For five months, Georgia’s nursing homes and assisted living facilities have operated in lockdown mode. Visitors aren’t allowed. Residents are confined largely to their rooms, with no communal dining or group activities. Only workers can come in and out.
In spite of the extreme measures, COVID-19 cases inside the homes have been trending sharply upward in recent weeks. Senior care operators know their workers are more likely than ever to bring the virus into a facility because rates are so high in communities throughout Georgia and finding adequate supplies of masks, gowns and gloves can still be a challenge.
The facilities are also still struggling to get the rapid, reliable testing they need to battle the virus, with recent backlogs at labs delaying test results for up to a week. “It’s so critical to get those tests back within 48 hours,” said Neil Pruitt Jr., CEO of PruittHealth, one of the largest senior care operators in the Southeast. “If we get them back in seven days, it’s too late.”
Such delays in identifying a COVID-positive worker can have grim consequences. It’s still routine for nursing homes to report large, sudden outbreaks and multiple deaths, with dozens of residents and workers testing positive, the AJC found in reviewing state and federal reports.
Yet federal and state support for testing has fallen far short of what’s needed to protect long-term care residents.
To enable nursing homes to run rapid tests onsite, the U.S. Department of Health and Human Services has begun sending the facilities “point-of-care” testing systems. In conjunction with the shipments, the Centers for Medicare and Medicaid Services, the agency that regulates nursing homes at the federal level, is preparing to impose a new requirement that the facilities in COVID-19 hot zones conduct weekly checks of nursing home workers.
But HHS will provide only an initial supply of test kits, it is likely to take months for the systems to arrive in every nursing home in the nation, and the rapid-result systems come with a high rate of false negatives. Plus, assisted living facilities and personal care homes, which are regulated at the state level, aren’t included in the federal plan.
Credit: Photo courtesy of A.G. Rhodes
Credit: Photo courtesy of A.G. Rhodes
Some other states — including Florida and Tennessee — are mandating frequent testing and equipping homes with test kits or paying for testing. But Georgia stopped sending test kits out with the National Guard weeks ago, and the state has announced no plans to help long-term care homes with testing going forward.
That has left Georgia’s senior care operators, whose residents are the most at-risk of death during the pandemic, largely on their own to decide how often their residents and workers should be tested and figure out a way to pay for it.
Some experts say a testing system is so important that the state needs to step forward.
“You can either have a Wild West where every provider is going to sink or swim on their own, in which case those providers with stronger networks and greater resources will do a better job of taking care of their populations, and those with less resources and likely a less affluent population of residents will do less well, " said Dr. Harry J. Heiman, an associate professor in the School of Public Health at Georgia State University. “Or, you can accept that this requires state leadership and coordination and support.”
Troubling trend
For nursing homes across Georgia, the opening days of the pandemic proved both deadly and frustrating. Hospitals got the priority for testing, masks and gowns. Finally, in June, things eased up. Senior homes could get better access to supplies and tests, and results were coming back quickly. The outbreaks and deaths slowed.
But that didn’t last long. “Unfortunately the month of July saw [coronavirus] cases grow by over 2,700, which was the highest month that we have had,” said Tony Marshall, president and CEO of the Georgia Health Care Association, which represents senior care providers.
The total number of long-term care residents who have tested positive during the pandemic now exceeds 11,000. The number of workers testing positive increased steeply during July, and that trendline is continuing.
National statistics mirror Georgia’s. “With the recent major spikes of COVID cases in many states across the country, we were very concerned this trend would lead to an increase in cases in nursing homes, and unfortunately it has,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living. “This is especially troubling since many nursing homes and other long term care facilities are still unable to acquire the personal protective equipment and testing they need to fully combat this virus.”
While PPE is easier to get than it used to be, dozens of homes across Georgia do not have a 7-day supply of critical items, according to an AJC review of federal reports.
A statewide mask mandate for everyone and more robust testing are the best ways to protect seniors living in long-term care, said Ginny Helms, president of LeadingAge Georgia, which represents non-profit and mission-driven senior care providers.
“We need the rapid testing,” Helms said. That way, homes can more quickly stop asymptomatic workers from infecting residents.
A.G. Rhodes, a non-profit that operates three nursing homes in Georgia, has ordered on-site testing systems that are supposed to offer the most reliable results, but they are still waiting for them to arrive, said Mary Newton, a spokesperson. The organization is also working on a detailed testing plan, she said.
Pruitt, the CEO of PruittHealth, said he hopes the “point-of-care” systems that a federal agency is sending will be a game-changer even though he’s been told the tests are accurate just 75 percent of the time. His company plans to test part of each nursing home’s staff daily, which could identify outbreaks faster since results come back in an hour, instead of the days it takes now.
“We need the rapid testing."
Now, Pruitt said, his company is spending about $430,000 a month for its employee testing plan, which tests every other week in homes without outbreaks and more frequently in homes that have cases. “That’s a significant cost that other states are picking up,” Pruitt said.
He wants Georgia to do more to support the efforts of those running long-term care facilities who find themselves running from one crisis to the next. He’s not sure why nursing homes wouldn’t get the support here that other states are providing.
“We’re at the epicenter of this pandemic.,” he said, “We feel like every day we show up, we’re at war.”
‘A perfect storm'
A new state law requires all long-term care residents to undergo baseline testing by late September, and some homes are still working toward that requirement to test everyone for the first time. Assisted living communities and large personal care homes won’t face the federal weekly testing mandate, but they won’t get the point-of-care tests from CMS, either.
The homes that are already doing regular testing are focused on what tests work the best. “We all know the rapid tests aren’t as accurate as other ones, but the question is, what are you going to do?” said Beth Cayce, who operates a senior care company.
Cayce said frequent, accurate testing and careful use of PPE can stop the spread of a virus within a facility. But that doesn’t keep the virus out forever. Workers still have to go home, go to the grocery store and care for children who may soon attend in-person classes at school. Until community spread is slowed with more use of masks and social distancing, she said, even frequent testing can only do so much to protect residents.
Heiman said Georgia’s political and public health leaders should craft a plan for testing in long-term care, help pay for it and hold the facilities accountable for carrying out the plan, given how deadly the virus can be frail, elderly people.
“This is a perfect storm that should remind of us why we need to match resources to needs — to protect those who are most vulnerable,” he said.
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