Doctor in face mask is looking away through window with tiredness while having a break

The nation’s largest nursing home group has requested the federal government extend the current public health emergency declaration as providers continue their fight against emerging COVID variants. 

The American Health Care Association also used the opportunity to seek help in the battle against crushing staffing shortages that are threatening the survival of many of the country’s most vulnerable facilities.

“I ask for your continued support by extending the public health emergency (PHE) beyond its current October 13, 2022 expiration, so that long-term and post-acute care providers can continue to offer the most efficient and effective care possible to our nation’s most vulnerable population,” wrote AHCA/NCAL President and CEO Mark Parkinson on Tuesday. 

“This pandemic is not over, but that does not mean our nation is dealing with the same situation as in 2020 nor even in 2021,” Parkinson allowed in a letter to Secretary of Health and Human Services Xavier Becerra. Parkinson also observed “the virus continues to mutate into typically more contagious yet less severe variants.

“As we head into the fall, our healthcare settings must have the resources, flexibilities, and policies in place to appropriately respond to this virus and deliver high-quality care,” Parkinson added. 

He also appealed to the HHS Secretary to consider measures that could ultimately address the mounting staffing crisis. He reminded Becerra how nursing home workforces are ‘exhausted and burned out after fighting this virus for more than two years.”

Parkinson asked CMS to maintain enhanced Medicaid Federal Medical Assistance Percentages (FMAP) to states, and state Medicaid policy flexibilities, such as the waiver for Medicaid redeterminations. He also asked for reinstatement of the Section 1135 waiver on training and certification of nurse aides “in order to support retaining temporary nurse aides who have been a valuable member of the care team during this pandemic.”

 Still fighting variants

Parkinson told Becerra that with new COVID-19 variants emerging and flu season approaching, extending the PHE will ensure that long-term care facilities have the necessary resources to stay ahead of the virus.

 The group also urged officials to consider the various root causes of COVID-19 outbreaks.

“Location of a nursing home, asymptomatic spread and availability of testing — not quality ratings, infection citations or staffing — were determining factors in COVID-19 outbreaks, according to analyses by leading academic and healthcare experts, as well as government researchers,” the group noted in a review of the latest research findings from its Center for Health Policy Evaluation in Long-Term Care.

 Parkinson also asked Becerra for “infrastructure enhancements” and additional “resources” while stressing how COVID-19 variants continue to emerge, and the latest BA.5 variant is causing an increase of cases among the general public across the country.

The trends continue imposing specific consequences for nursing homes in particular.

The prevalence of COVID-19 in the broader community has an impact on long term care residents and staff,” he wrote. “Numerous independent studies have found that high community spread is correlated with outbreaks in nursing homes. As we head into influenza season this fall, we need to ensure our healthcare infrastructure can quickly adapt, especially should a future variant elude the protection of our vaccines.”

An uneven playing field

Parkinson also seemed to rail against what he termed as “inconsistent” standards among various health care segments, something that has cast undue burdens and costs on the nursing home sector alone.

 “Despite the progress we have made, nursing homes still must follow extremely stringent COVID-19 protocols in the areas of masking and personal protective equipment (PPE), testing, reporting, visitor screening, and isolation periods—or face harsh penalties,” he wrote. “Meanwhile, there are concerning reports that other health care settings are held to different standards with little to no consequences for failing to adhere to COVID protocols, even though the Centers for Disease Control and Prevention guidance is applicable to all health care settings.

Some medical professionals seemed to agree.

“The time has come to recognize the diversity of risk tolerance among this elderly population and return to them the autonomy of choice,” wrote Drs. K.C. “Karen” Coffey and Mary-Claire Roghmann, both professors at University of Maryland School of Medicine epidemiology and public health professors, who penned an OpEd in Monday’s Baltimore Sun appealing for relaxation of continued strict infection control protocols on nursing home residents.

“Now is the time for the Centers for Disease Control and Prevention to revise their recommendations and allow for local decision-making in nursing homes,” Coffey and Roghmann said, adding that such stringent rules contribute to a “continued sense of isolation and inequality for nursing home residents.”

 80% of deaths that occurred in the early months of the pandemic were in those over the age of 65 and that residents in congregate care facilities, like nursing homes, remain at the highest risk for severe complications and death from infection.

Evolving COVID guidance for care settings.

Parkinson also told Becerra to consider its set of evidence-based recommendations for infection prevention and control practices that recognize this current stage of the pandemic, brings consistency in policies and enforcement actions between various health care settings, adapts protocols based on local COVID metrics and “appropriately balances safety with quality of life for our nursing home residents and staff.”

He also asked for protocols to be adjusted toward the goal of restoring “balance.” 

In September 2020, CMS relaxed restrictions on visitations, group activities, and communal dining because officials recognized the need to balance protection from the virus with the overall quality of life for our residents. 

“We are asking the agencies under HHS — CDC and CMS — to strike this balance once again,” Parkinson added.