Protecting Nursing Home Residents From COVID-19

The COVID-19 pandemic has devastated US nursing homes and the process of protecting nursing home residents is ongoing.

While nursing home residents make up 0.6% of the U.S. population, they account for 42% of nationwide coronavirus deaths. In my home state of Pennsylvania, they accounted for over 68% of the deaths. According to federal data, there were 3,225 transfers from hospitals to nursing homes in Pennsylvania from Jan. 1 through May 31.  We saw this trend in many other states. The New York Times recently reported nursing homes accounted for a majority of deaths in other heavily hit states like New Jersey (52%), Massachusetts (59%), and Connecticut (55%), and for 80% of the deaths in otherwise lightly hit Minnesota.

Over the last few months, we have come to understand that COVID-19 tends to have more devastating effects on older individuals. Those with chronic heart disease, diabetes, kidney disease and respiratory illness also tend to be at higher risk. Nursing homes are generally made up of this group. As per a recent AARP article, certain conditions at nursing homes can exacerbate the spread of the disease:

  • shortages of coronavirus tests
  • shortages of or lack of access to personal protective equipment (PPE) such as masks and gowns
  • frequent physical contact between residents and staff
  • understaffing
  • employees who work in multiple facilities, increasing chances for exposure
  • residents sharing rooms
  • transfers of residents from hospitals and other settings

During the pandemic, the CDC and CMS issued guidance to these facilities in an effort to reduce the spread of COVID-19 in nursing homes. Facilities were instructed to:

  • strictly limit visitation
  • suspend communal dining and group activities for residents
  • screen residents daily for fever and other COVID-19 symptoms
  • screen anyone entering the building for symptoms and observe flexible sick-leave policies for staff members
  • require staff to wear masks

Also, if the disease was identified at a nursing home, the federal agencies urged the facility to restrict residents to their rooms; require health care staff to wear gowns, gloves, eye protection, and N95 or medical masks; and treat suspected and confirmed COVID-19 patients in a designated area, away from other residents.

In May of 2020 stricter reporting measures were put in place as well as infection control mandates.

As part of the efforts taken by the Trump Administration, President Trump announced on July 22, 2020 several new Centers for Medicare & Medicaid Services (CMS) initiatives designed to protect nursing home residents from coronavirus disease 2019 (COVID-19).

As per a CMS press release: “The U.S. Department of Health and Human Services (HHS) will devote $5 billion of the Provider Relief Fund authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control. This funding could be used to address critical needs in nursing homes including hiring additional staff, implementing infection control “mentorship” programs with subject matter experts, increasing testing, and providing additional services such as technology so residents can connect with their families if they are not able to visit. Nursing homes must participate in Nursing Home COVID-19 Training (described below) to be qualified to receive this funding. This new funding is in addition to the $4.9 billion previously announced to offset revenue losses and assist nursing homes with additional costs related to responding to the COVID-19 public health emergency (PHE) and the shipments of personal protective equipment (PPE) provided to nursing homes by the Federal Emergency Management Agency (FEMA).”

Some of the goals of this are:

New Funding

CMS reports that the U.S. Department of Health and Human Services (HHS) will devote $5 billion of the Provider Relief Fund authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control. This funding could be used to address critical needs in nursing homes including hiring additional staff, implementing infection control “mentorship” programs with subject matter experts, increasing testing, and providing additional services, such as technology so residents can connect with their families if they are not able to visit. Nursing homes must participate in the Nursing Home COVID-19 Training (described below) to be qualified to receive this funding. This new funding is in addition to the $4.9 billion previously announced to offset revenue losses and assist nursing homes with additional costs related to responding to the COVID-19 public health emergency (PHE) and the shipments of personal protective equipment (PPE) provided to nursing homes by the Federal Emergency Management Agency (FEMA).

Enhanced Testing

As quoted from the CMS website, The Department of Health and Human Services announced last week that rapid point-of-care diagnostic testing devices will be distributed to nursing homes, and the for new funding from the Provider Relief Fund, CMS will begin requiring, rather than recommending, that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week. This new staff testing requirement will enhance efforts to keep the virus from entering and spreading through nursing homes by identifying asymptomatic carriers.

Over the next few months more than 15,000 testing devices will be deployed to help support this mandate, with over 600 devices shipping this week. Funds from the Provider Relief Fund can also be used to pay for additional testing of visitors.

Additional Technical Assistance and Support

As per CMS the Trump administration recently deployed federal Task Force Strike Teams to provide onsite technical assistance and education to nursing homes experiencing outbreaks in an effort to help reduce transmission and the risk of COVID-19 spread among residents. The first deployments took place in 18 nursing homes in Illinois, Florida, Louisiana, Ohio, Pennsylvania and Texas between July 18 and July 20. The Task Force Strike Teams are composed of clinicians and public health service officials from CMS, the Centers for Disease Control & Prevention (CDC), and the Office of the Assistant Secretary for Health (OASH). 

The Task Force Strike Teams went into nursing homes based on data they reported to the CDC that indicated an increase in COVID-19 cases. The teams focused on the four key areas of support, including keeping COVID-19 out of facilities, detecting COVID-19 cases quickly, preventing virus transmission, and managing staff. The goal was to determine what immediate actions nursing homes needed to take to help reduce the spread and risk of COVID-19 among residents and to better understand what federal, state, and local resources nursing homes need to ensure the health and safety of their residents. CMS and its partners plan to use what is learned on the ground to determine remote education and other critical needs to support nursing homes and mitigate future outbreaks.

In addition, CMS, in partnership with the CDC, is rolling out online, self-paced, on-demand Nursing Home COVID-19 Training focused on infection control and best practices. The training being offered has 23 educational modules and scenario-based learning modules that include materials on cohorting strategies and using telehealth in nursing homes to assist facilities as they continue to work to mitigate the virus spread in their facilities. This program supplements training already underway to better equip nursing homes to contain and stop the spread of COVID-19. The training is a requirement for nursing homes to receive the additional funding from the Provider Relief Fund Program.

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