Due to the slow lab turnaround times for COVID-19 tests, delivery of point-of-care diagnostic testing instruments and tests from the federal government comes at the right time. That’s the word from the chief medical officer of the largest nursing home chain in the country.

Genesis Healthcare CMO Richard Feifer

The pending delivery of point-of-care test devices to every nursing home in the country over the coming months “is very important news and not a moment too soon,” Genesis HealthCare Chief Medical Officer Richard Feifer told McKnight’s Long-Term Care News in an interview late last week.

The process of sending out PCR [polymerase chain reaction] tests to outside labs “has crumbled as turnaround times have [slowed] again to five or seven days or more, making them nearly useless,” Feifer said.

Labs were keeping pace with testing until just a few weeks ago, he noted, but then demand from both nursing homes and society as a whole mushroomed.

“Because of that, we’ve seen dreadful turnaround times,” he said.

Genesis, which operates 350 long-term care and senior living facilities in 25 states, is planning to use the on-site diagnostic testing machines in all cases where it previously might have used the PCR test, which is the testing standard, he said.

“I’m very excited about the ability to have easy access to instant results for our residents and staff,” Feifer said.

The Centers for Medicare & Medicaid Services disclosed the point-of-care testing initiative last month. The government said on Friday that it had delivered 1 million tests to 1,019 nursing homes.

 More facilities affected, spread contained

 Genesis, headquartered in Kennett Square, PA, currently is seeing a steady growth of new cases, Feifer said. Some 12,000 residents and staff, including 8,500 residents, have contracted COVID-19 since the pandemic began, and the vast majority have recovered, he explained.

Recently, the company has seen an acceleration in the number of centers affected, especially as certain states have experienced surges. But the company’s infection prevention protocols have clearly had a mitigating effect, he pointed out, holding down the expansion of new cases.  

The pandemic, which Feifer described as “unlike any other infectious disease we’ve experienced in our careers or our lifetimes,” has forced the company to become aggressive with testing and screening. As a result, the transmission of the virus inside buildings has been limited, he said.

“What has clearly gotten better is the ability to contain the spread if the virus gets inside … because we’ve learned about the critical importance of testing and screening people even when they’re not symptomatic, and cohorting people based not upon symptoms and not upon exposure but based upon the results of those tests,” he explained.

However, the price of testing and other infection control protocols has put a major financial strain on the company, Feifer said.

“The additional cost burden of managing and caring for residents during this pandemic is staggering,” he said.

That financial burden includes the cost and volume of tests, along with the expense of personal protective equipment — facilities can burn through 23 gowns per patient per day, he noted — and the price tag associated with ensuring an adequate workforce in a time of increased need for skilled staffing.

“We’re grateful for federal and state financial support so far, but frankly that’s been inadequate,” he said.

 Operating under uncertainty

The biggest challenge of the pandemic for Feifer has been “operating with so much uncertainty, with so little information, with so little medical science,” he said. “We’ve had to learn how to make decisions at the patient level and the organization level and policy level with data that would have been unsatisfactory before the pandemic.”

In coming months, the most important concern is whether residents are vulnerable to reinfection, Feifer said. It’s an important question to ask because residents, due to their frail states, are the least likely to develop protected immunity, he pointed out.

“And because of that, of all the places in our society that we should worry about the possibility of reinfection, nursing homes are at the top of the list,” he explained, “because there is perhaps the greatest risk that nursing home residents did not develop immunity the first time they were infected and there is a continuous risk of virus being brought in from the community.”