Most nursing homes faced multiple, persistent outbreaks of COVID-19 among residents and staff, GAO reports

A health provider meets with a senior woman
Only 0.5% of certified nursing homes had never reported a COVID-19 outbreak as of January, per a new report. Forty-four percent experienced four or more outbreaks, and 85% said they had at least one outbreak lasting five or more weeks. (Getty/FG Trade)

U.S. nursing homes were frequently repeat victims of the COVID-19 pandemic with about 94% experiencing two or more outbreaks of the disease among residents or staff through January, a new report (PDF) from the U.S. Government Accountability Office (GAO) reveals.

Among a sample of 13,380 nursing homes, only 64 nursing homes (.5%) reported zero cases of COVID-19 to the Centers for Disease Control and Prevention (CDC), according to the GAO report.

One outbreak was reported among 761 homes (6%) while 5,943 (44%) reported four or more outbreaks over eight months of the pandemic. Collectively, the nursing homes averaged three outbreaks per facility.

“The Coronavirus Disease 2019 (COVID-19) pandemic has had a disproportionate impact on the 1.4 million elderly or disabled residents in the nation’s more than 15,000 Medicare- and Medicaid-certified nursing homes, who are often in frail health and living in close proximity to one another,” GAO wrote in the report. “While the introduction of vaccines and the sharp decline in nursing home cases and deaths since their peaks in December 2020 may indicate that nursing homes are seeing a reprieve, little is still known about the frequency and duration of COVID-19 outbreaks in nursing homes at critical points during the pandemic.”

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In addition to the high volume of outbreaks reported among nursing homes, the vast majority of facilities also had a hard time keeping their outbreaks under control, GAO wrote.

Just 267 homes were able to control their outbreaks after the initial week it was reported, while 2,005 (15%) needed up to four weeks to do so. The remaining 11,311 homes (85%) had at least one outbreak that persisted for five or more weeks.

A nursing home outbreak is defined by the CDC as beginning the week in which a new case among a resident or staff member is reported and ending when there are two weeks with no new cases.

The longer outbreaks peaked during October, November and December, GAO wrote, and generally reflected higher case counts among facilities. Homes with outbreaks lasting five or more weeks averaged 56 cases, whereas those reporting outbreaks shorter than five weeks averaged 13 cases per outbreak.

Nursing homes with long-duration outbreaks were more likely to have higher bed counts than those reporting outbreaks shorter than five weeks, the office wrote. However, it found no differences in outbreak duration based on a nursing home’s ownership—such as whether it was for-profit or government-owned—or if a home was cited for infection control and prevention deficiencies prior to the pandemic.

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Notably, GAO’s findings suggested nursing home staff were a common source of initial infection. Across the full sample, 8,720 homes (66%) reported that an outbreak began with a staff member who tested positive for COVID-19.

The office’s review included data from 88% of Medicare- and Medicaid-certified nursing homes. The homes reported these data to the CDC between the weeks ending on May 31, 2020 and Jan. 31, 2021.

GAO is directed to conduct these and other reviews of the country’s pandemic response under the CARES Act. The office plans to publish additional reports that “will examine more broadly infection prevention and control and emergency preparedness in nursing homes and CMS’ response to the COVID-19 pandemic,” it wrote.  

Among the federal government’s most recent pandemic monitoring efforts was a new interim final rule announced last week that will require nursing homes and long-term care facilities to report weekly COVID-19 vaccination data for both their residents and staff.

Nursing homes were hit hard early in the pandemic and as a result have shouldered a substantial share of the country’s COVID-19 mortality. Although residents and staff have accounted for just 4% of U.S. cases as of late April, more than 182,000 deaths tied to these facilities represent about a third of the country’s total COVID-19 deaths.