COVID-19 Testing In Nursing Homes and Senior Care Facilities

Over the past several months while the coronavirus pandemic has raged on, one of the hardest hit sections of the U.S. population has been seniors living in nursing homes and other long-term care facilities. For many of these older adults, underlying medical conditions put them at high risk of negative outcomes and death if they’re infected, and the population density and range of people they come into contact with regularly makes transmission from person to person within the community easier.

“Nursing home populations and residents in long-term care facilities, as well as the people that work there, are ultra-high-risk for contracting the virus. And the residents are at really high risk for experiencing severe disease, if not death,” says Dr. Anuj Mehta, a pulmonary and critical care physician at National Jewish Health in Denver and a member of the medical advisory group of the Governor’s Expert Emergency Epidemic Response Committee in Colorado, which is helping develop the state’s public health plan and policies for dealing with the pandemic.

[READ: Safety Measures at Assisted Living Communities.]

Health Crisis

This extra high risk and the highly contagious nature of this virus has amounted to a real crisis in nursing homes and long-term care facilities around the country. The Centers for Medicare and Medicare report that as of mid-October, there have been about 246,000 confirmed COVID-19 cases within nursing homes and nearly 142,000 additional suspected cases.

The death toll so far exceeds 58,480 among residents. Data curated by the New York Times notes that the death toll among residents and staff at these facilities exceeds 77,000, accounting for more than 40% of all COVID-19-related deaths in the United States.

In an effort to slow the wildfire-like spread of the disease throughout these facilities, back in July, CMS announced plans to dispense on-site COVID-19 testing units to all nursing homes across the country.

The kits arrived with starter supplies and guidelines recommending that staff be tested weekly to identify any ill workers, as these individuals often work at multiple nursing homes and may come into contact with dozens of residents daily. The hope was that the on-site testing would provide more opportunities for testing staff and residents and would provide results faster. All told, the CMS initiative estimated it would lead to 4 or 5 million tests per month. Some nursing homes in hotspot areas are churning out hundreds of tests per week, which has become an onerous mandate for some.

In August, CMS announced stricter requirements for testing in nursing homes. The agency announced that “facilities that do not comply with the new requirements will be cited for non-compliance and may face enforcement sanctions based on the severity of the noncompliance, such as civil money penalties in excess of $400 per day, or over $8,000 for an instance of noncompliance.”

CMS also issued a requirement for staff testing in order for a nursing home to receive Medicare and Medicaid reimbursement, thus putting some teeth behind requirements for routine staff testing. However, noting how some homes are making good faith efforts to test as much as possible within the constraints of staff time and available funding, the CMS has promised to use discretion before imposing fines on facilities that are attempting to meet their mandates.

The increased emphasis on testing is intended both for residents and staff, and the idea is that finding out who has the disease as soon as possible and getting them into quarantine right away can reduce the number of subsequent positives.

Dr. Howard Saft, a pulmonologist with National Jewish Health and director of the Colorado Long-Term Acute Care Hospital, both in Denver, says that “a lot of asymptomatic folks can spread the disease early,” and so testing early and often has helped improve the situation inside nursing homes. “Nursing homes are doing a lot of testing on a regular basis. The rapid testing has really, really helped a lot, and it’s had a huge impact on helping to control the spread.”

Increased testing has also provided some peace of mind for health care workers at these facilities. Many of these people must work very closely with residents, helping them with bathing, taking medicines and therapy. As a result, they are at high risk of catching the virus from a patient who’s infected. “They don’t want to spread it to patients, and they don’t want to spread it to their colleagues,” Saft says. “They also don’t want to get it themselves, so (frequent testing) helps to just reassure them.”

[Read: Helping Nursing Home Residents Overcome COVID-19 Isolation.]

Frequent Testing Is Expensive

While the increased testing has helped slow the spread of the virus through long-term care facilities, across the board, it has added costs and complexity for nursing home operators.

