our complaints,” she said.

At least one of the members of each survey team that performs an annual comprehensive annual inspection must be a registered nurse. Nurse surveyors don’t earn any more than non-nurse surveyors, and their pay didn’t stack up against similar nursing jobs in the public or private sector, officials told congressional investigators in December 2022.

According to state compensation data, surveyor annual salaries in Oregon range from $66,900 to $102,600. Public health nurses in the state, meanwhile, have a salary range topping out at $130,560, and registered nurses in general earn an average of $116,871.

In the meantime, the agency in December began the process to hire a third-party contract surveyor to help it work through its backlog of complaints. A 2023 congressional report suggests the nationwide shortage of qualified surveyors means states have little leverage to negotiate prices and often receive few responses to their solicitations.

Peter Gartrell, who led a congressional investigation for then-Sen. Bob Casey, Jr., a Pennsylvania Democrat who chaired the Senate Special Committee on Aging, said both federal and state policymakers have known for years that nursing home survey units around the country are understaffed and overstretched. The Obama, Trump and Biden administrations all cited the widespread problems in their annual budget requests, he said, but Congress has not allocated money to address the problem.

As a result, federal oversight funding has stayed essentially flat at 80 cents per day, per resident, for the last decade, he said.

Gartrell said surveyors have demanding, underpaid jobs in stressful environments, leading to frequent burnout. They work long hours, travel extensively, and spend their days interacting with residents who are often very sick and living in substandard conditions.

“It’s part police officer, part health care worker, part food inspector,” he said. “It’s a very antagonistic job.”

The Biden administration, in its final budget proposal, recommended $492 million for survey and certification programs, up 21% from two years ago. It also recommended establishing future funding to keep up with inspections and complaints.

But with President Trump and congressional Republicans making budget cuts a top priority, the prospects for an increase in federal spending on nursing home oversight are dim, Gartrell added.

“What I’m concerned with is that we as a society are relying on guardian angels to carry out these inspector jobs that not a lot of people want to do,” he said. “Until we make the investments necessary to have an adequately staffed nursing home inspections system, I don’t know how you’re going to enforce the rules on the books.”

– Ted Sickinger is a reporter on the investigations team. Reach him at 503-221-8505, [email protected] or @tedsickinger

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