While the U.S. coronavirus death toll continues to rise everywhere, the disease has been particularly deadly to residents in nursing homes.
Centers for Medicare and Medicaid Services data reported 95,515 confirmed COVID-19 cases in nursing homes and 31,782 total deaths, or 33%, as of May 31. According to Kaiser Family Foundation data, more than 50% of COVID-19 deaths in 27 states occurred in long-term care facilities, with the highest at 85% in Pennsylvania.
This is tragic but unfortunately not surprising. A Government Accountability Office report published on May 20 found that from 2013-2017, 82% of nursing homes surveyed had “an infection prevention and control deficiency” in at least one of those four years, and 48% of those nursing homes had persistent problems.
The deficiencies include staff’s inadequate hand hygiene, failure to implement preventative measures such as isolating sick patients during an infectious disease outbreak, and failure to wear personal protective equipment with proper frequency. Though GAO found that 99% of the deficiencies did not harm residents, it seems reasonable to presume that these previously “not severe” deficiencies contributed to the high coronavirus death rate in nursing homes.
The Trump administration took its first steps to prepare nursing homes for COVID-19 in February by issuing new guidance documents and offering payment incentives to use high-output rapid disease diagnosis techniques. On June 1, the administration announced “enhanced enforcement for nursing homes with violations of longstanding infection control practices” for state survey directors.
CMS Administrator Seema Verma said that the administration “is taking consistent action to protect the vulnerable.” She continued, “While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes’ patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”
At that time, approximately 80% of the 15,400 Medicare and Medicaid-certified nursing homes had reported COVID-19 data to CMS. The remaining 20% are required to conduct appropriate infection control surveys by July 31. Those that do not produce the data within 30 days beyond the due date will not receive any of the $80 million in additional funding provided under the CARES Act, and those funds will be given to other states.
Currently, states receive $397 million for oversight surveys and for certifying Medicare and Medicaid providers and suppliers, which includes nursing homes. By law, every nursing home facility receiving funding must submit to an on-site evaluation to ensure it is following federal standards. In early March, CMS asked state surveyors to focus on infection control with additional guidance and protocols to prevent the spread of COVID-19.
Disturbingly, CMS found survey compliance ranged from 11% to 100%, with a national average of 54%. For example, Colorado, Nevada, North Dakota, and Wyoming have surveyed all nursing homes. West Virginia has surveyed the lowest at 11.4%, followed by Idaho at 13.4%, and Virginia at 15%.
Analyzing this early data against CMS’s star-quality ratings, developed to help residents, families, and caregivers compare facilities, CMS found that nursing homes with a one-star quality rating were more likely to have a higher number of COVID-19 cases than those with a five-star quality rating. To prevent nursing homes from relapsing and increase accountability, CMS plans to gradually raise monetary penalties for infection control noncompliance, especially for facilities with past infection control failings.
Nursing home residents may finally get the care they deserve following the GAO report on the lack of infection control and the announcement of enhanced enforcement. That would be a very belated but positive outcome of the disproportionate and deadly impact on the elderly from the COVID-19 pandemic.
Elizabeth Wright is director of health and science policy for Citizens Against Government Waste.
