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New Federal Report Highlights Pandemic Lessons for Nursing Homes

Improved infection control and staffing are among recommendations

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Federal nursing home regulators must do more to prevent staffing shortages in nursing homes and strengthen infection controls to better protect residents after the COVID-19 pandemic, which resulted in more than 185,000 residents’ deaths, a government report found.

The report was aimed at the Centers for Medicare & Medicaid Services (CMS), the agency that regulates Medicare- and Medicaid-certified nursing homes. Investigators found that training and certification requirements for nursing home aides should be reassessed, updated guidance should be given to nursing homes on how to improve infection control and a system should be created to share information on best practices among nursing homes.   

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The report was released Feb. 29 by the Office of Inspector General of the Department of Health and Human Services.  ​​​

“Just because the public health emergency ended doesn’t mean we can go back to business as usual. There were long-standing problems in nursing homes that COVID exacerbated and rightfully brought to the fore,” said Rachel Bryan, the team leader for the study who is a social science analyst in the inspector general’s office, in an interview with AARP.

Bryan noted that now is the time to move from “emergency mode” to “a more reflective mode, think about what happened, face those challenges and try to implement lasting change.”

Nursing homes were not prepared for the pandemic and the report found “monumental and persistent staffing challenges,” as well as issues with infection control, she said.

Nursing home staffing shortages targeted

The agency’s report is the third in a series that examined the pandemic’s impact on nursing homes. This report provides a more in-depth look at the experiences of nursing homes during the pandemic and recommends five steps for improvement. Researchers spoke with administrators from 25 nursing homes.

Nursing homes struggled during the pandemic with staffing shortages because of high rates of turnover and burnout, the report said. They saw low worker morale, high costs of using outside staffing agencies to fill gaps, ineffective infection control practices, noncompliance on the use of personal protective equipment and low vaccination booster rates among staff, the report said.

On a positive note, the report found that nursing homes reported the initial vaccine rollout for residents and staff worked well and they received the rapid coronavirus tests provided by the government without issues.

CMS referred questions about the report to a response that Chiquita Brooks-LaSure, administrator of CMS, provided to investigators. In her response, which is included in the report, Brooks-LaSure suggested that three of five recommendations be removed from the report because the agency had implemented those changes already. She did not agree or disagree with the report’s findings in her response.

Brooks-LaSure wrote that CMS already has issued a proposed rule for minimum staffing requirements in nursing homes. That proposal, issued in September, outlined how U.S. nursing homes would need to meet specific staffing requirements for the first time. 

AARP has said the proposed minimum staffing standard is long overdue and an important step. Federal staffing requirements for nursing homes haven’t changed in decades despite mounting evidence that higher staffing levels are linked to better quality of care for residents, including better COVID-19 outcomes.

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CMS said it will invest $75 million in a federal program for tuition reimbursement and scholarships for people entering careers in nursing homes.

“CMS agrees with the need to strengthen the nursing home workforce, and in fact, has already implemented activities prior to this report (for those actions that are within our scope and authority),” Brooks-LaSure wrote.

The Office of Inspector General said in its report that the recommendations remained.

“While we appreciate the importance of these two actions and support them, neither has taken effect yet,” the report said.

“It’s a good first step, but it’s a very complex and entrenched problem. So we believe that it will take more than this one initiative to improve the nursing home workforce,” Bryan said.

Nancy Harrison, a deputy regional inspector general who worked on the report, said CMS needs to improve the survey process used when Medicare inspects a nursing home. The report found that, among nursing homes with the highest COVID-19 infection rates, more than half of them passed the inspections without any deficiencies.

“The survey process needs to be improved,” Harrison said, stressing that experts in infection control should be consulted.

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