Title: Efforts to Protect Nursing Home Residents from COVID-19 Also May Have Negatively Affected Some Residents Description: At the onset of the pandemic, steps were taken to protect elderly residents living in nursing homes from the spread of COVID-19. This included, for example, limiting visitors and isolating some residents. But these steps may have had unintended negative consequences on their mental and physical health. We find out more from GAO's John Dicken. Related GAO Work: GAO-22-105133, COVID-19 In Nursing Homes: CMS Needs to Continue to Strengthen Oversight of Infection Prevention and Control Released: September 2022 [Music] [John Dicken:] We do think there are opportunities for CMS to further strengthen infection prevention and control. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. At the onset of the pandemic, widespread outbreaks of COVID-19 in nursing homes and the resulting deaths of elderly residents were heavily reported in the news. Steps were taken to protect elderly residents, including, for example, limiting visitors and isolating some residents to prevent the spread. But these steps may have had unintended negative consequences on residents mental and physical health. Today, we'll talk with John Dicken, an expert on health care policy, about some of these negative effects, and also the steps the federal government is taking to improve infectious disease control in nursing homes. Thanks for joining us. [John Dicken:] Thank you. Glad to talk to you about this important issue. [Holly Hobbs:] So, John, is COVID still a threat in nursing homes? And if it is, how are they dealing with it now? Is it any better? [John Dicken:] Yes. COVID remains a serious concern in nursing homes. Nursing home residents remain clearly vulnerable, given age and prevalence of other health conditions, and being in a congregate setting. As communities more generally continue to experience spread of different variants of COVID, nursing home residents and staff also continue to face concerns. Compared to earlier in the pandemic, there are more tools and approaches, including that nursing homes were prioritized for vaccination and there's better availability of testing and protective equipment for staff. And so the situation is not as devastating as it had been earlier in the pandemic, but remains a serious concern. [Holly Hobbs:] And earlier in the pandemic, we also heard about nursing homes going into a sort of lockdown to prevent COVID from spreading through facilities. This saved a lot of lives, right. But what impact did that isolation have on residents? [John Dicken:] Yes, especially early on in the pandemic, federal, state, and nursing home guidelines severely restricted visitors to nursing homes. And while this was intended to reduce the spread of COVID, it also had some serious effects on the physical and mental health of residents. And, since November 2021, federal guidelines have no longer imposed those restrictions on visitation and so nursing homes are able to accept visitors or manage visitors consistent with their own infection prevention practices. [Holly Hobbs:] And how do we know that this had an impact? [John Dicken:] One was we talked to a number of nursing home administrators and staff and some nursing home officials we spoke with noted things like increased depression among residents. Others noted more falls by residents, as they may be alone in the room and tried to move without assistance. But we also looked at data of key clinical measures both before and after the pandemic, and saw that there were a number of both physical and mental health indicators that were worse during the pandemic than prior to the pandemic. [Holly Hobbs:] So prior to the pandemic and then peak-COVID, what steps were taken by federal entities—like the CDC or Centers for Medicare and Medicaid Services—to protect residents? [John Dicken:] CDC and CMS each took a number of steps. These included issuing a number of guidance for nursing homes and for states that inspect nursing homes. They waived certain requirements, including annual inspections of nursing homes, and allowed more flexibility in certain other requirements. And they focused inspections specifically on nursing home infection control practices. I also want to note that, some steps that federal agencies took prior to the pandemic took on really increased importance during the pandemic. One of which was requiring nursing homes to designate an infection preventionists on its staff. But we saw that the extent to which homes used staff as infection preventionists has really varied widely. [Holly Hobbs:] And what about more recently? [John Dicken:] Both CMS and CDC have continued to issue new guidance and to adapt as the pandemic has continued and evolved. They have over time adapted issues such as removing some of the early limitations on visitation, providing additional priorities earlier on for vaccinating nursing home residents, and more recently focusing on issues of staffing and trying to identify additional guidance for the homes as the pandemic has continued to evolve. {MUSIC} [Holly Hobbs:] So John just told us that while it may feel like the pandemic is winding down, COVID-19 remains a serious concern for nursing homes. Federal agencies as well as state entities and nursing homes have taken steps to protect residents, but their safety is still a concern. So, John, what additional actions do we think CMS and CDC should take to strengthen their efforts? [John Dicken:] We do think there are opportunities to further strengthen infection prevention and control. In particular, we think, leveraging the important role of staff designated as infection preventionists in nursing homes can help prevent and manage infections such as COVID. Specifically, we recommend several steps in this regard. One would be to establish minimum federal training standards for infection preventionists. Another would be to collect staffing data from nursing homes on the use of infection preventionists to help determine whether the current staffing requirement is sufficient, and really to provide additional guidance to states— who are inspecting the nursing homes— so that they can better cite when there are or are not deficiencies related to infection prevention and control. [Holly Hobbs:] And last question, what's the bottom line of this report? [John Dicken:] Nursing homes have really faced unprecedented challenges during the pandemic. So we think it's important to take a look at the experience of nursing homes during this time and identify lessons learned. One lesson we identified is strengthening training and the role of staff designated as infection preventionists in nursing homes. And as the pandemic continues and evolves, we think this can help better manage COVID, but more generally help better address the broader issue of infections among nursing home residents. [Holly Hobbs:] That was John Dicken talking about GAO's recent review of COVID-19 in nursing homes. Thanks for your time, John. [John Dicken:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify or wherever you listen and make sure to 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.