GAO Report Shows Residents’ Conditions Worsened on Seven of Eight Key Indicators in 2020
In a performance audit, the Government Accountability Office (GAO) finds that in seven of eight key indicators of nursing home residents’ mental and physical health, residents declined in 2020, the first year of the pandemic, and that in 2021, residents declined in six of the eight indicators. Residents declined in both years in depression, taking antipsychotic medications, taking antidepressant medication, unplanned weight loss, incontinence, and pressure ulcers.
As of April 2022, according to data from the Centers for Medicare & Medicaid Services (CMS), “about 40 percent of nursing homes went at least 16 months without receiving a standard survey.” Pre-pandemic, 95% of facilities had had a standard survey in each of the prior two years.
Turning to infection prevention and control (IPC), the GAO reports that the severity of the IPC deficiencies was higher during the pandemic. In a 2020 report, the GAO found that 99% of IPC deficiencies cited between 2013 and 2017 were classified as no harm. During the pandemic, in 2020 and 2021, 8% of IPC deficiencies were classified as actual harm and 4% of IPC deficiencies, as immediate jeopardy.
Seven of eight state survey agencies told the GAO that facilities’ persistent IPC challenges “were rooted in staffing challenges, including staffing shortages and high rates of staff turnover.” Turnover “made it difficult for a home to ensure that new or temporary staff are trained in IPC.” Three state survey agencies told the GAO that “while nursing homes typically do in-service training for their own permanent staff, they may not have had the time or resources to provide the same training to temporary staff during the pandemic, including staff from nurse staffing agencies.”
While the GAO describes actions taken by CMS to strengthen infection prevention and control, both before and during the pandemic, it suggests that CMS strengthen infection prevention and control oversight by
- establishing minimum infection preventionist training standards (so that facilities know which training programs are adequate and so that infection preventionists have the necessary skills);
- collecting (through the Payroll Based Journal System) and using infection preventionist staffing data (to assess whether CMS’s requirement for a part-time infection preventionist is sufficient to address infection risks in residents and staff and “to compare the relationship, if any, between IPC deficiencies and infection preventionist staffing levels”); and
- strengthening infection prevention and control guidance (by providing infection preventionist examples in Appendix PP)
October 13, 2022 – T. Edelman
 GAO, COVID-19 in Nursing Homes: CMS Needs to Continue to Strengthen Oversight of Infection Prevention and Control [hereinafter COVID-19 in Nursing Homes], GAO-22-105133 (Sep. 2022), https://www.gao.gov/assets/gao-22-105133.pdf
 Id. 18
 COVID-19 in Nursing Homes 15-16
 Id. 19
 Id. 27-32