GAO’s review of data from the Centers for Disease Control and Prevention (CDC) found that winter 2020 was marked by a significant surge in the number of COVID-19 cases and deaths in nursing homes. However, CDC data as of February 2021, show that both cases and deaths have declined by more than 80 percent since their peaks in December 2020. With the introduction of vaccines, observers are hopeful that nursing homes may be beginning to see a reprieve. Nevertheless, the emergence of more highly transmissible virus variants warrants the need for continued vigilance, according to public health officials.
GAO’s prior work has found that nursing homes have faced many difficult challenges battling COVID-19. While challenges related to staffing shortages have persisted through the pandemic, challenges related to obtaining Personal Protective Equipment (PPE) and conducting COVID-19 tests—although still notable—have generally shown signs of improvement since summer 2020. Further, with the decline in nursing homes cases, the Centers for Medicare and Medicaid Services (CMS) updated its guidance in March 2021 to expand resident visitation, an issue that has been an ongoing challenge during the pandemic. Some new challenges have also emerged as vaccinations began in nursing homes, such as reluctance among some staff to receive a COVID-19 vaccine.
The Department of Health and Human Services (HHS), primarily through CMS and the CDC, has taken steps to address COVID-19 in nursing homes. However, HHS has not implemented several relevant GAO recommendations, including:
- HHS has not implemented GAO’s recommendation related to the Nursing Home Commission report, which assessed the response to COVID-19 in nursing homes. CMS released the Nursing Home Commission’s report and recommendations in September 2020. When the report was released, CMS broadly outlined the actions the agency had taken, but the agency did not provide a plan that would allow it to track its progress. GAO recommended in November 2020 that HHS develop an implementation plan. As of February 2021, this recommendation had not been implemented.
- HHS has not implemented GAO’s recommendation to fill COVID-19 data voids. CMS required nursing homes to begin reporting the number of cases and deaths to the agency effective May 8, 2020. However, CMS made the reporting of the data prior to this date optional. GAO recommended in September 2020 that HHS develop a strategy to capture more complete COVID-19 data in nursing homes retroactively back to January 1, 2020. As of February 2021, this recommendation had not been implemented.
Implementing GAO’s recommendations could help address some of the challenges nursing homes continue to face and fill important gaps in the federal government’s understanding of, and transparency around, data on COVID-19 in nursing homes. In addition to monitoring HHS’s implementation of past recommendations, GAO has ongoing work related to COVID-19 outbreaks in nursing homes and CMS’s oversight of infection control and emergency preparedness.