The top federal official in charge of nursing home regulations on Thursday defended the administration’s response to COVID-19 in long-term care facilities, asserting that outbreaks were frequently the result of poor infection control.
“I think this idea of trying to finger-point, and blame the federal government, is absolutely ridiculous,” Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said on a Thursday call with reporters.
Verma was in particular responding to a question about the view, widely held among nursing home operators and some researchers, that long-term care facilities did not receive sufficient support — such as the provision of personal protective equipment (PPE), priority access to testing, and supplemental staffing — to meet stringent COVID-19 safety measures.
The mechanisms behind the spread of the novel coronavirus in nursing facilities have been center stage over the past week, as CMS released the first wave of national data on infections and deaths in long-term care.
Most recently updated Thursday, the toll currently sits at nearly 32,000 deaths and more than 95,000 infections, figures that will only increase as CMS works the kinks out of its reporting processes and universal testing programs cull more results.
Early academic probes have indicated that a building’s location and the racial demographics of its residents have more to do with the likelihood of COVID-19 cases than its infection-control history or quality ratings, prompting some researchers to criticize the government’s decision to ratchet up fines on providers while the pandemic still rages.
“I think these policies are at best premature, and at worst, probably a little dangerous,” University of Chicago professor R. Tamara Konetzka told SNN this week. “Most of the research that’s been done on quality and the probability of a nursing home having a COVID outbreak, or COVID-related deaths, has shown that there’s actually not much of a relationship with quality.”
In addition, industry leaders have repeatedly argued that without adequately funding routine testing in nursing homes, and providing large quantities of PPE, the federal government isn’t doing its part to fight the coronavirus — or support the space as it tentatively looks to reopen facilities to visitors amid the wider easing of social-distancing rules.
“There are just too many homes out there, and other aging services providers, that are still desperately in need of testing and personal protective equipment,” LeadingAge president and CEO Katie Smith Sloan told SNN last month. “And without those, it is virtually impossible to reopen nursing homes safely.”
Verma emphasized the host of actions that CMS has taken since the start of the pandemic, from working directly with nursing home leadership to boosting reimbursements for COVID-19 lab tests.
CMS has also asserted that there is a connection between prior quality and COVID, citing an early analysis showing that facilities with one star on the federal government’s scale were more likely to have outbreaks than those with five, the top rating.
Verma on Thursday spoke about her experience visiting a nursing home in Florida that had no reported cases, pointing to the property’s strict infection control protocols.
“They did all these different things, and they didn’t have any [cases] in that area,” she said. “It doesn’t mean that Florida wasn’t hit hard. Florida has lots of nursing homes, and yet the numbers were very different.”
The administrator pushed back on the community theory by asserting that even though isolated cases in a nursing home aren’t surprising, a rapid outbreak within a facility could be the result of poor practices.
“What’s concerning is that when we have significant spread, and that significant spread speaks to deficiencies and a breakdown in process,” she said. “The guidelines are very clear for infection control, and they’re not new — whether it’s the flu or the COVID virus.”
Verma also criticized a decision by some governors to mandate the admission of nursing home residents regardless of COVID-19 status.
“I think also some of the policies that governors had in place, forcing nursing homes to take patients coming out of the hospital, didn’t work well,” she said. “That was not appropriate. I think that may have contributed to this issue as well.”
The question of responsibility over those orders has made national headlines this week: Verma sparred in the media with Andrew Cuomo after the New York governor said his state’s policy of mandatory COVID-19 admissions was part of federal guidelines.
“The issue the governor is bringing up — which I disagree with — is that somehow federal guidance said you should put people who are COVID-positive in the nursing home,” Verma said during an appearance on a Fox News Radio show last week.
During the same Thursday call with the media, however, Verma praised the efforts of the industry as a whole, acknowledging that the facilities with cases represent a minority.
“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.
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