More Than a Thousand Nursing Homes Reached Infection Rates of 75% or More in the First Year of the COVID-19 Pandemic – Better Protections Are Needed for Future Emergencies

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare   

You read that correctly.  On January 19, 2023, the OIG posted this 40-page report.

Almost every American has been affected in some way by the COVID-19 pandemic. By the end of 2020, COVID-19 had spread throughout the United States. The COVID-19 pandemic has been particularly devastating for Medicare beneficiaries in nursing homes, which is why OIG embarked on a three-part series of evaluations focusing exclusively on the nursing home experience during 2020. The first report in this series focused on beneficiaries and found that 2 in 5 Medicare beneficiaries in nursing homes either had or likely had COVID-19 in 2020. Some Medicare beneficiaries in nursing homes seemed to be at greater risk than others. Specifically, Black beneficiaries, Hispanic beneficiaries, and Asian beneficiaries were more likely than White beneficiaries to have or likely have COVID-19. In addition, overall mortality for Medicare beneficiaries in nursing homes increased by almost one-third in 2020 from the 2019 level.

This is the second report in the series and builds on the first OIG report by focusing on nursing homes themselves. It looks at the extent to which they had residents who were diagnosed with COVID-19 or likely COVID-19, and the characteristics of nursing homes with extremely high infection rates. The third report will feature specific challenges nursing homes faced and the strategies they used to deal with them.

For the health and safety of residents, nursing homes must be prepared to face current and future health emergencies. Understanding how the COVID-19 pandemic has affected nursing homes can help the Centers for Medicare & Medicaid Services (CMS), Congress, and other stakeholders learn from what has happened and inform their decisions as they strive to improve care and better protect residents.

Here are the key takeaways from this OIG review:

  • Nursing homes had a surge of COVID-19 cases during the spring of 2020 and a greater surge during the fall, well after they were known to be vulnerable.
  • More than 1,300 nursing homes had extremely high infection rates—75 percent or more— during these surges. For-profit nursing homes made up a disproportionate percentage of these homes.
  • Nursing homes with extremely high infection rates experienced an average overall mortality rate approaching 20 percent— roughly double that of other nursing homes.
  • High COVID-19 transmission in a county did not always lead to nursing homes in that county reaching extremely high infection rates.
  • Significant changes are needed to protect residents and better prepare for future health emergencies.

Let those 5 takeaways sink in for a few minutes.

These findings make clear that nursing homes in the United States were not prepared for the sweeping health emergency that COVID-19 created. Nor were they able to stem the devastation once it was evident that nursing homes were especially vulnerable. The need for improvement is clear. For the health and safety of residents, nursing homes must be prepared to face current and future health emergencies. The administration has announced a major initiative to improve safety and quality of care in nursing homes. The findings in this report lend urgency to this initiative as well as the need to reform some areas of longstanding concern, including staffing and oversight. We recommend that CMS, as it supports the administration’s initiative, take the actions cited below.

  • 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 in most need of infection control intervention, and provide enhanced oversight and technical assistance to these facilities as appropriate

I strongly encourage you to share and review this entire OIG report with your team and colleagues.  This is a significant report, to be sure.  We also need to watch for the 3rd report in this series.  I’ll post that when it’s available.

[The link to my blog on OIG’s first report is here.  The title of the June 22, 2021 report is COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020.]