Healthcare stakeholders who regularly come into contact with skilled nursing residents should be subject to COVID-19 testing mandates similar to those for nursing home employees, a prominent long-term care group said Wednesday in a pair of letters to the head of the Centers for Medicare & Medicaid Services.
“We are confounded by what seems to be an inconsistency in testing policy and approach,” wrote LeadingAge President and CEO Katie Smith Sloan to CMS Administrator Seema Verma.
Sloan specifically requested testing mandates for state and federal surveyors, as well as for hospital workers and contractors. She noted that appeals about surveyors had been made previously to personnel in CMS’s Division of Nursing Homes but without results.
On Sept. 2, CMS mandated the testing of all staff in nursing homes, regardless of whether they come into contact with patients on a regular basis, or face the risk of penalties. Sloan noted that the agency also “strongly encourages” testing anyone who wants to visit a loved one. Those individuals must move directly to and from the loved one’s living space.
Yet state and federal surveyors, who are required to be on-site in nursing homes regularly, and move in and out of numerous patient rooms and other facility areas, do not have the same imperatives.
“Knowing that 40% of healthcare workers who have tested positive for COVID-19 have been asymptomatic and that nursing home deaths account for 41% of COVID-19 related deaths in the United States, we cannot afford to take chances,” Sloan wrote. “We urge you to reconsider CMS testing policies and mandate testing of state and federal surveyors, to be provided by CMS and the state survey agencies, in order to assist our nursing homes in protecting this most vulnerable population.”
LeadingAge is aware of “at least one” case of an infected surveyor entering at least one nursing home, said Vice President for Policy Ruth Katz during the group’s coronavirus conference call Wednesday.
“We know that nursing home staff are protected. However, those carefully protected people are put at risk. Nursing homes have done their part,” she said. “It’s time for surveyors and states to do the same.”
On the hospital front, Sloan cited federal Morbidity and Mortality Weekly Report authors who suggested that the 6% of frontline hospital workers found to be infected with COVID “were not adhering to universal use of face coverings and may have worked in hospitals that did not have dedicated cohorts of healthcare personnel caring for patients with COVID-19.”
The big fear is that with frequent trips between long-term care facilities and hospitals, patients could bring COVID back to nursing homes from acute-care settings.
“We’re seeing more and more research that hospital staff are transmitting COVID-19,” Katz said. “It is patently ridiculous to think that nursing home staff are a danger to people but hospital personnel are not.”
Sloan noted that while nursing homes must report every COVID-19 infection to federal authorities, there is no such requirement for hospitals. She further cited efforts by entities such as MedPage, Kaiser Health News and others to track healthcare worker mortality.
“A quick look at the MedPage listing makes it clear that the vast majority of the individuals on their list who have succumbed to COVID-19 were individuals who worked in hospitals,” she wrote.
Calling mandated testing of hospital workers “the right thing to do,” she added that a COVID-19 response team at the Imperial College of London found that mandating hospital worker testing would decrease virus transmission by 25% to 33%.