CHICAGO — Clinicians at Chicago-based medical group CIMPAR are urging nursing facilities nationwide to treat infection prevention and antibiotic stewardship as a unified clinical discipline rather than separate compliance exercises, as evidence mounts that a substantial share of antibiotic prescriptions in long-term care settings are unnecessary.
Approximately 70% of nursing home residents receive at least one course of antibiotics in a given year, according to reporting by Skilled Nursing News published April 14, 2026. Of those prescriptions, roughly 40% are inappropriate in drug choice, dosage, or duration — and about 8% involve broad-spectrum antibiotics that carry the greatest risk of accelerating drug resistance.
“We don’t have to track infections and stewardship separately, although a lot of that work that gets regulated is under the same bigger umbrella of federal regulation,” said Dr. Dheeraj Mahajan, president and chief executive of CIMPAR, in the report.
Mahajan and registered nurse Sylwia Jasniuk, both with CIMPAR, outlined practical benchmarks for facilities working to strengthen outcomes. Their recommendations center on monitoring point prevalence — the percentage of residents on antibiotics at any given moment — alongside therapy days per 1,000 resident days. These paired metrics give clinical teams a clearer picture of whether antibiotic use is rising, falling, or appropriately distributed across the resident population.
The CIMPAR clinicians emphasized applying established clinical criteria, specifically Loeb’s and McGeer’s criteria, to create evidence-based thresholds for when antibiotic treatment is medically justified. Facilities with certified medical directors, Mahajan noted, tend to achieve better quality outcomes in infection-related measures — a finding consistent with broader research on the value of credentialed clinical leadership in long-term care.
A Persistent Industrywide Challenge
The Centers for Medicare & Medicaid Services (CMS) requires nursing homes to operate infection control programs that include an antibiotic stewardship component, formalizing a standard that healthcare researchers have advocated for years. Despite the mandate, implementation varies widely across the roughly 15,000 skilled nursing facilities operating in the United States.
The Centers for Disease Control and Prevention (CDC) has developed a seven-element framework for antibiotic stewardship in nursing homes covering leadership commitment, staff accountability, access to drug expertise, policy adoption, prescribing tracking, regular reporting, and ongoing education. CDC guidance acknowledges that nursing home environments present distinct challenges compared to hospitals, including thinner staffing, more limited pharmacy access, and residents with complex comorbidities that can mimic infection symptoms.
Antibiotic-resistant bacteria infect at least 2 million Americans annually, according to CDC estimates, with roughly 23,000 deaths attributed to resistant infections each year. Long-term care facilities are considered high-risk environments for the development and spread of resistance, given the concentration of vulnerable residents and the frequency of antibiotic use across the population.
Economic analyses have reinforced the clinical case for stewardship programs. One study found that formal antibiotic stewardship saved $28 per resident in direct drug costs over the study period, and when accounting for the costs of treating antibiotic-related adverse health events, total savings reached $1,098 per resident.
Benchmarking and Collaboration
CIMPAR’s guidance emphasizes self-benchmarking — comparing a facility’s own prescribing data against prior performance and against peer organizations — as a foundation for improvement. Collaboration with local health departments and hospital partners has also emerged as a practical strategy for building stewardship capacity in facilities that lack internal clinical expertise.
The Illinois Department of Public Health has previously funded CIMPAR to deliver antimicrobial stewardship education across the state’s long-term care sector, reflecting growing recognition that the problem requires coordinated action beyond individual facilities.
Training for frontline nursing staff is viewed as particularly critical. Clinical criteria alone are insufficient if the nurses most likely to notice early signs of infection do not have clear guidance on applying evidence-based decision tools before initiating antibiotic treatment.
Why This Matters for Home Care
For families supporting loved ones with serious medical needs at home rather than in a skilled nursing facility, avoiding the infection exposure common in institutional settings is one of the practical advantages of home-based care — but it depends on creating a home environment that supports attentive, consistent care.
For families managing long-term or complex care needs at home, having the right equipment is a foundational part of that environment. SonderCare home hospital beds are certified to International Hospital Standard and feature the FallSafe Ultra-Low height system — designed to reduce fall risk, support safer transfers, and allow caregivers to maintain proper positioning that reduces complication risk. Explore the full range of home hospital beds at sondercare.com/beds/.
If your family is navigating long-term care at home, SonderCare’s care specialists can help identify the right bed configuration for your situation. Visit sondercare.com/beds/ or call to speak with a care expert.
Sources: Centers for Disease Control and Prevention, Core Elements of Antibiotic Stewardship for Nursing Homes; Centers for Medicare & Medicaid Services.
