Testing shortages reach nursing homes and home health agencies

WASHINGTON — Nursing homes and other elder care providers are grappling with the current shortage of rapid COVID-19 tests, with reports of low supplies as the administration makes a massive effort to increase testing capacity. country manufacturing.

The testing shortage is compounded by a worsening staffing crisis. The industry has lost hundreds of thousands of workers since the pandemic began, and soaring cases of the omicron variant are forcing more staff to call for unemployment.

The issue raises questions about elder care nationwide and whether the administration’s effort to ship 1 billion tests directly to households is further reducing supply to providers, who are already in compete with an increase in demand from the general public. Nursing home residents are particularly at risk from the virus, accounting for about 142,700 of the estimated 860,000 COVID-19 deaths in the United States – 17%, despite making up less than 1% of the population.

Centers for Disease Control and Prevention Director Rochelle Walensky told lawmakers in January that the Biden administration is sending about 2.8 million tests directly to long-term care facilities each week. But major industry groups like LeadingAge and the American Health Care Association/National Center for Assisted Living report that many members are struggling to find tests.

The Centers for Medicare & Medicaid Services requires skilled nursing facilities to test staff at least once a week when community transmission is considered moderate and twice if it is considered high. Many facilities have agreements with labs to perform PCR testing, but turnaround times can stretch to days as demand increases.

About a third of Leading Age members struggle to find rapid tests, according to a January survey of 752 members – including nursing homes, home health agencies, assisted living communities and groups affordable housing. Additionally, many respondents who said they had enough tests on hand warned that their supplies would soon run out.

LeadingAge spokeswoman Lisa Sanders told CQ Roll Call the numbers are likely already worse, as this is “a very rapidly changing situation.”

“I would say that we are now entering a situation where the needs are increasing,” she said. “Definitely growing.”

The AHCA/NCAL recently asked the administration to increase test shipments and keep long-term care a priority.

“There has been an increasing demand for testing among the general public and among other industries across the country due to the rise of omicron,” the group said. “So, as a result, many long-term care facilities are having difficulty acquiring tests and/or experiencing delays in retrieving PCR test results.”

A spokesperson for the Department of Health and Human Services said the department is in “constant communication” with nursing homes and other aged care providers, and is working to increase benefits .

At least one test maker, Abbott, halted production last year amid falling demand before the US pledged $3 billion over 13 months to the testing industry in autumn.

Assistant Secretary for Preparedness and Response Dawn O’Connell testified before the Senate Health, Education, Labor and Pensions Committee in January that federal contracts for the first $500 million The administration’s $1 billion testing initiative includes safeguards against interference with current market supply.

But at least the first shipments of rapid tests are from existing products on the market. The Departments of Defense and Health and Human Services have reached at least four agreements with non-manufacturers Medea Inc., Atlantic Trading LLC, Goldbelt Security LLC and Revival Health Inc. to procure tens of millions of existing tests .

An HHS spokesperson said the contracts prohibit diverting or delaying any testing already committed to other purchasers or discontinuing any other testing program.

“HHS will conduct rigorous monitoring to ensure that new purchases do not come from other testing programs,” she said. “The administration is working with states that are experiencing supply issues to expedite matters and ensure that health services meet their needs.”

Other elderly care providers are also struggling to access testing. National Home and Hospice Care Association President William Dombi said home health agencies were cut from HHS weekly stipends last year.

“Home care companies are having extraordinary difficulty finding tests,” he said. “We contacted manufacturers like Abbott and they said, ‘Sorry, we don’t have anything.'”

Dombi was quick to recognize that congregate settings such as nursing homes should be given priority for limited supplies. But home care providers are also caring for some of the oldest and most vulnerable patients, and caregivers frequently forgo testing.

“They go looking, like they did when we couldn’t find masks,” Dombi said. “They were knocking on the doors of tattoo parlors, nail salons and carpentry shops to get N95 and KN95 masks. So they will continue to do that.”

Personnel issues

The supply constraints come amid a severe personnel crisis exacerbated by the omicron variant.

Nursing home employment fell by 420,000 workers, or more than 12%, from January 2020 to December 2021, according to the Bureau of Labor Statistics.

Last month, two patients were found dead at a North Carolina nursing home where just three staff were caring for 98 residents.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants, which represents certified practical nurses doing much of the day-to-day care in nursing homes, said members were reporting dire situations daily. An assistant recently said he was the only person there, without a nurse to administer the drugs for hours.

“The president should call a national emergency, and anything that can be done to save these seniors should be done,” Porter said. “Because they are terrified.”

Two of NAHCA’s board members also recently quit their jobs after succumbing to an unsustainable workload, Porter said.

Calls are mounting to implement pass-through funding requirements in Medicare and Medicaid to raise wages for aides like certified nursing assistants, who earn about $13 an hour. Currently, federal dollars are nearly impossible to track through the maze of vendors and LLCs operated by many retirement home businesses.

The Democrats’ domestic spending bill includes provisions to raise wages and hire more caregivers for home and community services under Medicaid. The legislation is stalled in the Senate due to objections from moderate Democrats, but President Joe Biden recently expressed confidence that Congress could still pass “big chunks” of social spending and climate legislation.

Porter blames the federal and state governments for allowing systemic problems to escalate, given that the vast majority of nursing home revenue comes from Medicare and Medicaid. Two weeks ago, she launched an online CNA certification and mentoring platform with workforce management firm ShiftMed to boost industry recruitment after being rejected for a CMS grant.

Dombi agreed it would take more than money to fix the staffing issues, which he said are “beyond crisis levels”.

“You can’t go to Best Buy and buy a 3D printer to create a nurse or a home helper,” he said.