tered shared decision-making . Furthermore , different funding streams and oversight authorities complicate matters for owners and administrators trying to understand to whom they should go for additional help . Well-intentioned incentives may inadvertently create unintended consequences , such as care paradigms that are not person-centered or person-driven . Because reimbursement rates are higher for placing residents with COVID-19 in a room alone ( as compared to placing residents with a COVID-19 positive group ), nursing homes administrators may be more likely to isolate residents prematurely , contrary to resident-expressed desires to remain with other residents with the same infection status . During an outbreak , there may be insufficient time and funding for additional staff training on COVID-19 and other infectious-disease protocols . And , with limited staff available on a day-to-day basis , surge support often is unavailable to nursing homes in times of crisis . Staff members , already stretched thin , become more taxed while working on the front lines of the crisis — and subjecting themselves and their families to increased risk of contracting the disease . Nursing home staff have been asked to deploy themselves and their limited resources in new ways and with Herculean effort — a scenario likely to exacerbate turnover and staff shortages in the long term .”
“ The most pressing issues currently are the need for staff and vaccination compliance ,” emphasizes consultant Nancy Tuders . “ We still have COVID-19 . I do not think the public is aware of that . We may have no cases for a week or two but then a resident or staff is positive . It has slowed down , but it is far from gone . We are still in face shields or goggles , masks , gowns and gloves . I believe the last numbers I saw was 40 percent of staff are vaccinated . Staff are leery of getting vaccinated . They say the vaccine was rushed through and not enough is known about the long-term side effects . Mandating staff to get the vaccine would increase resignations and the LTC industry is already in desperate need of more staff .”
While significant pockets of need still exist in long-term care facilities , when it comes to pandemic response efforts , GAO points to how the Department of Health and Human Services ( HHS ), primarily through CMS and CDC , has taken a series of actions to address COVID-19 in nursing homes , such as providing guidance to these facilities on infection control practices and issuing waivers and regulatory flexibilities . For example , in March 2020 CMS waived the requirement that a nursing home not employ nurse aides for more than four months unless they meet certain training and certification requirements – a step taken to address potential staffing shortages . ( GAO , 2021b )
Other actions included temporarily suspending state survey agencies ’ standard surveys and many complaint investigations , instead shifting to targeted infection prevention and control surveys and high-priority complaint investigations . On June 1 , 2020 , CMS issued survey re-prioritization guidance as part of its nursing home reopening strategy . Specifically , once a state enters phase 3 — a threshold based on factors including case status in the community and the nursing home , as well as access to testing , PPE , and adequate staffing — state survey agencies were authorized to
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