HHS-OIG Makes Recommendations to CMS to Better Prepare Nursing Homes for Future Disease Outbreaks
The Department of Health and Human Services Office of Inspector General has published its third and final report on the impact of the COVID-19 pandemic on nursing homes. The report outlines the steps that should be taken to improve preparedness for future infectious disease outbreaks to better protect staff and residents and minimize disruptions.
The previous two reports detailed the devastating impact COVID-19 had on Medicare beneficiaries in nursing homes in 2020 when 2 in 5 residents had or likely had contracted COVID-19. During that year, more than 1,300 nursing homes had extremely high infection rates of 75 percent or more during surge periods, in April 2020 more than 1,000 more Medicare beneficiaries in nursing homes died per day compared to April 2019, and mortality rates increased from 17% in 2019 to 22% in 2020.
The review confirmed that nursing homes faced monumental challenges during the pandemic. There was a significant loss of staff and major difficulties with hiring, training, and retaining new staff members. All nursing homes interviewed by HHS-OIG said they faced staffing challenges with most describing them as significant and ongoing. Many nursing homes tried changing the working environment and providing incentives; however, success was mixed, with some saying that even paying huge salaries wouldn’t have made any difference as there were simply not enough staff available and it would only have resulted in shortages in other nursing homes. The staffing problems meant many nursing homes had to use third-party staffing agencies, which had significant disadvantages – high costs, unfamiliarity with systems and residents, and unreliability.
After the initial challenges of the pandemic were resolved, nursing homes continued to struggle with additional costs, testing protocols, and complying with personal protective equipment requirements. Throughout the pandemic, nursing homes faced challenges with implementing effective infection control measures and opportunities for improvement. One common theme during the interviews was the dire physical, mental, and emotional toll the COVID-19 pandemic took on residents and staff. Residents faced isolation, loneliness, and a decrease in quality of life, and staff had an extreme emotional burden due to them often being residents’ only human interactions.
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Such a terrible situation should not be allowed to happen again. HHS-OIG has recommended that the HHS Centers for Medicare and Medicaid Services (CMS) implement and expand upon its policies and programs to strengthen the nursing home workforce; reassess nurse aide training and certification requirements, incorporate the lessons learned from the COVID-19 pandemic into nursing home requirements for infection control, provide guidance and assistance to nursing homes on how to comply with infection control requirements, and facilitate the sharing of strategies and information to help nursing homes overcome challenges and improve care.
