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GAO Report on Nursing Home Infection Control Deficiencies

A Government Accountability Office (GAO) report released on May 20, 2020 analyzed infection control deficiencies cited during nursing home surveys. The analysis of Centers for Medicare and Medicaid Services (CMS) data shows that infection prevention and control deficiencies were the most common type of deficiency cited in surveyed nursing homes, with most homes having an infection prevention and control deficiency cited in one or more years from 2013 through 2017 (13,299 nursing homes, or 82 percent of all surveyed homes).

In each individual year, the GAO found that about 40 percent of surveyed nursing homes had infection prevention and control deficiencies, and this continued in 2018 and 2019. About half – 6,427 of 13,299 (48 percent) – of the nursing homes with an infection prevention and control deficiency had this deficiency cited in multiple consecutive years from 2013 through 2017. This is seen as an indicator of persistent problems at these nursing homes.

In each year from 2013 through 2017, nearly all infection prevention and control deficiencies (about 99 percent in each year) were classified by surveyors as not severe, meaning that the surveyor determined that residents were not harmed. The GAO review of CMS data shows that implemented enforcement actions for these deficiencies were typically rare: from 2013 through 2017, CMS implemented enforcement actions for 1 percent of these infection prevention and control deficiencies classified as not severe. The GAO plans to examine CMS guidance and oversight of infection prevention and control in a future report, including the classification of infection prevention and control deficiencies.

Beginning with the adoption of the Mega Rule in late 2016, the development of clearer survey guidelines, and a focusing of attention on infection control issues as a key CMS priority, infection control deficiencies have been the most cited deficiency both nationwide and in New York State. With the current COVID-19 pandemic, CMS has suspended recertification surveys, Life Safety Code surveys, and revisits and is, for the most part, only conducting Focused Infection Control Surveys.

Most recently, on May 18, 2020, CMS issued memorandum QSO 20-30-NH providing recommendations on the reopening of nursing homes and announcing plans for the prioritization of survey activities. Not surprisingly, current and past survey deficiencies in infection control practices will be a key factor in determining when a nursing home will have a survey.

Recognizing the need for an effective infection control program to protect residents and to be compliant with regulatory expectations, LeadingAge NY ProCare has worked with members to provide education and guidance around infection control issues. We encourage members to seek out one of our ProCare consultants with any infection control questions and concerns and to consider a review of your current program, including policies, procedures, staff education, and training. Contact ProCare at 518-867-8383.

Contact: Elliott Frost, efrost@leadingageny.org, 518-441-8761