There are 1.3 million people in the country’s roughly 15,000 nursing homes. More than 16,000 long-term-care residents and staff have died of COVID-19, according to a USA TODAY analysis of government data. And nearly 97,000 residents and staff have tested positive for the virus.
American nursing homes are not up to the task of protecting their older and infirm residents from COVID-19. Infection control and prevention problems were the most frequently cited violation in nursing homes last year, and one-third of Medicare beneficiaries admitted to nursing homes suffer harm within two weeks of entry, according to a 2014 report from the federal Office of Inspector General. The weaknesses in patient care and oversight at nursing homes are widespread and well known, and only intensify the risk that residents will not only die from COVID-19 but also from the erosion of care the pandemic is causing, increasing neglect and abuse.
And yet the federal government is considering rolling back infection control requirements in U.S. nursing homes — even as the long-term-care industry’s residents and workers continue to be overwhelmed by the coronavirus. A rule proposed last year by the Centers for Medicare and Medicaid Services (CMS) would modify the amount of time an infection preventionist must devote to a facility from at least part-time to “sufficient time.”
This is an undefined term that lets the facility decide how much time should be spent. The regulation has not been finalized, but CMS recently defended its proposal, saying it aims to reduce regulatory burden and strengthen infection control. Opponents of the change said the rule could leave nursing home residents more vulnerable to infection.
The changes were first proposed in July 2019, part of an ongoing effort by the Trump administration to reduce regulations for nursing home providers and suppliers. The proposed rule would also reduce the need for a facility-wide assessment from once a year to every other year and allow certain facilities to disregard a requirement that caps residents at two per room.
Experts say COVID-19’s devastating effect on nursing homes is the result of a complex mix of factors: the characteristics of the virus, the vulnerability of elders and those with underlying conditions, staffing levels, and the national availability of testing and personal protective equipment. For some, the virus’ effect on nursing homes has renewed their concerns about the proposed rule.
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