According to the HHS Office of Inspector General (OIG), nursing facilities were not prepared for the pandemic and could not “stem the devastation once it was evident that nursing homes were especially vulnerable.” In “More than a Thousand Nursing Homes Reached Infection Rates of 75 Percent or More in the First Year of the COVID-19 Pandemic; Better Protections Are Needed for Future Emergencies,” OIG reports that, in 2020, more than 45% of residents in most facilities were infected with COVID-19 and only 24 of 15,086 nursing homes in the country (0.2%) did not have a single resident with COVID-19.
Focusing in its Data Brief on the 1,358 nursing facilities that had extremely high COVID-19 infection rates among residents of 75% or more in 2020, OIG finds:
- Resident mortality rates (from all causes) in facilities with extremely high infection rates were more than double the mortality rates in other facilities in the Spring 2020.
- “For-profit nursing homes made up a disproportionate percentage of the nursing homes with extremely high infection rates during both surges” [Spring and Fall 2020] – 77% – although accounting for 71% of nursing facilities.
- “High COVID-19 transmission in a county did not always lead to nursing homes in that county reaching extremely high infection rates. . . . In other words, being located in a high-transmission county did not make it inevitable that a nursing home would have an extremely high infection rate.” This finding totally negates the nursing home industry’s claim that there was nothing facilities could do if COVID-19 was in the community (Also see the Center for Medicare Advocacy’s report “Geography Is Not Destiny: Protecting Nursing Homes from the Next Pandemic”).
Two additional OIG findings are serious indictments of the federal regulatory system. First, OIG finds that many nursing homes with extremely high infection rates were not identified as having infection control deficiencies in their targeted infection control surveys. OIG observes, “This raises questions as to how effective the survey process is in preventing and mitigating the spread of infectious disease in nursing homes.” Second, OIG reports that 95% of the facilities with extremely high infection rates met federal staffing standards – a registered nurse eight consecutive hours per day and licensed nurses 24 hours per day. OIG writes, this finding “may indicate that these requirements are not adequate to keep residents safe from infectious diseases.”
OIG recommends that the Centers for Medicare & Medicaid Services (CMS)
- “Re-examine current nursing staff requirements and revise them as necessary.”
- “Improve how surveys identify infection control risks to nursing home residents and strengthen guidance on assessing the scope and severity of those risks.”
- “Target nursing homes most in need of infection control intervention, and provide enhanced oversight and technical assistance to these facilities as appropriate.”
CMS concurred with OIG’s first and third recommendations, but neither concurred nor disagreed with the second recommendation. It is troubling that CMS does not strongly agree that changes to the survey and enforcement systems are needed.
Jan. 26, 2023. T. Edelman