The federal government’s top Medicare official on Thursday expressed grave concerns about the rising number of COVID-19 cases in nursing homes, citing growth in community spread and widespread evidence of lingering infection control problems at facilities across the country.
“We are deeply concerned about the situation that we are seeing in nursing homes,” Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said on a conference call with nursing home operators.
Federal data, collected through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN), is currently showing about 12,000 new nursing home cases per week, Verma said — exceeding the earlier weekly peak of around 11,000, and far surpassing the recent cycle low of 6,319 at the end of June.
All told, the federal data effort tallied 45,958 COVID-19 deaths in nursing homes since CMS and CDC began requiring data collection in mid-May, with more than 177,000 confirmed cases and over 109,000 suspected positives. These figures are almost certainly undercounts given the federal government’s inability to require retroactive reporting to the start of the crisis.
To help combat the challenges of containing COVID-19 in SNFs, the Department of Health and Human Services (HHS) announced last month that it would be sending point-of-care testing devices to all SNFs in the country. But due to supply constraints as the test production ramps up, SNFs in hotspots received first priority, with 600 facilities getting the first round of devices.
“We will have point-of-care [devices] to every nursing home with a CLIA waiver by the end of September,” HHS Assistant Secretary for Health Admiral Brett P. Giroir said in a media call on Thursday.
But while Verma acknowledged that the gradual rollout of point-of-care testing devices and nagging shortages of personal protective equipment (PPE) have represented challenges for nursing home operators, she pointed to unsettling problems uncovered by federal strike teams and Quality Improvement Organizations (QIOs) on the ground.
“This is not just a testing issue or a supply issue, and our deep concern is that even in nursing homes that are doing testing on a regular basis, that we are still seeing significant spread — and so even with our commitment to do more testing, to ensure you have the supplies that you need, our concern is that that’s not going to necessarily completely address the problem,” Verma said.
Those issues include basic infection control missteps, from a lack of proper hand-washing techniques to problems with donning and doffing PPE, CMS chief medical officer Dr. Lee Fleisher noted on the call.
Some properties have also had difficulty maintaining proper distancing between employees during meals, given the small size of break rooms, and Fleisher repeatedly hammered the need for alcohol-based hand sanitizer dispensers to be distributed throughout facilities.
“What we are seeing are significant deficiencies in infection control practices,” Verma said. “A lot of your management seems to be very attuned to the requirements and the guidelines. These are long-standing guidelines that we’ve had in place. Unfortunately, what we’re seeing on the ground is that some of the translation to frontline staff — sometimes that there are issues there.”
CMS has cracked down on infection control through multiple avenues during the COVID-19 crisis, including increased fines and targeted infection surveys for all facilities across the country.
As early as late March, CMS found that 36% of facilities were not following hand-washing protocols, and 25% showed evidence of improper PPE use.
“Both of these are long-standing infection-control measures that all nursing homes are expected to follow per federal regulation,” CMS warned at the time. “CMS is continuing to conduct targeted infection control inspections to ensure nursing homes are prepared to confront COVID-19 and keep their residents safe.”
That said, only 2% of nursing homes inspected through June 24 received any infection control citations, according to an analysis from the Center for Medicare Advocacy, with less than 1% receiving fines.
“These data are simply not plausible during the COVID-19 pandemic, especially when infection control deficiencies were the most commonly-cited deficiencies before the pandemic,” the Washington, D.C.-based beneficiary advocacy group concluded.
The CMS officials on Thursday urged operators to redouble their infection-control efforts on the front lines through repeated training, and fostering a culture where calling out failures is encouraged.
“I’m asking you all to really double down on those practices,” Verma said.
But as she has in the past, though, Verma indicated that she views the agency’s role in overseeing nursing homes during the COVID-19 crisis as largely collaborative.
“We are here to help you and support you,” she said. “This isn’t a time of fines and being punitive, it is a time … to be problem-solvers. I want you to know that whatever you need, we are here to help you on any level — whether it’s staffing, whether it’s supplies, whether it’s testing, whether it’s just technical assistance. We’re here to get you whatever you need.”