This week, a new federal government report on nursing home safety, "Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes," was released by the Office of Inspector General (OIG) at the Department of Health and Human Services.

Among other things, the OIG report recommends updating infection control lessons from the pandemic and providing more effective guidance to nursing homes on infection control requirements.

The OIG found that:

• Nursing homes faced monumental and ongoing staffing challenges, including a significant loss of staff and substantial difficulties in hiring, training, and retaining new staff. Many nursing homes used outside staffing agencies to fill gaps, which had significant downsides.
• Nursing homes continued to struggle with costs, testing protocols, personal protective equipment (PPE) compliance, and vaccination rates after initial challenges were resolved.
• Nursing homes identified challenges with implementing effective infection control practices and opportunities for improvement.

The OIG recommends that the Centers for Medicare & Medicaid Services (CMS):
1. Implement and expand upon its policies and programs to strengthen the nursing home workforce.
2. Reassess nurse aide training and certification requirements.
3. Update the nursing home requirements for infection control to incorporate lessons learned from the pandemic.
4. Provide effective guidance and assistance to nursing homes on how to comply with updated infection control requirements.
5. Facilitate sharing of strategies and information to help nursing homes overcome challenges and improve care.

CMS did not explicitly state its concurrence or nonconcurrence for the five recommendations.

Devin A. Jopp, EdD, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC) made the following statement: "The nation’s infection preventionists agree with the findings of the new report from the U.S. Department of Health and Human Services Office of Inspector General that the U.S. needs to take drastic steps to better protect our seniors from potentially deadly infections in nursing homes. As the report highlights, the pandemic exposed dangerous conditions that led to more than 1,300 nursing homes reaching unacceptably high COVID-19 infection rates of 75% or more. The problems were especially acute at for-profit nursing homes, and among Black, Hispanic, and Asian American nursing home residents. This is the third report produced by the OIG about the devastating effects of the COVID-19 pandemic on nursing homes without adequate solutions proposed by the Centers for Medicare & Medicaid Services. As an organization committed to infection prevention and control, APIC is disappointed by CMS’s inadequate response to the recommendations."

APIC strongly recommends:
• Infection Prevention Staffing - Each nursing home should be required to have at least one dedicated, full-time, certified infection preventionist on staff. Currently, the designated role of infection preventionist often falls to staff who are already overburdened with critical roles such as director or assistant director of nursing. They may have no interest and minimal infection prevention training. This lack of infection prevention and control support leaves residents vulnerable to fatal, healthcare-associated infections (HAIs).
• The Centers for Medicare & Medicaid Services (CMS) Surveyor Workforce – The federal inspectors of the long-term care industry should be adequately funded, and the surveyors themselves properly trained. Many current CMS surveyors lack official training and expertise in infection prevention and control (IPC). Surveyors should be equipped with basic IPC content knowledge to ensure that facilities adhere to evidence-based practices and their own IPC plans.
• HAI Surveillance - Long-term care facilities should be required to have systems in place to track HAIs. Currently, nursing homes are not required to report HAIs to CDC’s tracking system, the National Healthcare Safety Network (NHSN). To adequately prevent and control infections that severely impact elderly Americans, long-term care facilities must be required to use NHSN to track and monitor HAIs and other IPC metrics in order to address and improve gaps in prevention processes.

Numerous reports by the United States Health and Human Services (HHS) and the Government Accountability Office all point to the need to improve infection prevention and control staffing, infrastructure, and surveillance in nursing homes, APIC says. It is time for action and APIC stands ready to work with HHS, Congress, state health authorities, and other advocates to ensure that we not only learn from the pandemic but also act to protect our most vulnerable communities from being adversely affected in the future, the organization adds.