New testing requirement adds to stress on nursing homes

New federal guidelines require nursing homes in counties with high infection rates to test staff once or twice a week. Westbury Medical Care & Rehab in Jackson is among nursing homes in Georgia that have had to adjust to meet the new requirements that took effect this month. CURTIS COMPTON / CCOMPTON@AJC.COM

From the outset of the coronavirus pandemic, nursing homes and other long-term care facilities in Georgia struggled to control a virus that can easily be passed by those who may not show symptoms.

But as the state came to have one of the nation’s highest infection rates, August turned out to be the worst month for the state’s long-term care facilities, with their death toll climbing past 2,000.

Now, an ambitious new federal testing requirement for nursing homes that took effect this month is being touted as a critical step toward ensuring the safety of vulnerable senior care residents. In counties where the virus is most prevalent, all the staff in the nursing homes must be tested for the coronavirus twice a week. In counties with significant community spread, staff must be tested weekly. In the remaining counties, monthly tests are required.

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Those that fail to comply can face fines and lose access to Medicare and Medicaid, which are their major sources of funding.

However, the first two weeks of the roll-out has placed new strains on homes that say it is a costly drain on staff time with mixed results. The industry now is bringing new urgency to its effort to seek direct state support.

“I think testing is one of the most important tools in our arsenal right now,” said Deke Cateau, CEO of A.G. Rhodes Health & Rehab, which operates three facilities in Cobb, DeKalb and Fulton counties. “But the testing has proved to be a logistical nightmare for nursing homes. It has also proved to have huge labor force and financial implications.”

To help nursing homes across the country meet the new requirements, CMS sent rapid test equipment and kits. The federal government also provided an additional $10,000 per nursing home plus more than $1,000 per bed to help cover the costs of testing, protective equipment and staffing.

That’s not enough to cover the costs of increased testing and other expenses and revenue losses from the pandemic, Georgia nursing homes say.

In the first five and a half months of the pandemic, Georgia’s nursing homes and assisted living facilities tested a total of 57,000 staff.

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The new requirements will mean nursing homes each week will have to test up to 60,000 staff, according to the Georgia Health Care Association, which represents nursing home providers across the state. That’s in part because so many of their operators are in counties where the infection rates are high.

Across the country, more than 800 counties where infection rates top 10 percent are identified as red zones where nursing homes must do twice weekly testing, according to the latest figures released last week by the federal Centers for Medicare and Medicaid Services (CMS). Georgia has 76 counties in red zones.

In counties identified as yellow zones, where the infection rates are between 5 and 10 percent, nursing homes must test staff weekly. That’s the case for 58 Georgia counties.

Nursing homes in green zone counties, with infection rates below 5 percent, must do monthly testing. Georgia has 24 green zone counties.

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“We’ve said all along that testing affords us the greatest ability to prevent Covid in our centers,” said Tony Marshall, president and CEO of the trade group. “Our challenge is to meet the financial burden that comes with it.”

To that end, the nursing home industry has been pressing the state and Gov. Brian Kemp’s administration to provide more direct financial relief. Marshall said most other southeastern states have increased Medicaid payments or provided some other financial relief to help long-term care facilities offset some of the costs.

While Georgia hasn’t provided direct financial relief, Kemp’s office says the state has provided support to nursing homes and will continue to do so. The governor’s office points to more than $20 million spent to provide staff support to 93 nursing homes that were short-staffed because of outbreaks or faced other challenges during the pandemic.

His office also noted that George Emergency Management Agency has sent nearly 6 million masks, 9.1 million gloves and 1.9 million gowns to nursing homes, though some nursing homes still struggle to secure enough personal protective equipment.

The state was one of the first to employ its National Guard for infection control and testing, administering close to 20,000 tests in the first six months of the pandemic. Kemp’s office said the state is ready to assist with additional testing for residents or when outbreaks occur.

Governor Kemp’s top priority in our fight against COVID-19 has been protecting our state’s most vulnerable populations,” said Cody Hall, Kemp’s press secretary.

Still, some nursing homes have felt worn down and strained as weeks battling the virus have turned into months with no end in sight. The new testing requirements have added another layer of stress.

Westbury Medical Care and Rehab, which suffered from an early outbreak that resulted in 34 deaths last spring, had already enlisted a new testing program for staff when the federal requirements began.

The facility had to start testing twice a week under the new rules because Butts County where it operates had a high infection rate. That means it has had to test 200 employees twice a week, said Jennifer Vasil, the home’s administrator.

Initially, the rapid tests provided by CMS resulted in 16 staff testing positive this month. Follow-up tests showed a dozen of those were false positives. Still, the initial reaction to the new round of positive tests caused a scare in the community and was costly as the home had to pay overtime to cover shifts of staff who were quarantined.

“All those things, it’s been financially taxing on us," Vasil said, adding that the twice weekly testing take a toll on employees. What’s more, the criteria based on community spread is completely out of the facility’s control.

“There’s nothing we can do," she said. “We want our residents well cared for. We want them to have the best quality care. We want them to be safe.”

Neil Pruitt, Chairman and CEO of PruittHealth, which operates nursing homes in Georgia and across the southeast, said the company anticipates administering 60,000 tests a month in Georgia at a cost of $1.3 million.

He said it’s a day-by-day challenge to get enough test kits and the company anticipates challenging months ahead.

“We don’t see anything changing until the spring," Pruitt said. "We’re heading into flu season. We expect that will compound the problem.”