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Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes

Issued on  | Posted on  | Report number: OEI-02-20-00492

Report Materials

Why OIG Did This Review

  • Nursing home residents and staff have been especially impacted by the COVID‑19 pandemic. Now, it is critical to learn from what happened in nursing homes and take steps to better protect residents and staff during future infectious disease outbreaks, emergencies, or other disruptions to the health care system.
  • This is the third and final report in a three-part series about the effects of the COVID‑19 pandemic on nursing homes. The previous reports found that COVID-19 had a devastating impact on Medicare beneficiaries in nursing homes during 2020, as 2 in 5 residents had or likely had COVID-19 in 2020. Also, more than 1,300 nursing homes had infection rates of 75 percent or higher during surge periods.

What OIG Found

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 compliance, and vaccination rates after initial challenges were resolved.

Nursing homes identified challenges with implementing effective infection control practices and opportunities for improvement.

What OIG Recommends

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. For two of the five recommendations, CMS’s response generally conveyed agreement. CMS agreed with the intent of the remaining three recommendations and indicated that it has implemented them, and suggested that they be removed from the report. OIG maintains that additional actions are needed and continues to support all five recommendations.

COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020

More Than a Thousand Nursing Homes Reached Infection Rates of 75 Percent or More in the First Year of the COVID-19 Pandemic; Better Protections Are Needed for Future Emergencies

Centers for Medicare and Medicaid Services
Nursing Homes, Nursing Facilities, and Assisted Living Facilities COVID-19 Quality of Care Emergency Preparedness and Response
Medicaid Medicare A