U.S. nursing homes that participate in Medicare and Medicaid will be getting a $5 billion infusion of “provider relief funds” from the Department of Health and Human Services, President Trump announced on July 22. The funds are meant to help with testing, purchasing personal protective equipment and hiring additional staff.
Nursing homes in “hot spots” like Florida, Texas, and California will be at the top of the list, according to The Seattle Times. The funding package also includes the distribution of additional rapid point-of-care diagnostic testing devices. The Center for Medicare and Medicaid Services also will begin requiring, rather than just recommending, that all nursing homes in states with a 5% positivity rate or higher test all nursing home staff each week. This new staff testing requirement is designed to better keep the virus from entering and spreading through nursing homes by identifying asymptomatic carriers.
CMS data for the week ending July 12 showed 142, 231 total confirmed COVID-19 cases, 90,600 suspected cases and 38,518 deaths from the virus in nursing facilities throughout the U.S.
“I am very glad that CMS is requiring testing, but I think the testing of all nursing home workers should be broader than (the 5% positivity rate) and mandated with penalties if nursing homes don’t comply,” said Charlene Harrington, Ph.D. R.N., professor emerita, Department of Social & Behavioral Sciences at the University of California, San Francisco.
“Also, I hope that CMS will mandate that the money is used for staffing, PPE and testing rather than giving them another blank check,” she said in an email. Harrington previously served as director of the California Division of Licensing and Certification for nursing homes and on the Institute of Medicine’s (IOM) Committee on Nursing Home Regulation.
Nursing homes have long been epicenters of the COVID outbreak. In Florida alone, 6,700 staff and residents at nursing homes and assisted living facilities have been infected with COVID-19 in July, a 129-percent increase, the Tampa Bay Times reports. Nationally, nearly half of COVID-19 deaths are nursing home residents and staff, according to Leading Age, the association of nonprofit providers of aging services, including nursing homes.
The “$5 billion for nursing homes from the Provider Relief Fund is a good next step, but any effort must be backed by a coordinated national plan that will help protect millions of older adults,” said Katie Smith Sloan, Leading Age president and CEO, in an emailed statement. “There are important unanswered questions about this program, including how far this funding will go to support the new mandate of increased staff testing.”
According to CMS, more than 15,000 testing devices will be deployed over the next few months to help support this mandate, with over 600 devices shipping this week. Funds from the Provider Relief Fund also can be used to pay for additional testing of visitors. CMS, in partnership with the CDC, is rolling out a self-paced, on-demand online nursing home COVID-19 training focused on infection control and best practices to help mitigate virus spread in their facilities. The training is a requirement for nursing homes to receive additional funding from the Provider Relief Fund Program and will be available for all 15,400 nursing homes nationwide. Specialized technical assistance will be available to nursing homes found to have infection prevention deficiencies in their most recent CMS inspection and have recorded recent COVID-19 cases based upon their data submissions to CDC.
“There is simply no replacement for rapid repeat testing when it comes to managing the virus in nursing homes,” Sloan said. “We’ve been talking about the critical importance of testing for months, in hope of getting federal support. Any little bit helps. But it is important to get this right. The lives of older adults and their care providers are on the line.”
Meanwhile, nursing homes in some states are cautiously opening up facilities to visitors, something they hope will help ease the social isolation and loneliness that many residents experience. Restrictions, such as maintaining distancing, temperature checks, mandatory masks and proof of negative COVID-19 tests, are among the requirements facilities are enacting to help ensure resident and worker safety. However, many families and residents are grateful to see each other in person after months of waiting, as this story in the Buffalo News describes.
“The visitors are certainly as safe as the staff and they can provide enormous benefits for the residents psychologically, as well as helping with eating, walking, toileting, etc.,” Harrington said.
Despite current safety precautions, many nursing homes are not doing enough to keep residents and workers safe. Asymptomatic workers, who live in the community and may be employed at more than one facility, can unknowingly transmit the virus to residents or co-workers, as Medscape reported. A recent poll from the California Health Care Foundation shows that a majority of nursing home workers in L.A. County have co-workers who have been infected with COVID-19.
“I think the nursing home spread is just going to continue because CMS is not being tough enough and clear enough with their requirements,” Harrington said.
According to Sloan, the most important question for millions of older adults and their families is whether this latest effort by the administration is yet another patch in the patchwork federal response seen so far or a signal that real relief is on its way. She said what is most needed is meaningful support from Congress in the next COVID-19 relief package and a comprehensive strategy from the White House.
“Aging service provides must be placed at the front of the line alongside hospitals,” she said.
Here are some issues to investigate in your community:
- Are local facilities are receiving adequate PPE and testing kits?
- The New York Times recently reported on some serious problems with PPE delivered from FEMA. Did your local facilities receive faulty gear?
- What about testing issues — some communities report extensive delays in turnaround time.
- What are facilities doing to foster communication between residents and families? Have they begun allowing visitors?