In the federal government’s fight against COVID-19, nursing homes have effectively been left for dead. Despite a death count that began with the February outbreak in a Kirkland, Washington, nursing home, hospitals were prioritized for personal protective equipment. Hospital workers were publicly held out as exemplars of courage. Meanwhile, a long-marginalized nursing home caregiving workforce that on its frontline is 92% women — mostly women of color — struggled to contain lethal outbreaks.
Considerable media attention was paid to hospital finances, as elective procedures were suspended. And yet the nursing home sector operated at a net average loss prior to the pandemic, according to the March report to Congress by the Medicare Payment Advisory Commission. Most of those cared for in nursing homes are on Medicaid, and states knowingly underfund their care costs. Hospitals will see a resumption of the private insurance income that nursing homes never receive.
Congress appropriated $175 billion for health care provider relief under the CARES Act. Yet even with a latest distribution of $2.5 billion, nursing home care has only seen 4.2% of what Congress appropriated – despite being the setting where 41% of all U.S. COVID-19 deaths have occurred. An effort by Senate Democrats to appropriate $20 billion directly to nursing home relief was blocked by Senate Majority Leader Mitch McConnell. As Sen. Maggie Hassan (D-NH) said then on the Senate floor: “Months into this pandemic, there is still no robust federal strategy to support residents and employees of nursing homes. That is inexcusable.”
That is still true. And the costs of trying to retain staff — who are not unreasonably fearful about heightened virus risk — are bankrupting facilities. Incredibly, the $2.5 billion distribution cannot be applied toward staff retention.
It was not until April 30 that the Federal Emergency Management Agency announced that, by July, the nation’s nursing homes would receive a 14-day supply of personal protective equipment (PPE). And yet even those shipments, the parsimony of which seemingly presumed the pandemic would quickly end, were full of defective equipment according to reporting — oddities such as disposable gowns that resembled garbage bags, self-styled “surgical masks” that couldn’t fit faces, and extra-small gloves.
Now, with at least 68,000 nursing home residents and staff having died from COVID-19, the federal government has finally begun shipping rapid-result testing machines to nursing homes. And yet there are critical flaws with this strategy.
These antigen testing machines, according to their own manufacturers, should only be used for those who appear symptomatic with COVID-19. Yet the virus’s entry into facilities has been through asymptomatic staff according to academic researchers, with their research finding the best facilities helpless against community spread (a Maine wedding outbreak in August even made its way into a nursing home). Furthermore, one of the two testing machines has a false-negative rate of 16% (the other’s false-negative rate is only 3%).
It is mystifying why the federal government is sending out two different testing machines — one effective and the other essentially defective. In an experiment you might assign human subjects to two groups to examine the effects of a treatment. But here you know that anyone incorrectly cleared for COVID-19, and yet shedding the virus, can kill vulnerable people. Wouldn’t you provide the best protection available against that possibility?
In New Hampshire we are fortunate to have a state that, early on, began a state-paid sentinel testing program for all nursing home staff, and has tried to ensure facilities have access to PPE. But nursing homes are federally regulated — the State Operations Manual under which they are surveyed is over 700 pages long — so why can’t the federal government pull off what New Hampshire has? And, absent the federal funding necessary to sustain care until a vaccine is available, more unendurable suffering is on the horizon.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.