Nursing home advocates are raising the alarm that states are reopening their economies without the ability to protect residents.
Nursing homes have been devastated by COVID-19, and advocates say states and the Trump administration have failed to ensure operators are protecting the most vulnerable.
According to a Kaiser Family Foundation analysis of publicly reported data, more than 30,000 people have died in nursing homes and other assisted-living facilities due to COVID-19. This would account for 41 percent of all COVID-19 deaths in the country.
Industry groups and advocates worry that nursing homes don’t have enough protective gear, or the ability to test every resident and staff member, two essential keys to eventually reopening safely.
“The reality is that too many nursing homes and other aging services providers are still desperately in need of testing and personal protective equipment (PPE), and we don’t know when or if it’s coming,” Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit aging services providers, said in a statement.
The administration released detailed guidance on Tuesday and urged states to exercise extreme caution in reopening nursing homes, but just like President Trump’s guidelines on lifting state restrictions, the decisions are up to individual governors.
“I think in some ways it makes sense to leave it up to states, but the failure to have a [set] policy for what we expect states and nursing homes to be doing has been problematic and exacerbated the problems,” said Richard Mollott, executive director of the Long Term Care Community Coalition.
The administration recommended that nursing homes should be “among the last” institutions to reopen in a community, and that adequate protective gear and staffing is needed first.
No nursing home in any state should start to reopen or relax any restrictions until all residents and staff have received a base-line negative test, the guidelines said.
The ultimate goal for states is to reopen nursing homes to allow visitors back in. But with tens of thousands of people dead over just three months, advocates and experts are skeptical that can happen without a significant federal investment in testing and infection control measures.
“Everything is based on accurately knowing where the virus is. Unless we test everyone, we’re not going to know where it is,” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, a group that advocates for nursing home residents.
“Each state is trying to figure out on its own what to do. But there’s not a national plan. We need better leadership at the federal level,” Edelman said.
Part of the problem is the patchwork of nursing home oversight. While the federal government has oversight of some facilities, most nursing home oversight is conducted by states. Almost 70 percent of the country’s nursing homes are run by for-profit companies, with the rest run by nonprofit companies.
Nathan Boucher, an assistant research professor in the Sanford School of Public Policy at Duke University, said the federal government should have ultimate responsibility.
“If this is a North Carolina problem, I would say North Carolina should be responsible, but this is … affecting the whole country so I definitely think there needs to be a lot more federal leadership in this,” Boucher said.
“Everybody has to be working in unison to make this happen, the ownership of the facility working with the state, and then getting help from the federal level,” Boucher said.
The Trump administration on May 11 recommended to governors that every nursing home resident and staff get tested over the next two weeks, but did not mandate it.
A senior administration official said there was no need for a federal mandate. During a recent call with reporters, the official said the administration has “fully supplied” states with the testing kits needed to investigate COVID-19 outbreaks in nursing homes
“If there needs to be a heavier hand moving into the future, I don’t think there will be, but we’re always prepared to do that,” the official said.
The administration is also sending a two-week supply of PPE to more than 15,000 Medicare and Medicaid-certified nursing homes across the country.
A growing number of states have begun to mandate testing, but the decision is coming nearly two months into the pandemic.
New York, which leads the country in nursing home deaths, announced mandatory testing on May 10.
Every staff member must be tested twice per week, and Gov. Andrew Cuomo (D) has guaranteed the tests will be available to those employees. He will be sending 320,000 testing kits to homes across the state.
But testing is just one part of how states and nursing homes should be prepared to protect their residents, and not every state has the ability to pay for the tens of thousands of testing kits needed to ensure bi-weekly tests.
“I’m not sure you can practically do testing every day. I don’t think that would be feasible,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told senators in recent testimony.
Fauci said nursing homes will need to develop surveillance capabilities, to both prevent infections from entering, and to isolate someone if they do become infected.
“In the long range, we will have to have infection control capabilities in nursing homes that are really pristine and really unassailable. General testing for all is a good start but when you look where are you going to go in the future, there needs to be a significant degree of surveillance capability,” Fauci said.