Clostridium difficile transmission and mortality rates are far higher in nursing homes and other healthcare settings than the most recent government statistics suggest, an investigation has found. However, strained nursing home budgets prevent facilities from hiring more nurses or infection control specialists.

The Centers for Disease Control and Prevention estimated in March that c. diff kills 14,000 people a year, based on death certificate records. A USA Today analysis of records from the federal Agency for Healthcare Research and Quality, however, found more than 30,000 c. diff fatalities per year, and suggests as many as 500,000 infections every year. The newspaper’s own analysis looked at hospital billing rates rather than death certificates, which do not always list the cause of death as complications from c. diff.

Due to the high volume of resident transfers, it can be difficult to pinpoint when and where c. diff infections start since the infection can originate in a hospital or in a nursing home, officials said.

U.S. hospitals will be required to report their rates of c. diff in 2013, but there are no such regulations — yet — for nursing homes.