June 2, 2020

More than 60,000 nursing home residents have been infected with the new coronavirus and nearly 26,000 have died, according to CMS and CDC data released Monday—but the data does not account for all nursing homes in the country, meaning the actual totals of nursing home residents who've been infected with the virus and died likely are higher.

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US Covid-19 cases surpass 1.8M, death toll tops 105K

The data comes as U.S. officials as of Tuesday morning had reported 1,820,200 cases of Covid-19, the disease caused by the new coronavirus—up from 1,798,700 cases as of Monday morning.

As of Tuesday morning, officials also had reported a total of 105,095 U.S. deaths linked to the new coronavirus—up from 104,381 deaths reported as of Monday morning. 

Data provides first look at reported Covid-19 cases and deaths among nursing home residents, staff

The CMS and CDC data released Monday is based on reports of Covid-19 cases and related deaths from 80%, or about 12,500, of America's roughly 15,400 nursing homes. The federal government did not require nursing homes to submit information on Covid-19 cases or related deaths that were identified at nursing homes until early May, but CMS Administrator Seema Verma said she believes the "vast majority" of nursing homes reported data on cases and deaths identified before that point.

The data doesn't include information on Covid-19 cases and deaths at assisted-living facilities, which aren't regulated by CMS. CMS and CDC plan to make the full data available to researchers and the general public via CMS' Nursing Home Compare website on Thursday. CMS said it will update the data weekly once it's published.

In addition to the reported totals of Covid-19 cases and related deaths among nursing home residents, the data showed that the nursing homes had reported more than 34,400 cases of Covid-19 among staff at the facilities and nearly 450 related deaths among staff.

Verma said about a quarter of the 80% of nursing homes that reported data on Covid-19 cases had confirmed at least one case of Covid-19 at their facilities, and about one-fifth reported at least one death related to the new coronavirus. Rates of reported Covid-19 cases and deaths at nursing homes varied by state. For example, Washington, D.C., reported the highest rate of identified Covid-19 cases among nursing homes, at 206 cases per 1,000 residents, with Massachusetts and Arizona reporting the second- and third-highest rates. In comparison, Hawaii reported no identified cases of Covid-19 among nursing home residents, and Montana and Vermont each reported less than one case per 1,000 residents.

The data showed that nursing homes with lower ratings on CMS' five-star rating system for the facilities were more likely to report large numbers of Covid-19 cases when compared with nursing homes with higher star ratings. However, Beth Martino, senior VP of public affairs at the American Health Care Association, said, "Significant research from leading health experts, including analysis from Harvard Medical School and Brown University as well as testimony to Congress by the University of Chicago, has shown no correlation between Covid-19 outbreak and [CMS'] star-rating system." She added, "In fact, the first Covid case was at a five-star rated facility. As this research shows, the amount of Covid-19 cases in nursing homes has been directly linked to the level of the virus in the surrounding local community."

Overall, CDC Director Robert Redfield said the "data, and anecdotal reports across the country, clearly show that nursing homes have been devastated by the" new coronavirus.

Experts say controlling Covid-19 outbreaks at nursing homes is difficult—and inspections are lacking

Verma said practicing proper infection control techniques, such as handwashing, to curb Covid-19 outbreaks at nursing homes has been difficult.

David Grabowski, a Harvard University professor who studies post-acute care, said nursing homes' physical structures—including shared bathrooms, how air is circulated throughout the facility, and more—can make it difficult to control the new coronavirus' spread. He noted that "[s]ome facilities have tried to set up [coronavirus] units or wings or floors," but that isn't always "doable based on the numbers and the layout."

Joseph Ouslander, a geriatrician and professor at Florida Atlantic University, said nursing homes also have been plagued with inadequate levels of personal protective equipment and diagnostic testing for the new coronavirus. Because of those challenges, "[t]here are going to be, unfortunately, more and more clusters of infection and death in nursing homes," he said.

Verma called on states to increase inspections at nursing homes to ensure they're complying with federal infection control standards. "There is no substitute for boots on the ground," she said.

According to the data, there are significant disparities between states when it comes to the percentages of nursing homes they've inspected for compliance with infection control standards since America's Covid-19 epidemic first spiked in early March. For example, the data showed that Colorado and Nevada each have inspected 100% of the states' nursing homes, while West Virginia has inspected about 11% of nursing homes in the state. On average, states have inspected about 54% of nursing homes nationally, according to the data.

CMS ups penalties related to infection-control policies for states, nursing homes

To address those disparities, CMS on Monday announced that it is now requiring states that do not inspect all Medicare-certified nursing homes by July 31 to submit a corrective action plan to the agency, and Verma said CMS will dole out $80 million to help states bolster their inspection rates. However, CMS said states that still have not inspected all Medicare-certified nursing homes by August could lose 10% or more of that funding.

In addition, CMS said it will increase financial penalties for nursing homes that have persistently violated federal infection-control policies and those that have widespread infections, with penalties ranging from $5,000 to $20,000. CMS said the new actions will "help prevent backsliding, improve accountability, and ensure prompt compliance" with federal infection-control standards at nursing homes (Alonso-Zaldivar/Choi, Associated Press, 6/1; New York Times, 6/2; Kamp/Wilde Mathews, Wall Street Journal, 6/1; Cenziper et al., Washington Post, 6/1; Jaffe, NPR, 6/1; Luhby, CNN, 6/1; Owens, "Vitals," Axios, 6/2; Weixel, The Hill, 6/1; Cirruzzo, Inside Health Policy, 6/1 [subscription required]; Brady, Modern Healthcare, 6/1; CMS release, 6/1).

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