On June 1, 2020, the Centers for Medicare & Medicaid Services (CMS) reported that the 12,500 nursing facilities (approximately 80% of facilities nationwide) sending data to the Centers for Disease Control and Prevention reported, as of May 24, 2020, that 25,923 residents and 449 staff (totaling 26,372 people) have died of COVID-19.[1] The Kaiser Family Foundation reported a considerably higher number: 39,039 deaths from COVID-19 occurring in nursing facilities in 47 states, as of May 29, 2020.[2]
Large as both numbers are, they are still likely to be understated. Many nursing home residents who die from COVID-19 did not have symptoms of elevated temperature, coughs, or respiratory symptoms and may not have been tested for COVID-19. A study of residents at the Washington State nursing facility, where the coronavirus was first identified, found that more than half the residents who tested positive did not have any symptoms.[3] Other reports have also found that older people may be lethargic, sleep more, stop eating, become dizzy, or become disoriented and unable to speak, but do not have more typical symptoms of COVID-19.[4]
In final rules published in 2016, CMS described infection prevention control as a “critical” issue, with failures in infection control leading to millions of infections each year, hundreds of thousands of residents’ hospitalizations and deaths, and billions of dollars in health care costs. 81 Fed. Reg. 68688, 68808 (Oct. 4, 2016), https://www.govinfo.gov/content/pkg/FR-2016-10-04/pdf/2016-23503.pdf. Strengthening longstanding infection prevention and control standards was a key requirement of the 2016 rules.
Instead of rolling back nursing home regulations, CMS needs to impose meaningful and appropriate sanctions when facilities fail to meet standards for infection prevention and control. Unless the regulatory system treats these essential standards seriously, as the life-and-death requirements they are, we risk seeing repeated loss of residents’ lives.
T. Edelman
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[1] CMS, Nursing Home COVID-19 Data
[2] https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/#stateleveldata
[3] Melissa M. Arons, et al, “Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility,” The New England Journal of Medicine (Apr. 24, 2020), https://www.nejm.org/doi/full/10.1056/NEJMoa2008457?query=featured_home.
[4] Judith Graham, “Seniors With COVI-19 Show Unusual Symptoms, Doctors Say,” Kaiser Health News (Apr. 24, 2020), https://khn.org/news/seniors-with-covid-19-show-unusual-symptoms-doctors-say/.