GAO report finds lapses in infection prevention in 82 percent of nursing homes

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A government watchdog report released on Wednesday found that eight in 10 nursing homes inspected were cited for infection-control problems and there were “persistent problems” when it came to infection prevention.

The report by the Government Accountability Office, which analyzed data from the Centers for Medicare & Medicaid Services from 2013 to 2017, found that 82 percent of nursing homes – over 13,000 in all – had received citations for either cutting corners or failing to implement to correct controls in that time frame.

“Our analysis of CMS data shows that infection prevention and control deficiencies were the most common type of deficiency cited in surveyed nursing homes,” John Dicken, the director of the healthcare team at the GAO wrote in a letter to Sen. Ron Wyden of Oregon, the top Democrat on a committee that oversees Medicare and Medicaid. “Infection prevention and control deficiencies cited by surveyors can include situations where nursing home staff did not regularly use proper hand hygiene or failed to implement preventive measures during an infectious disease outbreak, such as isolating sick residents and using masks and other personal protective equipment to control the spread of infection."

Dicken added: “Many of these practices can be critical to preventing the spread of infectious diseases, including COVID19.”

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Nursing homes are 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.

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An ongoing count by The Associated Press has found that outbreaks in nursing homes and long-term care facilities have killed more than 30,000 people, more than one-third of all coronavirus deaths in the country. New York, as with much of the other grim news from the outbreak, has been the epicenter of deaths in nursing homes with more than 5,000 being reported as of earlier this week.

“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.”

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The GAO report found that about 40 percent 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 percent 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.

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Seema Verma, head of the federal Medicare and Medicaid agency, said this 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.

The Associated Press contributed to this report.