The Government Accountability Office (GAO) recommended doing away with limits on visitation and group activities at nursing homes and called for more infection prevention research, training and control as well as staffing solutions in a report issued on Monday.
The government agency shared these and other recommendations for the Department of Health and Human Services (HHS) as nursing homes continue to recover from the pandemic.
GAO breaks down suggestions between actions facilities should continue, initiatives that need enhancement and actions that are no longer relevant.
The only recommendation for discontinuation – that of limiting visitation and group activities – was suggested because it proved detrimental to the physical and mental health of residents, the agency said. Limitations were also ineffective at keeping Covid from entering the nursing homes, the report noted.
“HHS could consider developing evidence-based standards for when, if at all, to implement any limitations on visitation and group activities in future infectious disease emergencies and for how long,” GAO officials said in the report. “HHS could also consider issuing guidance that outlines tools nursing homes can use to enable visitation during an outbreak.”
Six suggestions fell under the enhancement category; a notable recommendation among them being more use of non-monetary enforcement actions and incentivizing infection prevention and control research.
By non-monetary, GAO refers to directed plans of correction from HHS. The suggestion runs somewhat counter to what the industry has seen during the pandemic and from the Biden administration, since its reform initiatives announced last February.
The administration had proposed raising the dollar limit on per-instance penalties for facilities, while opting for a nearly 25% increase to support nursing home health and safety inspections.
While civil monetary penalties tied to infection prevention and control deficiencies were used to encourage nursing homes to swiftly fix deficient practices, such action didn’t help facilities find and correct a root cause, the GAO report found.
“Experts said that surveyors could more frequently use directed plans of correction — a non-monetary type of enforcement action that describes the actions the nursing home is required to take to correct the deficient practices,” GAO researchers said.
The 14 suggestions listed in the GAO report were the result of roundtable discussions among 13 experts. The federal watchdog arm contracted with the National Academies of Sciences, Engineering, and Medicine (NASEM) to ensure a range of perspectives were represented in discussion.
Researchers and infectious disease specialists, nursing home staff, individuals with nursing home oversight and regulatory experience, resident representatives and their families were included in discussions, according to the report.
Officials from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) were interviewed as well for the report.
GAO was quick to point out the suggestions weren’t in any specific rank or order – nor should suggestions be interpreted as endorsements by the entity.
CMS officials did say the agency in June 2020 launched an enforcement program for infection prevention and control noncompliance, which included imposing directed plans of correction, so it makes sense that this suggestion falls under GAO’s enhancement category.
Incentivizing infection prevention and control research is needed, according to the GAO report, because there is simply a lack of research to best evaluate and implement protocols in this setting. Most infection prevention protocols in place now are based on research in the acute care setting.
“The acute care setting is different from the nursing home setting in terms of resources, the population served, and staffing, which makes applying infection prevention and control guidance from acute care settings to the nursing home setting difficult,” GAO researchers said.
CDC officials were supportive of the idea, and noted that increased funding and resources would need to be made available to SNFs and agencies for the endeavor.
Other enhancement suggestions for HHS included: developing staffing solutions, strengthening infection prevention and control training, increasing infection prevention and control technical assistance, and strengthening emergency preparedness.
Continuing actions for HHS included: requiring data reporting to the National Healthcare Safety Network, emphasizing and prioritizing infection prevention and control, prioritizing nursing homes for resources, using strike teams, considering federal flexibilities for future emergencies, and holding stakeholder communication and briefings.
