Nursing homes to feds: Expand COVID-19 testing to all, pay $120K per facility, increase PPE shipments

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By James M. Berklan, Mcknight’s Long-Term Care News, May 5 2020

The nation’s largest nursing home and assisted living association is turning up the pressure on the federal government by sending formal letters to federal authorities this morning, asking for priority COVID-19 testing for all residents and staff — regardless of symptoms — and a host of other enhancements. 

The American Health Care Association/National Center for Assisted Living also is placing another urgent call for an “emergency response fund” of $10 billion. Initially, it would grant an average facility $120,000, or $1.8 billion nationwide. The roughly 5,000 facilities with COVID-19 positive residents also would receive another $600 million. The fund would be spread out over the next three to four months.

In addition, providers are requesting expedited shipments of personal protective equipment from the Federal Emergency Management Agency. Last week, FEMA pledged to send two weeks’ worth of masks, gowns, eyewear and gloves before July 4. Now, providers want it all delivered “by the beginning of June,” and also have assisted living facilities included. 

AHCA’s Mark Parkinson

“Long-term care should be made a higher priority and have access to more supplies as we wait for some of the manufacturing and supply chain issues to be resolved,” said AHCA/NCAL President and CEO Mark Parkinson in a letter to be emailed Tuesday morning to Health and Human Services Secretary Alex Azar and FEMA Administrator Peter Gaynor. 

It comes just five days after AHCA/NCAL applauded the announcement of the planned FEMA equipment shipments — which today’s letter says wouldn’t include “much needed N-95 masks.” Last Thursday also marked the announcement of a new White House nursing home quality and safety commission and release of the framework for reporting COVID-19 infections directly to the Centers for Disease Control and Prevention. 

The AHCA/NCAL letter praised all of the above again but said more is needed. The White House acknowledged in an unrelated action Monday that the number of COVID-19-related deaths could double in the coming months. At least 30% of COVID-related deaths in the U.S. are estimated to be long-term care patient-related.

“Given the gravity of the situation we are facing with this deadly virus and its impact on our vulnerable community, which cannot be overstated, long-term care facilities require additional support and funding from state and federal governments to reduce the spread of this deadly virus,” Parkinson wrote.

LeadingAge keeps up the heat

The AHCA letter largely reflects positions expressed last Thursday by Katie Smith Sloan, the leader of LeadingAge, the second-largest nursing home association in the U.S. She continued her criticism Sunday over what she and her organization saw as lack of responsiveness by President Trump and the administration during a staged media event at the Lincoln Memorial.

Katie Smith Sloan
Katie Smith Sloan

“We didn’t hear an answer,” Smith Sloan said about a question posed to Trump on what the government is doing in the short term and long term to help residents of nursing homes, assisted living facilities and senior housing.

“Fear has grown as fast as infections and death tolls, with older people and their care workers not knowing whether the equipment, testing, and support they need to protect their lives would arrive in time,” Smith Sloan said in a statement. “[Nursing homes] are fighting and scrounging for every mask and gown they can muster … These heroes providing hands-on care sounded the alarm, but the cavalry never came.”

She called last week’s announcement about FEMA equipment distribution “too little, too late,” a position AHCA/NCAL also had come around to by Monday, when its letter to the agency heads was composed.

AHCA/NCAL also is enlarging its request on testing to include all residents and staff.  Numerous recent studies have shown that virus carriers can be asymptomatic and have unknowingly put many others at risk.

Parkinson also has proposed framework for the $10 billion fund request he first floated well ahead of last Thursday’s nursing home “event” at the East Room of the White House, which he, Smith Sloan and other long-term care leaders attended.

Proposed payouts

Initial payments to nursing homes should be made “as quickly as possible” based on their size, Parkinson said in today’s letter. Under his proposal, facilities with 50 or fewer beds would get $50,000; 51 to 100 beds would receive $100,000; 101 to 200 beds would get $150,000; and those with more than 200 beds would receive $200,000.

Facilities with COVID-19 positive residents would receive double the above amounts, no matter how big or small the outbreak.

“With all nursing homes now required to submit this data to CDC on a weekly basis, it allows for identification of these facilities more readily,” Parkinson noted. 

“While there is likely a more targeted way to distribute funds, we need help immediately,” he added. “We encourage HHS to use this formula, or another simple one, and then perhaps consider a more targeted approach after the first month.”

Funding could be used only for PPE and testing; additional staff; incentive pay for staff; and lost revenue, “as the statute provides, but capped at 25% of the facility’s grant.”

Parkinson also said federal emergency funding being considered for Medicaid-only providers on the front lines should be expedited.

In today’s letter, he says it is still “not too late to make an enormous difference in the outcome of the COVID-19 battle in America’s long-term care facilities. The best public health policy is to focus where the battle is taking place, which is not most prevalent in nursing homes and assisted living communities across the country.”

“Without adequate funding, testing and supplies, long-term care facilities will not be able to overcome this unprecedented health crisis and protect our residents and caregivers.”