From the U.S. Government Accountability Office, www.gao.gov Transcript for: Infection Control in Nursing Homes Description: Because they're so close to each other, and often have underlying health issues, nursing home residents are particularly vulnerable to the spread of diseases like COVID-19. John Dicken joins the Watchdog Report to discuss a GAO study of infection controls in the nation's nursing homes prior to this current pandemic. Related GAO Work: GAO-20-576R, Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic Released: May 2020 [ Intro Music ] [John Dicken:] The extent to which nursing homes are falling short on some basic infection control requirements has unfortunately been persistent over multiple years. [Matt Oldham:] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. One of the more vulnerable population groups during this COVID-19 pandemic is the elderly. And of particular concern is the nation's 1.4 million nursing home residents, who are often in frail health and living in close proximity to each other. And with me to talk about a study on infection control in nursing homes is John Dicken, a GAO Health Care director. Thanks for joining me, John. [John Dicken:] Thank you, Matt. [Matt Oldham:] So, John, did you look at COVID-19 issues specifically? [John Dicken:] The report that GAO is releasing has examined the prevalence of nursing homes with deficiencies in infection control prior to the COVID-19 pandemic. We do have work underway that will examine the federal government's response to COVID-19, but this particular report was looking at the years before the pandemic. [Matt Oldham:] And what did you find? [John Dicken:] We found that a number of nursing homes had deficiencies in their infection prevention and control efforts, and that these deficiencies unfortunately were widespread across most nursing homes, and many nursing homes were persistent over multiple years. You know, more specifically, we saw that 82% of all nursing homes had at least one deficiency cited for infection control over the five years we examined from 2013 to 2017. And these were the most common types of deficiencies that inspectors find when they do their regular inspections of nursing homes. Not only were there a large proportion of homes at any one time, but about half of the homes had a deficiency in multiple years, so it was not just that a number of nursing homes had deficiencies in terms of their infection control, but these were often seen repeatedly in multiple years. Often they were at lower levels, but those are concerning given that they are basic efforts that can help prevent or control infections. [Matt Oldham:] While we're talking about infection controls, could you give some examples of what those are? [John Dicken:] Yeah. We looked at some of the types of things where nursing homes were being cited for falling short of infection control standards and that included things like staff that may not have been doing appropriate handwashing in between patients, that they may have been displaying symptoms-- the staff themselves were having fevers or coughs and still doing direct care for residents. It can include not disinfecting medical equipment or basic things like thermometers that might be used by multiple nursing home residents. And so there were a wide range of types of basic practices to make sure that individuals were not being exposed to infections as well as that when those infections do occur that they would be isolated and handled by staff with appropriate protective equipment. [Matt Oldham:] So, John, what's the federal government's role here? [John Dicken:] Well, the federal government is the largest payer of long-term care in the United States, and so both with Medicaid and Medicare being major sources of funding for nursing homes, any home that would accept Medicare and Medicaid payments must also meet federal requirements to make sure that the residents are safe and to maintain the health of residents. It's a partnership between the federal government and states, and so state inspectors will regularly do inspections of nursing homes and make sure that they're meeting the federal standards and guidelines, have reporting to the federal government that's made publicly available, and that, if there are problems, the federal government can impose enforcement actions when necessary. [Matt Oldham:] So, it sounds like you took a look at a five-year period when it comes to infection control in nursing homes, from 2013 to 2017, and you found that most nursing homes were cited for infection prevention and control deficiencies. John, would it be fair to assume infection control deficiencies wouldn't help prevent the spread of a disease like COVID-19? [John Dicken:] Clearly, COVID-19 has been really devastating in nursing homes, with many homes facing outbreaks and being among the settings that have had some of the most cases and deaths in the current pandemic. But, even prior to COVID, infection control is a major concern for nursing homes and many of the efforts that are required and that we saw that nursing homes were being cited for not meeting are basic steps that could either prevent infections or when infections do occur try to limit their spread. And so, when nursing homes may not be meeting those basic efforts to prevent-- either prevent infections or limit their spread, those are serious concerns and hopefully that if homes are held accountable for meeting those basic federal standards that could help mitigate some of the concerns, which are clearly very challenging with a vulnerable population and the infectious nature of COVID-19 and other infections that affect nursing home residents. [Matt Oldham:] John, is there anything the federal government could do going forward to improve this situation? [John Dicken:] Well, the HHS and the federal government have been taking a number of actions in the current environment. As COVID-19 has unfolded, they've certainly enhanced their guidance, they've targeted nursing home inspections to look specifically at infection control. They have plans to do more reporting and try to learn the lessons from the current experience. So, there have been a number of new guidance, a lot of action by the federal government in support of states and the nursing home industry to try to mitigate some of the ongoing devastating effects of COVID-19 in nursing homes. GAO will be, you know, we're beginning work that will be evaluating that and further looking to see if there are other opportunities for improvement. [Matt Oldham:] John, last question. What's the bottom line here? [John Dicken:] Well, certainly, as the COVID pandemic has demonstrated, nursing homes are vulnerable to fairly devastating effects from infections with nursing home residents vulnerable. And so, when we've looked kind of at prior to the pandemic, we've seen that the extent to which nursing homes are falling short on some basic infection control requirements has unfortunately been widespread and persisted over multiple years, so really feel that these-- holding nursing homes accountable under the federal requirements to ensure that they're taking steps to prevent, identify, and control infection is key to reducing the likelihood that residents and staff become infected and, when those infections do occur, to take appropriate measures to control their spread. [Matt Oldham:] John Dicken was talking about a GAO study on infection control in the nation's nursing homes. Thank you for your time, John. [John Dicken:] Thank you, Matt. [Matt Oldham:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. Make sure you leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.