Joel Landau

The No. 1 priority of all skilled nursing facilities (SNFs) during the ongoing coronavirus pandemic remains resident safety. That’s not even a question, as those operating SNFs serve a population that is in a high-risk age range, and in many cases is dealing with a preexisting condition as well. These patients must be protected as much as possible — a sizable challenge, given how pernicious the virus has proven to be.

But just as important is staff safety, as they are the ones on the proverbial front lines. They are the ones whose duties dictate that they cannot remain socially distant from those suffering from COVID-19 — or any other malady, for that matter. It is their job to work in close proximity with one and all, no matter the risks, and to do so day after day, week after week, month after month.

They do this routinely, and it falls upon management to provide the proper safeguards and meet various regulatory guidelines. Namely, to make sure there are adequate stockpiles of personal protective equipment on hand and to implement adequate infection-control measures. It’s a continual challenge, but the nursing homes that have most efficiently and proactively rolled out these safeguards have been best able to keep the virus at bay.

Routine testing guidance

It is generally conceded that one of the best ways to protect workers is through regular testing. The Centers for Disease Control, in a document updated July 17, recommends that healthcare professionals be subjected to such measures if they exhibit any symptoms of the coronavirus (fever, shortness of breath, loss of taste or smell, etc.); if it is suspected they have been exposed to someone who is infected; if they are asymptomatic but are scheduled to work in what the CDC describes as a “special setting” (e.g., a nursing home); or to determine whether someone previously afflicted is now free of infection.

Given the vulnerability of the population these workers serve, and the close quarters in which they interact, it’s not difficult to see why such measures have been deemed necessary. And in August the federal government began belatedly providing rapid-result test kits to 14,000 skilled nursing facilities. 

There were, however, frustrations, not the least of which concerned the accuracy of the tests and the costs the SNFs incurred after the initial supply ran out. 

Cost challenges

Cost had also been the stumbling block with previous protocols. Interestingly, that was the reason the testing of healthcare workers in New York State, first mandated to take place three times a week, has since been scaled back to twice a week. It was also the reason weekly testing in Connecticut was reduced; in that state alone, it costs $117 for each test, which equates to over $2 million for each of the state’s 20,000 workers.

Other states are facing similar hurdles. Officials in Florida, for example, fear that the twice-monthly testing of nursing-home staff will have to be halted in September unless the state provides more test kits or the federal government manages to provide additional funding.

Steve Bahmer, president/CEO of the industry group LeadingAge Florida, told the Pensacola News Journal that facilities will have to shell out anywhere from $25,000 to $300,000 per month to cover the cost of testing, numbers that are not sustainable. The situation is so dire, he said, that he compared it to that of a Category 5 hurricane.

The state’s Agency for Health Care Administration has been providing test kits to nursing homes, free of charge, but Bahmer and others worry that facilities will have to begin paying for them in September. 

Officials in another hot spot, North Carolina, announced at the beginning of August that bi-weekly tests of nursing-home workers would be required, with the funding coming from the federal CARES Act. According to the Raleigh News & Observer, that funding will only be provided through November, however.

The Centers for Medicare and Medicaid Services also announced in late July that nursing homes in hard-hit states would be required to test employees every week, with the funding also coming from the CARES Act. But there were questions about how this measure would be implemented, and whether it was even feasible to process so many tests.

Faced with such challenges, nursing-home operators are left to consider other means to protect workers. One French study, for instance, concluded that self-confining — i.e., requiring employees to live in the facility where they work — is an effective way to stop the spread of infection. That is not always possible in the U.S., given the frequency with which staffers work second jobs.

Some states have also begun deploying so-called strike teams to facilities in which virus flare-ups occur. These teams, composed of no more than 10 people from emergency services and health departments in a given area, support and in some cases fill in for facility personnel, depending upon the circumstances.

It’s about people

The point remains that human resources are the most precious resource within a skilled nursing facility, and should be treated as such, especially in challenging times like these. In particular the words of someone like Tanya Beckford, a nursing assistant in a Connecticut SNF, should be heeded. She told Time Magazine that it has reached the point where she has grown tired of “hearing the word hero, hero, hero being thrown around for us.”

Rather, Beckford — and others like her — want honest-to-goodness support: the proper equipment, adequate pay and, when possible, testing. In other words, they want evidence that management truly has their backs. That means going the extra mile, understanding the extraordinary challenges they face, and finding the means to keep them safe. 

Robust and consistent testing may not be feasible for all SNFs right now, but that shouldn’t stop us from finding creative ways to prioritize the safety of our front line workers. It’s the least we can do to thank them for their heroism. 

Joel Landau is the founder and chairman of The Allure Group, a rapidly expanding provider of skilled nursing and rehabilitation services throughout the New York downstate area.