Nursing homes and assisted living facilities are a major source of COVID-19 cases in Unites States. While 10 percent of the country’s cases have occurred in long-term care facilities, deaths related to COVID -19 illness in these facilities account for more than 42 percent of the total mortality. .As of August 17th, 2020, Michigan state has reported 2083 COVID related deaths among individuals who lived in nursing facilities and 21 deaths among staff members (Figure: Data from MDHHS (Michigan Department of Health and Human Services).
A number of risk mitigation strategies have been developed by the state to control the spread of the pandemic in nursing homes. Due to the risk of asymptomatic carriers spreading COVID-19, a strategy for universal SARS-CoV-2 testing of nursing home residents and employees once a week, with rapid turnaround, would allow for the identification, isolation, and treatment of infectious but asymptomatic residents. This would require a new policy by the State of Michigan Health Department to be introduced to be followed by all the nursing homes in the state.
On a national level, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) has allocated approximately $5 billion, to protect residents of nursing homes and long-term care facilities from the impact of COVID-19, however most of the upfront funding is directed to support increased testing, staffing, and PPE needs. There will also be funding available for those establishing COVID isolation facilities. However, the HHS does not address state specific needs for universal COVID testing in Nursing Homes, especially in states with high incidence of COVID 19 , At the same time , the Centers for Medicare & Medicaid Services, (CMS) , proposed that rapid point-of-care diagnostic testing devices to be distributed to nursing homes, and through the new funding from the Provider Relief Fund, CMS Is now requiring, rather than recommending, that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week. The CMS , being more closely involved in Nursing homes functioning and their outcomes, understands the need of nursing homes better and would be able to allocate more funds in the right direction for universal testing, This will help with decrease in the rate of infection and reduce overall morbidity and mortality and cut costs despite an initial investment.
At the state level, Director of the Department of Health and Human Services (“DHHS”), State of Michigan, plays a crucial role in policy making for universal COVID testing in nursing homes in Michigan. Michigan Department of Health and Human Services (“MDHHS”) issued an order requiring nursing homes to conduct diagnostic testing for COVID-19 of all staff members once. However, there is no such regulatory requirement of testing of nursing home residents. With the help of federal funding and utilizing the funding from state government, MDHHS would need to set up a task force to mandate testing of all Nursing home residents. This would also help in mitigating COVID spread, incase a second wave was to hit the state in fall or winter months.
Local healthcare organizations with representatives from health care workers and administrators working on ground Zero have a pivotal role to play in advocacy of this policy with the DHHS. One such organization is Health Care Association of Michigan (HCAM),which is the professional association representing nursing and rehabilitation communities including for and not for profit, county medical care and hospital based providers. HCAM currently represents 350 nursing facilities in the state of Michigan. This association has been contacting legislators and urging them to fight for the needed resources, both funding and equipment, for nursing facilities during this crisis. A signature campaign for Universal Testing of COVID 19 in Nursing Homes from Health care providers across the state would pressurize the DHHS to pass a policy and allocate sufficient funds pertaining to the issue .
Additional support to this campaign and policy could be garnered from Laboratory Corporation of America (LabCorp) with LabCorp’s COVID-19 RT-PCR , being one of the few FDA approved labs for testing COVID 19, the company would have vested interest in universal testing to increase their margin for profit .A collaboration with the State of Michigan to provide testing at lower rates if universal testing is made available to nursing home may be a mutually beneficial option for both parties involved.
The most important stakeholders in development and implementation of this policy would be the Individual nursing homes’ Management and administration The downside to the policy is that private nursing homes may have to bear cost of COVID 19 testing and related infrastructure and personnel, Additionally, universal testing would increase the number of COVID positive cases , thus increasing demands from separate areas for isolation of these patients . Also, increase in COVID positivity rate may be detrimental to the reputation of the nursing home. All these concerns would need to be brought up by representatives from HCAM and addressed by the MDHHS , with the goal of providing affordable testing and quality metrics to nursing home administration , so that they participate both in the development of the policy as well as implementation.
To conclude, a policy mandating universal COVID 19 testing of nursing home residents and employees, is the need of the hour to mitigate the spread of COVID 19 in this high risk population , and the regional professional organizations have a major role in advocating for this policy to state government ( with help of federal resources) .
Tags: covid 19, Nursing home
Social, Cultural & Behavioral Issues in PHC & Global Health 
August 19, 2020 at 9:09 pm |
This is a very interesting blog. I have a few thoughts for consideration. The first would be to factor in the false negative rate on testing (in some studies quite high). How would that impact a reduction in disease transmission? Also, this method (universal testing) should also be considered in other circumstances where there is crowding or people living together. There have been studies showing that the homeless who live in shelters are at much higher risk, for example, and this might be a risk mitigation strategy for that as well.
August 20, 2020 at 12:11 pm |
Thank you for your though provoking post on such a timely issue. Another though is that they could employ rapid batch testing as many universities are currently doing. They could keep testing of residents and employees separate. That could potentially help with accuracy of tests and avoiding false negatives. Hopefully the state government (with federal support) can come up with an effective quickly.
August 23, 2020 at 12:59 pm |
This is a very timely and interesting blog post. In my own state (Connecticut) ,which has had a lower incidence of COVID-19 as compared to the rest of the country, a recent outbreak in a nursing home affecting 13 residents and 3 staff members has led to investigations as to how this could occur. Prior to this outbreak, the state mandated weekly testing of staff at long-term care facilities for the duration of the public health emergency, or until there are no new cases detected at that facility after 14 consecutive days. However, local union leaders have cited delays in testing for weeks after this mandate was enacted, mostly due to insufficient assistance from state government. In any event, this highlights the need to be vigilant about testing, even in those areas/states deemed to have the pandemic relatively well-controlled.
August 24, 2020 at 11:58 pm |
Thank you for such and interesting and relevant post. It particularly hits close to home because I have a family member that has been in a nursing home since earlier this spring. The nursing home population are typically older and have multiple health conditions, making them more prone to experience morbidity and mortality from CoVID-19. A regular testing program for patients and providers is critical to the control of disease. A temperature and symptom screening before and after shifts has also been helpful in identifying insidious cases. Having a positive case almost seems inevitable however. At that time, its imperative that nursing homes have separated wings where they can transfer CoVID-19 positive patients to keep from transmitting the virus to the general nursing home population. Another critical aspect of controlling spread in nursing homes has been the education of proper PPE use and appropriate donning and doffing techniques.