WASHINGTON -- Nearly 26,000 nursing home residents have died from COVID-19, the government reported Monday, as federal officials demanded states carry out more inspections and vowed higher fines for facilities with poor infection control.
Monday's report will add to the national soul-searching about the disproportionately high toll of the virus in nursing homes. It's also likely to set off finger-pointing among federal agencies, state authorities and the industry over who is responsible for making things better. More than 60,000 people in nursing homes got sick as the coronavirus spread rapidly among frail residents.
Medicare and Medicaid Administrator Seema Verma told reporters that hand-washing continues to be a challenge in some nursing homes and that many states — who are charged with determining compliance with federal standards— must double down on inspections. “There is no substitute for boots on the ground,” Verma said.
Her agency noted wide disparities among states in the percentage of homes they have inspected for infection controls since the outbreak accelerated in early March. West Virginia, for example, inspected 11% of its homes, while Colorado inspected 100%. The agency said failure to complete inspections could result in states seeing reduced COVID-19 relief funding.
The numbers showed a sobering toll among nursing home staffers, with more than 34,400 getting sick and nearly 450 dying from the coronavirus.
“This data, and anecdotal reports across the country, clearly show that nursing homes have been devastated by the virus,” wrote Verma and CDC Director Robert Redfield to governors.
Verma said 1 in 4 facilities had at least one COVID-19 case, and 1 in 5 reported at least one death. Nursing homes rated at 1 or 2 stars in the government's 5-star rating system fared worse. About 12,500 of some 15,400 nursing homes had reported as of May 24.
CMS is expecting to post the full data for researchers and the general public later this week. Nursing homes are also being required to report COVID cases to the families of residents. CMS will increase fines for nursing homes failing to comply with longstanding infection control requirements.
A federal watchdog report last month found a “persistent” pattern of infection control problems in nursing homes even before the coronavirus. The Government Accountability Office said that about 40% of the nursing homes inspected in each of the past two years were cited for problems with infection control and prevention.
Although the first wave of the pandemic may be easing in much of the country, that doesn’t mean nursing homes are in any less danger. Experts say in a virus rebound they can again become the stage for tragic scenes of death and despair, as well as a risk for the broader community.
“What is going on in a nursing home can be a barometer for where the virus is,” said Tamara Konetzka, a research professor at the University of Chicago, who specializes in long-term care issues. “You’ve got to be watching out and expecting a lot of cases in that community as well.”
It’s widely agreed that prompt, methodical, ongoing testing of residents and staff is the key to making nursing homes safer, but a White House recommendation for states to test all residents within two weeks failed to produce desired results. A recent AP review found a patchwork of progress, with only a handful of states meeting the goal. Nationwide, about 1.4 million elderly and disabled residents live in some 15,400 facilities.
The nursing home industry says money is one of the main obstacles to widespread testing, particularly to pay for testing of staff, who number more than 1 million people. An industry trade group, the American Health Care Association, estimates it would cost $672 million for a one-time test for all residents and staff in nursing homes and assisted living facilities. And that would not solve the problem, since public health experts recommend ongoing testing.
Mark Parkinson, head of the nursing home association, says the cost of a well-designed national testing program could reach into the billions of dollars.
“It’s very important in the next stimulus bill not to just order testing,” said Parkinson, adding that Congress needs to provide the money as well.
Federal officials at CMS have recommended a one-time test for all residents and staff, as well as weekly retesting of staff. Facilities should retest residents weekly until none test positive. CMS administrator Verma says states should use “extreme caution” before reopening nursing homes to visitors.
Some policy experts are hoping that the loss of life in nursing homes will lead state and national leaders to overhaul policies toward the industry, long a stepchild of the health care system.
“This is not a nursing home problem; this is a health system problem,” said Terry Fulmer, president of the John A. Hartford Foundation, which works to improve care for older adults. “Every system produces the outcome it is set up for. If you set up a system where the sickest and frailest people are in locations that are forgotten about and ignored, where the staff is paid less, why should that surprise anyone?"