“There’s no mechanism in place for reporting,” said Kim Schilling, the vice president of health services at Friendship Haven, which runs a nursing home in rural Iowa. “We were on the phone yesterday trying to figure this out with the department of public health and it was very overwhelming for them too.”
Katie Smith Sloan, the president of LeadingAge, an association of nonprofit providers of aging services, said the Trump administration’s focus on fines and stringent reporting requirements were the wrong approach to addressing a crisis that was aggravated by federal inaction in the early months of the pandemic.
“For seven months, nursing homes have been saving and protecting lives while dealing with staffing shortages, testing and personal protective equipment challenges and growing unexpected costs,” she said.
David Grabowski, a health care policy expert at Harvard Medical School, described the federal rapid-test program as “a positive step but late in the game,” and said Washington should do more to address the systemic financial and staffing problems that have long bedeviled the industry’s efforts to shield vulnerable residents from infectious pathogens. Because federal reimbursements do not cover the full cost of care in much of the country, nursing home operators who serve predominantly Medicaid patients say they often lack the money to hire enough skilled workers willing to take on a grueling job that the pandemic has made increasingly stressful and fraught with risk.
“I don’t have a problem penalizing nursing homes guilty of gross negligence, but my sense is that most of the facilities out there have been doing their best despite dealing with sick workers, a lack of resources and poor guidance from the federal government,” Mr. Grabowski said. “Putting efforts into training workers on infection control, boosting wages and offering paid sick leave would be a better approach.”
The new testing requirements are governed by a complex set of guidelines from the Centers for Disease Control and Prevention that are pegged to the positivity rate of tests for coronavirus infections in the county where facilities are situated. When community positivity rates surpass 10 percent, nursing homes must test their residents and personnel twice a week. The testing requirements drop to once a week when the community positivity rate is between five and 10 percent, and once a month when it is below 5 percent.
As of Sept. 13, more than 3,100 counties across the country reported positivity rates greater than 5 percent, according to CMS data.