During a September 9, 2020, press conference hosted by LeadingAge, a member organization representing the field of aging services, Pam Koester, president and chief executive officer of Arizona LeadingAge, detailed some of the challenges nursing homes and other long-term care facilities are dealing with.

“Providers are spending approximately $83,000 per month on testing alone,” she said. Add that to the “$67,000 per month on PPE requirements and precautions” these faculties are spending on average for other pandemic-related needs, and you’re looking at a major crimp in the budget of many communities. In some cases, these costs are already being passed on to residents to make up the shortfall, and as the pandemic continues, those costs may increase.

Certainly, she adds “frequent testing is key to mitigating the spread of the virus,” but she says some of her members have reported problems with the testing machines provided by the federal government. “We have heard of numerous instances of the machines not being reliable or accurate.”

What’s more, “they’re labor intensive for an already short-handed workforce” that needs to be trained on how to properly use the machine. Additional materials, such as collection swabs, have also been in short supply, and ordering more supplies adds further costs. To help solve these issues, Koester called for more robust financial support from the government for nursing homes to keep residents and staff safe.

Another challenge as we head into the wintertime is how respiratory viruses tend to spread more readily when we’re indoors. Many facilities have severely limited visitation, which has been difficult for many residents. And some facilities are trying to find better ways of allowing families to visit while keeping residents safe this winter.

Saft says increased testing is part of the answer and can help nursing homes optimize trying to balance how to serve the needs of residents and their families while also keeping them safe. It’s not perfect, and many facilities are struggling to keep up with reporting requirements and added costs. But having the ability to test staff and residents and get results faster has helped facilities develop quarantine policies that work.

“Early on, there were a lot of challenges because people were a lot more fearful about some of the uncertainties. But I think now things are starting to settle down and settle out” as we’ve learned more about how the virus is transmitted and testing results are now coming back more quickly, Saft says.

More robust screening of people who come into the facility to check for symptoms or potential exposure has also helped keep residents safer by checking the virus at the door. Such measures have helped some facilities liberalize visitation policies, but these adjustments are being made at the facility level. There’s a lot of variation from one location to another, and some facilities are still struggling with containing this virus while attending to the needs of residents.

[READ: Assisted Living Checklist.]

What to Know If Your Loved One Lives in a Nursing Home

If you have a loved one in a nursing home, Saft recommends checking in with leaders there to make sure they’re following federal guidelines regarding infection control and testing. “Make sure they’re following these guidelines for using testing and screening. Ask how they’re screening employees and visitors,” and find out how they’ll handle it if a staff member or resident tests positive for the virus.

Some questions you can ask may include:

— Are residents who test positive moved to a separate quarantine area away from other residents who don’t have the virus?

— What sort of medical care will be provided?

— At what point will an ill resident be transported to the hospital for further treatment?

— How long must staff members remain away from the facility if they test positive?

— What sorts of disinfection and cleaning protocols have been established to help fight the spread of the virus?

And if your loved one tests positive for the coronavirus, Saft says it’s important not to panic. “There’s hope.” Since the pandemic began, he notes that research and development has created better treatments. “Combining the wisdom and evidence together” has resulted in improved outcomes versus earlier in the pandemic, even for older patients with underlying conditions.

For example, he says, “we had an 83-year-old great-great-grandmother in our clinic. Her family was told that she wasn’t going to make it, but she did. She’s doing great. She’s still working though some weakness and some other things,” but she survived and is progressing well. He adds that “getting the right level of care when it’s needed” is a big piece of helping elderly adults survive this pandemic.

For his part, Mehta notes that while testing is an important piece of containing the virus, a vaccine is really the best way to make life in long-term care facilities and nursing homes less risky. “Rather than testing, it’s going to be getting (residents and staff members) a vaccine as early as possible based on supply to protect those populations.” That will be the real game-changer.

While testing can help identify emerging hot spots, such as “a specific nursing home where there’s more burden of disease,” the best offense is a good defense. “We have to think about vaccinating everybody in that nursing home to address that individual hotspot.”

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