COVID-19 in Nursing Homes: CMS Names Names

Cheryl Clark

The public can now see -- for each of 13,600 nursing homes in the country by name -- which ones had suspected versus confirmed cases of COVID-19, which had COVID-19 deaths, and whether they were residents or staff.

With 88% of 15,400 Medicare and Medicaid-eligible nursing homes reporting as of May 31, Medicare officials yesterday rolled out a federal database showing how the nation's 95,515 confirmed COVID-19 cases, 58,288 suspected cases, and 31,782 deaths among nursing home residents were distributed.

Of the facilities that reported, 25% reported cases or deaths.

"This sort of national data from nursing homes is unprecedented and constitutes the backbone of a national COVID-19 virus surveillance system," Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said Thursday during a press call. The data, along with focused infection control inspections of nursing homes, Verma said, will "inform a number of new regulatory policies to protect nursing home residents."

The link to the data, which will be updated weekly, can be accessed on the CMS's Nursing Home Compare website or downloaded as a spreadsheet and filtered or sorted.

Verma emphasized that a prior problem with getting good data was that "every state was doing this a little bit differently, and now we have a national standard way of looking at nursing homes."

For example, some states count a COVID-19-infected nursing home patient who was transferred to a hospital and died there as a death in one of their residents, while other states attribute that resident's in-hospital death to that hospital. Some states include residents of assisted living facilities, while others do not.

These federal data, which the nursing homes send directly to the CDC and from there to CMS, and not through their states, only includes information from skilled nursing facilities under CMS's regulatory purview, Verma said. "That's part of the reason we built this system."

Verma cautioned that the dataset has limitations and errors. There may be confusion with some nursing homes confusing numbers of cumulative cases with numbers they had in the prior week, which should go in separate columns and may result in an overcount.

She expects a lot more cases to appear in coming weeks because states have been asked to test all nursing home residents and staff. "These and other factors should really prompt us to use caution when interpreting the data at this early stage," she said.

A member of the CMS technical staff, who spoke on background during the press briefing, noted that those nursing homes with higher numbers of cases and deaths from COVID-19 were more likely to have been given a low "one star" rating in the agency's system. "What that means is that facilities with a poor compliance history or poor survey history were more likely to have larger outbreaks," he said.

Verma said that CMS teams are working to get reports from the other 12% of nursing homes with missing data. After a grace period, she said, CMS will issue financial penalties to those facilities of $1,000 for the first week of delay. If it fails to report for a second week, the fine is another $1,500 for a total of $2,500, and more the longer the facility delays. That grace period ends June 7.

The CMS technical official said that the agency is encouraging family members to make it known if a loved one was diagnosed with COVID-19 in a facility and the facility hasn't reported that to CMS. "Families can be a very powerful motivating factor," he said.

Verma was asked by a reporter why so many facilities show a large number of cases and deaths, though state inspectors found no infection control violations and gave the facilities a clean bill.

She responded that inspections occur at "a point in time.... When you (inspectors) go into the nursing home, the staff know they're being observed and particularly on that day they go in, they're looking for things they may not see on that particular visit, but when the inspector leaves the nursing home, things can change, right?"

"There are some staff that may not be washing their hands at the frequency we suggest, or in the situations we suggest. There could be some lax practices around isolating patients."

Additionally, CMS is asking states to conduct focused infection control surveys or inspections whenever a nursing home facility has three diagnosed cases of COVID-19. It has also increased the penalties and fines around deficiencies found during such investigations.

The CMS technical official on the call also noted that just finding COVID-19 in a nursing home does not automatically mean the facility was non-compliant with infection control guidelines. For example, "many facilities were intentionally admitting residents from hospitals," he said.

During testimony Thursday before a House committee, CDC Director Robert Redfield, MD, touted the new website. "CMS and myself are working very closely together; one of our key priorities is to combat the impact on nursing homes. We now have the ability to require all nursing homes to report their data to us... so America knows what nursing homes are doing well and what ones aren't doing well, and we know so we can help them more with infection control."

The new data revealed these outliers with high numbers in certain categories:

Residents total confirmed COVID-19 cases: Smith Village, Chicago -- 1,105Residents total suspected COVID-19 cases: Spring Branch Transitional Care Center, Houston -- 390Residents total confirmed COVID-19 deaths: Dellridge Health & Rehabilitation Center, Paramus, New Jersey -- 753Staff total confirmed COVID-19 cases: Smith Village, Chicago -- 955Staff total suspected COVID-19 cases: Highland Pines Nursing Home, Longview, Texas -- 3,728Staff total COVID-19 deaths: Den-Mar Health and Rehabilitation Center, Rockport, Massachusetts -- 25

The new website also shows the rates of COVID-19 cases per 1,000 residents, number of residents, whether nursing home residents have access to COVID-19 testing in the facility, whether the facility has a shortage of nursing staff, clinical staff or aides, and the current supply of N95 masks, surgical masks, eye protection, gowns, gloves, hand sanitizer, ventilators, and ventilator supplies.

In response, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, said that while the CMS data have "too many qualifiers," it shows "that almost one-third of the residents with confirmed cases have died and that is a very shocking number, but not a surprise given all the problems with lax enforcement, lack of staff, proper PPE and infection control."

"But still, to have 32,000 nursing home residents die within the past three months, is a pretty terrible indictment of how we warehouse our ill elders," McGinnis added.

In a statement Thursday, Katie Smith Sloan, president and CEO of LeadingAge, an advocacy group for nonprofit nursing homes, called the numbers "devastating" and "a reminder of how this virulent virus has been allowed to rage on without protection or regard for older people and their care workers."

She criticized the Trump administration for appearing to "walk away from any substantive leadership role" in preventing COVID-19 among older people.

"Aging services providers have been promised little more than token personal protective equipment (PPE) assistance to care for vulnerable residents and staff, and many haven't even received that," her statement said.

MedPage Today News Editor Joyce Frieden contributed reporting to this article.

Last Updated June 05, 2020

Cheryl Clark


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