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GAO-20-576R 1 (2020-05-20)

handle is hein.gao/gaobaebdg0001 and id is 1 raw text is: GAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 May 20, 2020 The Honorable Ron Wyden Ranking Member Committee on Finance United States Senate Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic Dear Senator Wyden: The Coronavirus Disease 2019 (COVID-19) originated in late 2019 as a new and highly contagious respiratory disease causing severe illness and death, particularly among the elderly.1 Because of this, the health and safety of the nation's 1.4 million nursing home residents-who are often in frail health and living in close proximity to one another-has been a particular concern. One of the first major outbreaks reported in the U.S. occurred in a Washington State nursing home in February 2020. Since then, there has been a rapid increase in the number of COVID-19 cases in U.S. nursing homes, with estimates of more than 25,000 deaths as of May 2020.2 The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), is responsible for ensuring approximately 15,500 nursing homes nationwide meet federal quality standards to participate in the Medicare and Medicaid programs. These standards require, for example, that nursing homes establish and maintain an infection prevention and control program.3 To monitor compliance with these standards, CMS enters into agreements with agencies in each state government-known as state survey agencies-and oversees the work the state survey agencies do. In general, CMS requires that state survey agencies conduct standard surveys, or evaluations, approximately once each year of the state's nursing homes and investigate both complaints 1Patel, A., Jernigan, D.B. Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak-United States, December 31, 2019-February 4, 2020. CDC Morbidity and Mortality Weekly Report. vol. 69: 140-146 (2020). 2For examples, see Kaiser Family Foundation, State Reports of Long-Term Care Facility Cases and Deaths Related to COVID-1 9 (as of May 7, 2020), May 7, 2020. Also, see K. Yourish, K.K.R. Lai, D. Ivory, and M. Smith, One-Third of All U.S. Coronavirus Deaths are Nursing Home Residents or Workers, New York Times, May 11,2020. 3At a minimum, nursing homes must (1) have a system to prevent, identify, report, investigate, and control infections and communicable diseases for all residents, staff, volunteers, visitors, and others providing services in the home; (2) have written standards, policies, and procedures for their infection prevention and control program; (3) have antibiotic use protocols and a system to monitor antibiotic use; and (4) have a system for recording incidents identified under the home's infection prevention and control program and any corrective actions taken. 42 C.F.R. § 483.80(a)(1)-(4) (2019). GAO-20-576R Nursing Home Infection Control Page 1

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