In the U.S., more than 1.3 million people reside in nursing homes, as per a report by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). These individuals tend to be more vulnerable to infections due to their advanced age, medical fragility, and the close quarters they share with other residents and healthcare workers. The COVID-19 pandemic starkly highlighted this susceptibility, as the virus savagely swept through nursing homes, resulting in a disproportionate number of fatalities. According to Centers for Medicare and Medicaid Services (CMS) data, over 172,000 residents succumbed to the virus, and millions were infected.
In response to the pressing need for increased safety and quality measures in long-term care settings, the CMS introduced new standards in 2016. These standards necessitated the establishment of an infection prevention and control program within each nursing home. The detailed program mandates included a regimen to prevent, identify, and control infections, an antibiotic stewardship program, and a protocol for documenting incidents and implementing corrective actions. At the core of these programs should be an appointed individual, the infection preventionist, who is tasked with overseeing the preventative measures, and was required to have undergone specialized infection prevention and control training.
Despite these initiatives, reports from the OIG suggest that several nursing homes have not fully complied with the requirements. Six nursing homes, in particular, did not designate an infection preventionist for considerable periods during the audit review, ranging from 30 to 311 days. One facility had in fact, not appointed any preventionist for the duration of the audit period.
When questioned, officials from these nursing homes emphasized the issues that impaired their compliance, highlighting several deterring factors. These included difficulties in recruiting and retaining qualified personnel, considerable changes in the ownership, administrative roles, and prevention staff, access to in-person or online training, and finally logistical issues in completing training on time, given the numerous roles and shifting regulatory demands.
Nursing homes’ staffing issues have become increasingly worrisome. Statistical data from a Health Affairs study reveals that in 2018, pre-pandemic, approximately 23% of nursing homes enlisted temporary agency staff, consuming nearly 3% of all direct care nursing hours. By 2022, that fraction had notably increased, with about half of all nursing homes resorting to agency workers, who accounted for 11% of all direct care nursing hours.
In a bid to enhance health outcomes for residents and lessen staff turnover, the Biden administration proposed a regulation requiring facilities to provide each resident a minimum of 3.48 hours of care per day, specifically with at least 0.55 hours delivered by registered nurses. However, nursing homes, citing acute nursing shortages, argued it would be a daunting task to fulfill these requirements.
In a dramatic response, Texas sued the Biden administration over the purportedly onerous regulation, warning that the significant costs associated with implementing the rule could lead to care facility closures across the state.
In the light of these challenges, there may be room for adjustments and modifications in ongoing regulations and policies, to better balance the essential safeguarding of patient health without jeopardizing the viability of such critical long-term care facilities.