The Centers for Medicare & Medicaid Services has yet to create certain infection prevention standards for nursing homes, a federal watchdog complained Tuesday. The investigative group issued a critical report Tuesday, having made infection prevention recommendations to CMS months earlier.

The Government Accountability Office said in its report  that more than $4 trillion that federal agencies used to combat the COVID-19 virus and the various lockdown policies had been put into place by state and local jurisdictions. The agency’s review of data from the Centers for Medicare & Medicaid Services found that six of eight key indicators had improved slightly from 2020 to the 12-month report period, which ended in April 2023. But those indicators were worse when compared to 2019, the report said.

“Nursing home officials and national organizations we interviewed attributed this worsening, in part, to the isolation residents experienced from the limitations CMS placed on visitation or group activities in nursing homes during the pandemic to limit the transmission of COVID-19,” the report stated. 

Nearly 64% of nursing homes residents reported feeling depressed in 2020, compared to 61.5% in 2021. In addition, 19.3% of residents reported unexplained weight loss in 2020 compared to 17.4% in 2021, according to the report. In 2019, 60.2% of nursing homes residents reported feeling depressed and 15% experienced sudden weight loss, the report said. 

The report, “COVID-19: GAO Recommendations Can Help Federal Agencies Better Prepare for Future Public Health Emergencies,” had harsh words for CMS regarding infection prevention.

“[U]ntil CMS clarifies guidance on the scope and severity examples for infection prevention control deficiencies specific to COVID-19 and other respiratory diseases, state survey agencies will continue to face uncertainty about how to inspect nursing homes for adherence to infection prevention control requirements,” the report stated. 

The GAO recommended that CMS establish “minimum training standards” for IP and collecting staffing data to determine whether current staffing required in facilities is sufficient. It noted that CMS agreed with the recommendation to create training standards, but that the regulatory agency “neither agreed nor disagreed” with collecting staffing data and providing additional infection prevention and control guidance.

However, the report noted that the recommendations “remained open” as of March and suggested that Congress might need to get involved. 

Included under the GAO’s section headlined “Considerations for Congress,” the report said that a “growing body of work” shows that the pandemic exposed “longstanding” IP problems in nursing homes. 

“Sustained congressional oversight of agencies’ efforts to address the effects of the pandemic is important,” the report said. “As the nation moves forward, proper infection prevention and control procedures will remain critical to ensuring resident safety against not only the threat of COVID-19, but also other infectious diseases.”