26,000 COVID-19 Deaths in Nursing Homes Might Spur Federal-State Blame Game

As the United States moves cautiously toward a reopening that will include the gradual lifting of social distancing guidelines and-hopefully-the resurgence of a battered economy, health officials will keep a close eye on what might spark a second wave of the COVID-19 pandemic that forced the lockdown in the first place. Throughout the pandemic, nursing homes and other long-term care facilities proved to be one of the nexuses of the SARS CoV-2 virus, and more information came to light yesterday suggesting that the problem with nursing homes as COVID-spreaders is far from being solved. 

The Associated Press reports that 25,923 nursing home residents in the US died from COVID-19 during the pandemic and federal health officials charge that states have not done enough to address the problem.

That information is contained in a letter that the AP obtained that’s addressed to the nation’s governors from Seema Verma, the administrator for the US Centers for Medicare and Medicaid Services (CMS) and Robert Redfield, the director of the US Centers for Disease Control and Prevention (CDC). 

Most likely the COVID death count of nursing homes will mount as more information comes to light, as only about 80% of the nation’s approximately 15,400 nursing homes have reported their data. In addition, those federal data don’t include numbers of dead from assisted living facilities. The report cited by Verma and Redfield is expected to be released later this week.  

“This data, and anecdotal reports across the country, clearly show that nursing homes have been devastated by the virus,” Verma and Redfield write. 

More than 60,000 people in nursing homes were stricken by COVID-19 and, as the AP reports, this latest estimate of deaths will likely lead to finger-pointing, as those who run nursing homes and other long-term care facilities argue that they are understaffed, underfunded and in no position to take on surges of COVID-19 cases. As Infection Control Today^® reported last month, some experts feel that nursing homes will be blamed for those surges nonetheless. 

Verma wants the states to speed up inspections of nursing homes. CMS cites wide disparities among states, with West Virginia inspecting 11% of its nursing homes and Colorado inspecting 100%. The agency warns that federal funding for nursing homes might be tied to how many of the facilities are inspected.

Meanwhile, the toll among nursing home employees has been eye-opening, as well, with more than 34,400 workers getting sick and 450 dying from COVID-19. About 1 in 4 facilities had at least one COVID-19 case, and 1 in 5 reported at least one death.

Kevin Kavanagh, MD, a member of ICT^®’s Editorial Advisory Board, said that the problems with with nursing homes are systemic and existed long before the COVID onslaught and added that the nursing home industry needs to undergo a “significant transformation” in order to prevent a repeat of what happened in the first wave. “Infection control in nursing homes has been almost non-existent for years along with effective regulations to serve as guidance,” Kavanagh said. “We are also concerned with a reactionary program of inspections based on non-specific regulations.”

Kavanagh would like to see a sustained program of oversight using detailed metrics designed to drive a high-quality outcome. “Specifically, there should be reporting of all acquisitions in patients and staff of all dangerous and drug resistant pathogens in nursing homes,” Kavanagh said. “Ample PPE and hand washing stations need to be available, along with staff training in infectious disease by a full-time onsite IP professional. Screening of admission for these pathogens and the patient’s microbiome needs to take place. And residents placed in facilities or wards with other patients having compatible microbiome.”

Bottom line according to most health experts: Nursing homes are still vulnerable even as the first wave of the COVID-19 pandemic appears to be easing. If there is a second wave, it will strike in nursing homes first and then spread to the broader community. 

Tamara Konetzka, a research professor at the University of Chicago, who specializes in long-term care issues, tells AP: “What is going on in a nursing home can be a barometer for where the virus is. You’ve got to be watching out and expecting a lot of cases in that community as well.”