The federal government on Thursday afternoon updated its Nursing Home Compare database to include individual building-level data on COVID-19 outbreaks, following through on a transparency pledge months in the making.
The Centers for Medicare & Medicaid Services (CMS) incorporated its previously released COVID-19 case and death counts into the consumer-facing tool, allowing family members and researchers to probe individual facilities’ coronavirus status.
The Thursday move also included the release of all nursing home surveys conducted since March 4, when CMS reoriented its entire inspection strategy around targeting infection control violations.
“This national data for nursing homes is unprecedented and constitutes the backbone of a national COVID-19 virus surveillance system,” CMS administrator Seema Verma said on a Thursday press call.
The website now includes an interactive map that provides a count of resident infections and deaths, though it remains separate from buildings’ individual pages on the main Nursing Home Compare site. Researchers and reporters can also download the aggregate data for further analysis.
The data, collected in conjunction with the Centers for Disease Control & Prevention (CDC), initially revealed nearly 26,000 deaths in long-term care facilities from the novel coronavirus, along with about 60,000 total infections, based on reporting from 80% of the nation’s more than 15,000 nursing homes.
With 88% of facilities reporting as of Thursday, those figures have risen to almost 32,000 deaths and more than 95,000 confirmed cases, Verma said, though she emphasized that it was a result of receiving additional data and not a new spike in cases.
“I want to be very clear, though, that this is not an increase of six thousand deaths in a few days,” she said.
Those figures include patients who contracted the disease in a nursing home, but died only after they were transferred to a hospital, CMS officials confirmed.
The Kaiser Family Foundation, which has conducted its own survey of reported COVID-19 cases in long-term care facilities, pegged the death toll at more than 39,000 in the 39 states where data was available. The organization also found nearly 200,000 cases in the LTC setting across 43 states.
The CMS/CDC numbers will rise as more facilities come into compliance with an interim final rule requiring nursing homes to report that data through the CDC’s National Healthcare Safety Network (NHSN) portal. Universal testing efforts under way in many states are also certain to drive the official total upwards.
Moving forward, the Nursing Home Compare data will be updated weekly.
The formal figures represent 97% of the facilities that have reported so far, and Verma cautioned that the early numbers may contain some irregularities that the agency is working to resolve. For instance, buildings may have double-counted cases, while some provided more comprehensive retrospective data than others.
“As with any new program, some facilities are going to struggle as they come on line, and there’s going to be honest errors in data entry,” Verma said.
Individual states have implemented varying degrees of public and private reporting requirements for COVID-19 cases in nursing homes, though pressure from elected officials and resident advocates caused CMS to roll out the mandatory federal reporting program in April.
The initial federal results prompted CMS to implement stricter fines for infection control violations, with individual penalties topping out at $20,000 per infraction for operators with a history of problems in that domain.
Early returns from CMS’s coronavirus-focused inspections revealed persistent problems around basic infection-control protocols such as hand-washing, as well as trouble with appropriately using personal protective equipment (PPE) and separating positive and negative cases within facilities.
That said, Verma generally praised the performance of nursing homes during the crisis, calling the buildings that prevented outbreaks “a very important story.”
“The vast majority of nursing homes across this country didn’t have significant numbers of cases — or didn’t even have any cases, or any deaths in their nursing homes, and I think it speaks to the nursing homes that were more focused on the federal guidelines and the recommendations, and did a good job with implementing those,” she said.
The overhaul to Nursing Home Compare marks the first major change to the database since an October 2019 decision to include a warning icon on facilities with a recent history of citations for abuse. About 5% of nursing home entries on the site have since received the icon.