Trump officials may undo nursing home mandates for reporting COVID
Advocates for nursing home residents reacted with dismay to the proposed rollback.
Nursing homes would no longer be required to report each week how many residents were stricken by COVID-19 and other respiratory diseases, under a Trump administration plan to repeal a key public health response to thousands of pandemic deaths.
A draft summary of the proposed rule obtained by The New York Times outlines how the administration agrees with the industry’s objections to weekly reporting of viral caseloads, calling it burdensome. In its waning days, the Biden administration made COVID reporting rules permanent, adding influenza and respiratory syncytial virus to the list of threats that facilities also must track and record. The policy took effect in January 2025.
Advocates for nursing home residents reacted with dismay to the proposed rollback. Elderly, frail residents are especially vulnerable to infections, and they live in close quarters, where viruses can spread rapidly.
“That’s crazy,” said Sam Brooks, director of public policy at the nonprofit National Consumer Voice for Quality Long-Term Care. “We know, if anything, that respiratory disease has a disproportionate and deadly impact on nursing home residents.”
He said the Centers for Medicare and Medicaid Services, or CMS, which regulates nursing homes, would be blinding itself to an important method for tracking infection control and pinpointing problems.
The administration has cut back on data updates at other agencies, including the Centers for Disease Control and Prevention, where a study published this year found that databases related to vaccine and respiratory diseases had gone dormant.
Nursing home industry representatives declined to comment on specifics, because the changes have not been announced. They contend infection reporting consumes too much staff time and is duplicative, because infection data is reported to the federal government and states in other ways.
CMS, which drafted the plan, declined to discuss the proposal or disclose when it would be made public.
During the peak years of the pandemic, from early 2020 through early 2022, more than 200,000 nursing home residents and staff members died after being infected by coronavirus, according to KFF, an independent health policy organization, which cited CDC data.
The high death toll has been attributed in part to a lack of preparedness and weak infection controls. The Government Accountability Office said in 2020 that inspectors had cited 82% of nursing homes for infection control deficiencies from 2013 to 2017, and that half of those were found to be repeat violators.
In the internal document obtained by the Times, Dr. Mehmet Oz, the director of CMS, recommended to his boss, Health Secretary Robert F. Kennedy Jr., that the agency pursue steps to undo the mandate.
“The agency does not comment on purported internal or predecisional deliberative materials,” a CMS a spokesperson said in an email. He said the agency evaluated regulations to ensure they “allow providers to focus time and resources on delivering care rather than unnecessary administrative burden.”
The draft memo from Oz to Kennedy said CMS would reserve the power to reinstate weekly reporting if another public health emergency occurred.
The plan also would end a requirement that nursing home staffs be educated about COVID vaccines and offered the shots. Groups representing residents called the move unwise, pointing out that front-line caregivers were a key pathway for the coronavirus to enter nursing homes during the height of the pandemic. COVID vaccine rates among staff members in recent years have been below 10%, the CDC has reported.
The administration plan would continue to mandate that facilities offer the COVID vaccine to residents.
The nursing home industry has already achieved its biggest goal of President Donald Trump’s second term: After a heavy lobbying blitz, the administration last year scrapped Biden-era minimum staffing rules that were intended to improve resident care.
Biden officials, in pushing the staff minimums, had cited COVID deaths along with decades of concerns about poor care, including deaths from bedsores, falls and medication errors. But the Trump administration said too many nursing homes, especially in rural areas, could not find enough staff to satisfy the requirements. Many workers who care for the elderly are typically paid less than janitors and retail employees, and the work can be grueling.
With the proposed change on infection reporting, the administration anticipates favorable reaction from the industry, according to the draft memo.
Two main nursing home lobbying groups — the American Health Care Association and LeadingAge — reiterated their opposition to weekly respiratory infection reporting, saying that other government programs track COVID infections and that respiratory illnesses are reported to many local health departments.
“This outdated reporting requirement is only adding hours of unnecessary administrative tasks to caregivers each week” said Holly Harmon, the American Health Care Association’s senior vice president of quality, regulatory and clinical affairs. “It’s time to streamline public health reporting and put patients over paperwork.”
But industry critics contend that operators are failing to heed the lessons of the pandemic. With low staffing levels and high turnover, infection control efforts are most likely in line with the prepandemic patterns flagged by the GAO, said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy.
“I don’t think there is any reason to believe they have beefed up what they are supposed to be doing,” Edelman said.
