GAO Report Reveals Alarming Rate of Pre-COVID Infection Control Citations in Nursing Homes

At a time when many nursing homes are struggling with outbreaks of COVID-19, the U.S. Government Accountability Office (GAO) on May 20, 2020 released a report detailing the prevalence of infection prevention and control (IPC) deficiencies in nursing homes prior to the COVID-19 pandemic.  The GAO report was requested by Sen. Ron Wyden (D-OR) and is the first in a series of reports on the topic of infection prevention and control in nursing homes.

The GAO analyzed deficiencies cited from 2013 through 2017 and found that of the roughly 15,000 nursing homes, 82 percent (82%) (13,299 homes) received IPC deficiencies, with approximately 40 percent (40%) being cited during any one year.  The GAO also looked at publicly available data available on the Nursing Home Compare website for 2018 and 2019 and found a similar annual rate of deficiency for infection prevention and control among homes surveyed.

Other findings from the report:

• Nearly half (48%) of the nursing homes that received IPC deficiencies in multiple years received them in consecutive years, with 2,636 homes receiving deficiencies in at least three consecutive years.
• Homes in all 50 states and the District of Columbia had IPC deficiencies cited in multiple consecutive years.
• 99 percent (99%) of the IPC deficiencies cited were cited at a scope and severity level of F (widespread; no actual harm with potential for more than minimal harm that is not immediate jeopardy) or below.
• Nonprofit homes fared better than their for-profit counterparts.
  • For-profit homes accounted for nearly 68% of all homes surveyed during 2013-17 yet only accounted for 60.8% of those homes that did not receive an IPC deficiency. These same homes accounted for 72.3% of facilities cited for IPC deficiencies in multiple years. By contrast, nonprofit homes accounted for 23.5% of homes surveyed and nearly 30% of the homes that did not receive an IPC deficiency.  They accounted for only 19.8 percent of the homes with IPC deficiencies in multiple years.

Future GAO reports will address CMS’s oversight of IPC protocols and the adequacy of emergency preparedness standards for emerging infectious diseases in nursing homes, as well as the Centers for Medicare and Medicaid Services’ response to the pandemic.  While these future reports likely will shed light on the statistics, the rapid spread of COVID-19 in nursing facilities undoubtedly will be accompanied by calls from lawmakers, advocacy groups, and families for CMS to do more to protect nursing home residents.  As a result, homes will want to analyze their own IPC deficiency patterns to pinpoint the problem areas and begin to address them now, whether that be through more intensive staff training, more specific policies and procedures, or some other intervention.  One thing is for certain, however, as a result of COVID-19, IPC will remain at the forefront of the national conversation around nursing home operations for the foreseeable future.