Financially , assistance came from billions of dollars in payments from the Provider Relief Fund , established with funds provided under the CARES Act and other COVID-19 relief laws , as direct payments to assist nursing homes with responding to COVID-19 .
As of Jan . 15 , 2021 ,
$ 5 billion in Provider Relief Funds had been allocated for nursing homes and
$ 4.764 billion had been disbursed .
• expand beyond conducting targeted infection control surveys and high-priority complaint investigations to include lower-priority complaint investigations . On Aug . 17 , 2020 , CMS revised this guidance to authorize traditional , comprehensive , standard surveys and lowerpriority complaint investigations as soon as state survey agencies have the resources , such as staff and PPE .
Financially , assistance came from billions of dollars in payments from the Provider Relief Fund , established with funds provided under the CARES Act and other COVID-19 relief laws , as direct payments to assist nursing homes with responding to COVID-19 . As of Jan . 15 , 2021 , $ 5 billion in Provider Relief Funds had been allocated for nursing homes and $ 4.764 billion had been disbursed .
Despite relief efforts , nursing homes are facing myriad challenges relating to post-pandemic imperatives .
“ Low census is a concern , but I feel it is slowly improving ,” Tuders says . “ Sufficient staff is also a challenge in many areas . The work is hard and the pay not stellar . I think with some of the unemployment expansions and other perks , many people are getting along just fine without a job . Before the pandemic we knew the requirement was coming for a trained infection preventionist , so we were preparing for that mandate . However , when COVID hit , it became our main focus . Many other priorities were no longer priorities , so we did have to scramble a bit earlier this year to assure compliance .”
Ongoing pain points include helping nursing leadership survive and attempt to thrive in the “ new normal ” going forward .
“ We are trying to provide ongoing support for our leaders in the facilities ,” Tuders says . “ They are multi-tasking like never before , trying to increase census , hire staff , monitor for COVID-19 , get N95 masks test-fitted for new hires , be ready each day for any one of a multitude of surveys for licensure , a complaint that often was self-reported , their annual survey which is likely more than 20 months late and there is also a 20 percent chance a facility could receive an infection control survey under CMS guidance from last year . I do not think anyone in a leadership position in long-term care would say the survey environment is stress-free . It is tough .”
Tuders continues , “ My hat goes off to all the staff who work tirelessly in long-term care . They are juggling so many critical pieces when the world stood still for COVID-19 . You must have energy , commitment , be able to multi-task , and most importantly have a sense of humor . I have found most people who work in long-term care do it for the love of the residents .”
Tuders says that the pandemic provides an opportunity to move long-term care from being seen in a negative light to one in which it is better understood and appreciated .
“ Long-term care has 500 regulations that must be met daily ,” she emphasizes . “ The only other industry that is higher is nuclear power plants . We need respect and some understanding of the year we lost to COVID-19 when that was our main priority . I think the regulatory process could ease up a bit as we transition back into being able to focus on more than COVID-19 as our cases decrease and we begin to digest the fact this disease is the new normal . It feels to me the regulatory process has gotten more stringent than ever before and at a time when hiring staff is already a challenge . The work is physically demanding and often very stressful . It is not glamorous work but life-enriching . We lose staff to hospitals who can pay more due to the much higher reimbursement they receive ; a battle it seems we will never win . If we truly want to provide the best care possible to our residents , we need to pay our staff better and look at some of the regulations to see if they are truly necessary . I would like to say thank you from the bottom of my heart to all those who have stayed the course for the residents they love – you are all true heroes .”
Let us examine the issues facing long-term care in greater depth .
Nursing homes with ...
... no deficiencies cited for infection prevention and control
18 % ( 2,967 )
... an infection prevention and control deficiency cited in one or more years
82 % ( 13,299 )
Source : GAO analysis of Centers for Medicare & Medicaid Services ’ ( CMS ) data . | GAO-20-576R
Clinical Challenges
It has been estimated that 1.6 to 3.8 million healthcare-associated infections ( HAIs ) occur in nursing homes annually . GAO , as well as the independent Coronavirus Commission for Safety and Quality in Nursing Homes and many others have affirmed the ongoing , systemic problems that underline the difficulties of preventing and treating infections in nursing homes .
Grabowski ( 2019 ) summarizes the causes of poor care practices : “ In the context of staff shortages , nursing homes often use labor-saving practices to deliver care . These labor-saving practices are typically associated with a greater risk of morbidity and mortality . For example , managing incontinence maybe labor-intensive , through regularly scheduled toileting and bladder rehabilitation , or labor-saving through urethral catheterization . Urethral catheterization