Long-Term Care Has a Big Problem with Infection Control

April 1, 2021
April 1, 2021

Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care

The coronavirus pandemic has made the vulnerability of American long-term care facilities even more obvious. Not only are long-term care residents more susceptible to infection due to age or disease, but the very nature of the facilities, from their structure to how care is delivered, makes it easier for diseases to spread. Kaiser Health News reports that “More nursing homes have been faulted for failing to follow practices designed to prevent and control infections—such as staffers washing their hands before and after helping each resident and wearing gowns and masks around contagious patients— than for any other type of error” (Rau & Lucas, 2020).

CMS requires regular inspection of nursing homes, which occurs every nine to 15 months and involves a comprehensive evaluation. Kaiser Health also reports that “Infections are a persistent challenge for skilled nursing facilities. As many as 3.8 million occur in homes each year, killing nearly 388,000 residents. Bacteria and viruses can spread through urinary catheters used by immobile patients and attack patients through soft tissues exposed as bedsores or wounds” (Rau & Lucas, 2020). The numbers behind the infection problems are sobering. According to CNN/Kaiser Health News, an analysis of infection citation records since 2017 found  that “9,372 nursing homes, or 61%, were cited for one or more infection-control deficiencies... It also found violations were more common at homes with fewer nurses and aides than at facilities with higher staffing levels (Rau, 2020)

Even among nursing homes crowned with the maximum government rating of five stars for overall quality, 4 in 10 have been cited for an infection-control lapse” (Rau, 2020). Statistics like these have led to a concerted effort to reduce the toll of infection in this setting. An important measure is the “Centers for Medicare & Medicaid Services (CMS) final rule [requiring] that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP)” (Stone et al, 2018). Despite this requirement and other efforts, nursing homes will likely continue to struggle with infection for multiple reasons, ranging from understaffing and high rates of turnover, lack of sufficient staff education about infection prevention, and importantly, the extreme susceptibility to infection of this population.

In March 2020, CMS announced it was temporarily suspending non-emergency surveys in response to the COVID-19 Pandemic. When surveys resume fully, the agency has indicated that they will focus heavily on infection prevention and control. To help SNFs prepare, CMS has released an infection prevention-focused self-assessment, that nursing homes can use to identify issues and address them before surveys resume.


Rau, J., “Even without coronavirus, many highly rated nursing homes have infection-control lapses,” Kaiser Health News, March 4, 2020, Retrieved at https://www.cnn.com/2020/03/04/health/nursing-home-infection-control-coronavirus-partner/index.html.
Rau, J., andLucas, E., “How Well Does Your Nursing Home Fight Infections? Look It Up Here,” Kaiser Health News, March 13, 2020, Retrieved at https://khn.org/news/how-well-does-your-nursing-home-fight-infections-look-it-up-here/.
Stone, P., et al, “Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study,” Inquiry 2018 Jan-Dec; 55, Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5974557/.


This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

  • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
  • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
  • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures
  • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs
  • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans
  • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.