States Pandemic Guidance To Nursing Homes Confusing And Conflicting, Auditor Finds

Delaware’s long-term care facilities, which have been disproportionately affected by the COVID-19 pandemic, needed clearer guidance and assistance from the state during the early stages of the pandemic, State Auditor Kathy McGuiness said today.

“My team reviewed publicly reported COVID-19 data at the state and federal levels, and they surveyed and interviewed long-term care facility administrators,” McGuiness said. “What we learned was that confusing and sometimes conflicting guidance from state and federal officials led those administrators to ask the state many questions – and those imperative questions were often not answered in a timely manner.

In a new special report, titled “Unanswered Questions: Improving Technology, Communications, and Reporting in Long-Term Care Facilities During the Pandemic,” McGuiness highlights three observations about COVID-19 reporting by and communication to the state’s long-term care facilities (LTCFs):

  1. Pandemic information: COVID-19 guidance changed frequently, came from multiple sources, was hard to interpret or was completely absent.
  2. Crisis communications: When faced with difficult situations, LTCFs were unable to contact or receive timely assistance from state health agencies.
  3. Pandemic reporting: Data reported to the federal government did not match data reported through state Department of Health and Social Services (DHSS) news releases; 18 LTCFs were not reporting data to the federal Centers for Medicare & Medicaid Services (CMS).

“Long-term care facility residents are among those most affected by the COVID-19 pandemic,” McGuiness said. “Regardless of whether you look at state or federal data, that much is clear.”

McGuiness pointed out that her team’s research shows that state health officials have worked diligently to provide guidance to LTCFs since the beginning of the pandemic.

“I applaud Delaware’s health officials for their tireless work over the last year to guide Delawareans through this pandemic,” McGuiness said. “This special report is meant to help state health officials see specific areas related to long-term care facilities so they can improve their communication, guidance, and data reporting to provide an accurate picture of how these facilities’ residents and staff are being affected.”

To make her determinations, McGuiness directed her team to survey LTCF administrators about the guidance and assistance their facilities received both at the beginning of the pandemic and six months later. The team also reviewed federal and state guidance provided to LTCFs during those time periods, as well as publicly available data on and on Delaware’s official website,

The new special report, which offers six recommendations for improvement, can be found on the Auditor’s Office website here.

Under Delaware Code 2909, the Auditor of Accounts may produce special reports that examine state agencies’ performance and offer recommendations for greater accuracy and efficiency, as well as data, information, and recommendations the auditor deems advisable and necessary.

Source: State Auditor