Unprepared to face pandemic
Report: Nursing homes had ‘persistent’ issues with infection control
WASHINGTON — Before COVID-19 killed thousands of nursing home residents, about 4 in 10 homes inspected were cited for infection control problems, according to a government watchdog report that finds a “persistent” pattern of lapses.
In light of the pandemic, seemingly minor cutting of corners, such as an employee caring for residents while battling a cold, has taken on new significance.
“Warning signs were ignored and nursing homes were unprepared to face a pandemic,” said Sen. Ron Wyden of Oregon, the top Democrat on a committee that oversees Medicare and Medicaid. “There need to be big changes in the way nursing homes care for seniors.”
The report released Wednesday from the Government Accountability Office found that state inspectors who help enforce federal nursing home standards classified the overwhelming majority of violations as not severe, generally meaning there was no actual harm to residents. The federal Centers for Medicare & Medicare Services carried out enforcement actions for 1% of violations classified as not severe from 2013-2017, the report said.
Nursing homes ended up bearing the brunt of the coronavirus outbreak. About 1.4 million people live in some 15,500 facilities in the United States. Most of those people were already at higher risk due to age and medical history, and they also shared dining rooms, recreation areas, bathrooms and sleeping quarters.
The GAO report found that about 40% of the nursing homes inspected in each of the past two years were cited for problems with infection control and prevention.
Looking deeper into federal data for 2013-2017, investigators found a recurring pattern of problems. Data for that five-year period showed that 82% of nursing homes inspected, or 13,299, had at least one deficiency related to infection control and prevention. About half of the facilities had an infection-related deficiency in multiple consecutive years.
“This is an indicator of persistent problems,” the GAO’s nonpartisan investigators said. The agency carries out oversight for Congress.
The types of problems involved such issues as failing to properly wash hands and not isolating sick residents during outbreaks. “Many of these practices can be critical to preventing the spread of infectious diseases, including COVID-19,” investigators wrote.
The nursing homes cited in the report were not identified.
Seema Verma, head of the Centers for Medicare & Medicare Services, said last week that governors should exercise “extreme caution” before allowing nursing homes to reopen to visitors. Verma has announced that CMS plans to name a commission to examine the nursing home response to coronavirus and make recommendations.
The GAO said it plans other reports to independently examine how CMS responded to the outbreak as well as the agency’s oversight of infection control in nursing homes.
The head of the nursing home trade group, the American Health Care Association, has flagged infection control as a priority for the industry.
“We are absolutely committed to a renewed emphasis on infection control,” Mark Parkinson said in a recent interview.
While about 40% of nursing homes nationwide were cited for infection control problems, the GAO found wide differences among states. In 2017, nearly 61% of the inspected facilities in California had a deficiency, while in Rhode Island it was less than 4%.