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GAO-21-367 Published: May 19, 2021. Publicly Released: May 19, 2021.
COVID-19 has had a disproportionate impact on the 1.4 million residents who live in nursing homes in the U.S.
We looked at the frequency and duration of COVID-19 outbreaks in nursing homes from May 2020 through January 2021. A nursing home outbreak begins when a nursing home reports a new case among residents or staff and ends when the home has two consecutive weeks with no new cases.
We found that during this 8-month period:
- Nursing homes in our review had an average of about three outbreaks
- 94% of nursing homes in our review experienced more than one outbreak
- 85% of the nursing homes we reviewed had an outbreak lasting 5 or more weeks
What GAO Found
GAO analysis of data from the Centers for Disease Control and Prevention (CDC) shows that, from May 2020 through January 2021, nursing homes commonly experienced multiple COVID-19 outbreaks. According to CDC, an outbreak starts the week a nursing home reports a new resident or staff COVID-19 case and ends when there are 2 weeks with no new cases. GAO found that nursing homes had an average of about three outbreaks during the review period, with most of the nursing homes (94 percent, or 12,555 of the 13,380 nursing homes) experiencing more than one COVID-19 outbreak.
Note: Percentages may not add to 100 due to rounding. Data are from the weeks ending May 31, 2020, through January 31, 2021. An outbreak begins when a nursing home reports a new case of COVID-19 in residents or staff.
For each nursing home's longest-lasting COVID-19 outbreak, GAO found that about 85 percent (11,311 nursing homes) had outbreaks lasting 5 or more weeks. Conversely, for about 15 percent of nursing homes (2,005 homes), the longest outbreak was shorter in duration, lasting between 1 and 4 weeks, with 267 of those homes able to control their outbreaks after the initial week.
- The average number of COVID-19 cases per outbreak for nursing homes with a long-duration outbreak was 56, while the average for nursing homes with a short-duration outbreak was 13.
- For both long- and short-duration outbreaks, over half of the nursing homes (66 percent, or 8,720 homes) reported that these outbreaks began with a staff member who tested positive the first week.
Note: Of 13,380 nursing homes reviewed, 13,316 nursing homes had COVID-19 outbreaks and 64 nursing homes did not. Data are from the weeks ending May 31, 2020, through January 31, 2021.
Why GAO Did This Study
The 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. The Centers for Medicare & Medicaid Services (CMS) is responsible for ensuring that nursing homes nationwide meet federal quality standards.
The CARES Act includes a provision directing GAO to monitor the federal pandemic response. GAO was also asked to review CMS oversight of nursing homes in light of the pandemic. This report describes the frequency and duration of COVID-19 outbreaks in nursing homes. Future GAO reports will further examine nursing homes' experiences with COVID-19 outbreaks.
To conduct this work, GAO analyzed CDC data on COVID-19 reported by nursing homes each week of the review period from May 2020 through January 2021, the most recent data available at the time GAO conducted its review. Using CDC's definition of an outbreak, GAO determined the number and duration of outbreaks each nursing home experienced during the review period. GAO included data from the 13,380 Medicare- and Medicaid-certified homes (88 percent of Medicare- and Medicaid-certified homes) that passed CDC and CMS quality checks each week of the review period—the most reliable data for calculating the number and duration of outbreaks. GAO also categorized the nursing homes into two groups based on the duration of their longest outbreak: 1) those nursing homes with outbreaks lasting less than 5 weeks and 2) those nursing homes with outbreaks lasting at least 5 weeks.
For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
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COVID-19 in Nursing Homes: Most Homes Had Multiple Outbreaks and Weeks of Sustained Transmission from May 2020 through January 2021 - Government Accountability Office
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