On March 4, 2020, the Centers for Medicare & Medicaid Services (CMS) suspended non-emergency inspections of health care facilities[1] and on March 20, CMS limited surveys to two types: targeted infection control surveys and complaint/facility-reported incidents triaged as immediate jeopardy.[2] Three months later, CMS released infection control survey data for 5724 nursing facilities that were conducted during the COVID-19 pandemic. These data show a dramatic and implausible decline in infection control deficiencies. Less than three percent of infection control surveys since March cited an infection control deficiency and 161 of 163 of the deficiencies (cited in 162 facilities) were classified as causing residents “no harm.” Even if some additional deficiencies were cited but are not publicly reported because the facilities have appealed them, the number of reported deficiencies is startlingly low.
Infection prevention and control is a longstanding, serious problem in nursing facilities. The General Accounting Office reported in May 2020 that between 2013 and 2017, 82 percent of nursing facilities nationwide were cited with one or more infection control deficiencies, including 48 percent of facilities with infection control deficiencies cited in multiple consecutive years.[3] Kaiser Health News has reported that infection control is the most commonly cited deficiency in nursing facilities, but that most infection control deficiencies are cited at such a low level of severity that financial penalties are not imposed.[4]
While no national data were available for three months, media at the state and local level had begun to analyze infection control surveys.
An analysis of 35 of 79 infection control surveys conducted in New York City found that in 25 facilities where more than 600 residents had died from COVID-19, no infection control deficiencies were cited.[5] One New York City nursing facility had a second infection control survey, following families’ complaints about the spread of the virus. Neither survey cited a deficiency, although 54 residents in the 227-bed facility had died of confirmed or presumed COVID-19.
In Kentucky, 154 of Kentucky’s 285 licensed nursing facilities, “including facilities that have reported some of the highest number of cases,” had infection control surveys. Kentucky cited just two facilities with infection control deficiencies (both involving only problems with face masks).[6] In 2019, 102 Kentucky nursing facilities were cited with an infection control deficiency. If the same percentage (36 percent) of facilities received an infection control deficiency during the focused infection control surveys as in 2019, approximately 55 facilities would have been cited with infection control deficiencies. Two hundred thirty-nine Kentucky nursing home residents and two staff members have died of COVID-19, reflecting 60 percent of Kentucky’s COVID-19 deaths.
The limited number of facilities cited with infection prevention and control deficiencies during the focused infection control surveys cited in these reports is similar to the findings of the Center for Medicare Advocacy. Analyzing 171 infection control surveys conducted between late March and late April 2020, which CMS sent to advocates, the Center found that 76 percent of the surveys did not cite any infection control deficiencies and that most of the deficiencies that were cited were labeled “no harm.”[7] Twelve of the 20 states with infection control surveys (Alabama, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, and Texas), with 73 surveys (43 percent of the infection control surveys conducted), did not cite any infection control deficiencies.
Finally, on June 4, 2020, CMS released the results from 5724 targeted infection control surveys, out of the more than 8,300 infection control surveys completed by CMS and state inspectors since March 4, 2020.[8] Analysis of the data released by CMS indicates that only a very small fraction of facilities, 2.83 percent, received deficiencies for infection control.
Nursing homes are the epicenter of the current coronavirus pandemic, accounting for almost 40 percent of coronavirus deaths, as of June 2, 2020.[9] It is not possible or believable that the infection control surveys accurately portray the extent of infection control deficiencies in U.S. nursing facilities.
The Center for Medicare Advocacy analyzed the deficiencies and has issued a full report. For example, the Center identified the number of infection control deficiencies cited in the 30 states that cited such deficiencies.
To read the full report, see: https://medicareadvocacy.org/wp-content/uploads/2020/06/Infection-Control-Surveys-Report.pdf
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[1] CMS, “Suspension of Survey Activities,” QSO-20-12-All (Mar. 4, 2020), https://www.cms.gov/files/document/qso-20-12-all.pdf.
[2] CMS, ‘Prioritization of Survey Activities,” QSO-20-20-All (Mar. 23, 2020), https://www.cms.gov/files/document/qso-20-20-all.pdf.
[3] Government Accountability Office, Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic (May 20, 2020), https://www.gao.gov/assets/710/707069.pdf. This report was discussed in CMA, “GAO on Infection Control Deficiencies in Nursing Facilities Before COVID-19 Pandemic: ‘Widespread,’ ‘Persistent,’ ‘Ignored’” (CMA Alert, May 21, 2020), https://medicareadvocacy.org/gao-widespread-snf-deficiencies/.
[4] Jordan Rau, “As Coronavirus Cases Grow, So Does Scrutiny of Nursing Home Infection Plans,” Kaiser Health News (Mar. 4, 2020), https://khn.org/news/as-coronavirus-cases-grow-so-does-scrutiny-of-nursing-home-infection-plans/ (reporting 61% of facilities had been cited with infection prevention deficiencies in the prior three years, including more than one-third that had been cited more than once); Jordan Rau, “Infection Lapses Rampant In Nursing Homes But Punishment Is Rare,” Kaiser HealthNews (Dec. 22, 2017), https://khn.org/news/infection-oflapses-rampant-in-nursing-homes-but-punishment-is-rare/ (reporting 74% of nursing homes cited for infection control deficiencies, more than any other deficiency, but only one is 75 facilities received a high-level deficiency that can lead to a financial penalty).
[5] Susan Jaffe, “Hundreds Died of COVID at NYC Nursing Homes With Spotless Infection Inspections,” The City (May 27, 2020), https://www.thecity.nyc/health/2020/5/27/21273143/hundreds-died-of-covid-at-nyc-nursing-homes-with-spotless-infection-inspections.
[6] Bailey Loosemore, “Most Kentucky nursing homes have passed COVID-19 inspections despite widespread outbreaks,” Louisville Courier Journal (May 28, 2020), https://www.courier-journal.com/story/news/local/2020/05/27/coronavirus-most-kentucky-nursing-homes-pass-covid-19-inspections/5268217002/.
[7] CMA, “Infection Control Surveys at Nursing Facilities: It Looks Like Business As Usual” (Report, May 7, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/05/Special-Report-Infection-Control-5-7-2020.pdf.
[8] CMS, “Nursing Home COVID-19 Data and Inspection Results Available on Nursing Home Compare” (Press Release, Jun. 4, 2020), https://www.cms.gov/newsroom/press-releases/nursing-home-covid-19-data-and-inspections-results-available-nursing-home-compare. There were 5743 survey reports cited, but 20 were immediate jeopardy surveys. Since one infection control survey cited immediate jeopardy, this report reduces the total number of survey reports (5743) by 19 reports to discuss 5724 infection control surveys.
[9] Suzy Khimm and Laura Strickler, “The government counts 26,000 COVID-19 deaths in nursing homes. That’s at least 14,000 deaths too low,” NBC News (Jun. 2, 2020), https://www.nbcnews.com/health/health-news/government-counts-26-000-covid-19-deaths-nursing-homes-s-n1221496.
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