A new report from the US Government Accountability Office (GAO) shows that the average COVID-19 nursing home outbreak in 2020 to 2022 lasted 4 weeks and was strongly tied to community spread, with the longest outbreaks in government-owned facilities with more than 100 beds and staff shortages.
The GAO analyzed data from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid (CMS) on the nation's 15,281 Medicare- and Medicaid-certified nursing homes from June 2020 to December 2021. The agency also interviewed researchers, national nursing home associations, state officials, and leaders at six nursing homes in California, Florida, Maryland, and Michigan.
Most began with staff case
The nursing homes each experienced 1 to 16 outbreaks, with an average of 7.6 and a total of 102,992. The surges lasted, on average, 4 weeks, ranging from 1 week (42% of total outbreaks) to 53 weeks (less than 1%). Nearly all nursing homes (91%) had at least one surge of 5 or more weeks.
The strongest factor in the length of an outbreak was community spread, with those in nursing homes in areas with low COVID-19 transmission seeing surges that were 7 days shorter than those in areas with high transmission.
Most outbreaks (75%) began with a report of a staff infection. "These results could indicate that, during times of higher community spread, staff have a greater likelihood of being exposed to the virus in the community and bringing it into the nursing home," the report said.
Officials at five nursing homes described staff shortages during case surges, with one official noting that at one time, staffing was down 25%. Three officials discussed difficulties in maintaining good morale amid traumatic circumstances that took the joy out of caregiving.
"Nursing home residents are at a high risk of infection and death due to COVID-19, as older adults and those with underlying health conditions are at a higher risk of severe disease," the GAO said. "In addition, the congregate nature of nursing homes increases the risk of transmission."