Analysis of data from the Centers for Disease Control and Prevention (CDC) shows that, from June 2020 through December 2021, nursing homes faced many separate COVID-19 outbreaks, with the average outbreak lasting four weeks.
The Government Accountability Office has found that certain factors increased the likelihood that a nursing home would have a longer outbreak.
Specifically, transmission of COVID-19 in the community surrounding a nursing home had the strongest association, with nursing homes located in areas with high transmission more likely to have longer outbreaks. Longer COVID-19 outbreaks were also associated with nursing homes that were larger than 100 beds, experiencing reported staff shortages, and government-owned.
GAO interviewed at six selected nursing homes in four states described a range of outbreak experiences, including critical challenges and some successes. For example, two critical challenges included:
- Staff shortages. Officials from five nursing homes described experiencing staffing shortages during outbreaks. For example, officials from one nursing home described a staffing crisis, noting that at one point the home was down about 25 percent of its workforce.
- Low staff morale. Officials from three nursing homes discussed the psychosocial effect the pandemic had on their staff and the difficulties in maintaining staff morale. For example, officials from one nursing home described how the outbreaks took away the joy of caregiving from staff, and officials believed that many staff were left traumatized.
GAO’s analysis of CDC and Centers for Medicare & Medicaid Services (CMS) data found that transmission of COVID-19 in the community surrounding a nursing home, known as community spread, had the strongest association with the duration of an outbreak. Controlling for other factors, prior to the introduction of COVID-19 vaccines, nursing homes in counties experiencing low community spread had outbreaks that ended an estimated seven days earlier than nursing homes in counties experiencing high community spread. GAO also found that most outbreaks (75 percent) began with a reported staff case during the first week. These results could indicate that, during times of higher community spread, staff have a greater likelihood of being exposed to the virus in the community and bringing it into the nursing home. Other factors GAO found that had a strong association with outbreak duration included nursing home size, reported staff shortages, and ownership type.