Nursing homes, long in the spotlight as a key battleground in the fight to prevent the spread of COVID-19, are making key structural changes to prepare for an expected third surge of the disease.
Facilities have implemented increased testing, promoted mask use and changed clinical practices in an effort to protect older Americans who are at higher risk of complications from the coronavirus.
While many changes are temporary to mitigate the virus until a vaccine is available, others are more permanent.
“I think that what won’t end will be a renewed and strengthened emphasis on infection control,” said Mark Parkinson, CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
The AHCA/NCAL, which represents more than 14,000 skilled nursing centers, assisted living communities and other homes, is preparing for “the next pandemic,” Parkinson said, as many weren’t prepared for the current one.
“We are on hyper, high alert every single day and we will be until there is a vaccine and everyone gets vaccines,” Parkinson said.
More than 60,400 nursing home residents have died from COVID-19, with more than 260,500 confirmed cases across the country, according to the Centers for Medicare & Medicaid Services (CMS).
Health care experts say that despite the high figures, the situation has improved from earlier this year, when the coronavirus was spreading like wildfire in nursing homes across the country.
Parkinson said the situation at nursing homes was “horrific” in March and April, with nearly 7,000 people dying of COVID-19 a month and a half into the pandemic.
The largest number of deaths have been in New York, California, New Jersey, Texas, Massachusetts, Florida and Illinois, with those seven states accounting for over 45 percent of all nursing home fatalities.
The states with the highest number of deaths per 1,000 residents include Massachusetts, New Jersey, Connecticut, Louisiana, Rhode Island, Mississippi, Georgia and Pennsylvania.
“Conditions in nursing homes have improved dramatically since March. The two biggest reasons are the availability of personal protective equipment [PPE] back in March and April — we just didn’t have the PPE that we needed to keep the virus from spreading — and the second thing that’s occurred is the availability of testing,” Parkinson said.
Alex Brill, resident fellow at the American Enterprise Institute, noted that while the situation at nursing homes is improving, an increase in cases in parts of the U.S. will impact facilities for older Americans.
“The nursing home COVID crisis in New York and New Jersey and Connecticut from the beginning of the pandemic, things are different and way better there. But as the pandemic is spreading throughout the country, we’re going to see it pop up in other nursing homes,” Brill said.
He added, “If there’s a nursing home that hasn’t had many or any COVID-related deaths yet, they have to continue to watch what’s happening in their local community and be prepared for outbreaks.”
The first spike in coronavirus cases in nursing homes happened in late May, with more than 9,300 confirmed cases in just one week, according to CMS. The second spike was in late July with more than 10,100 confirmed cases in just one week.
Now, AHCA/NCAL predicts a third spike is coming — but says it can be avoided.
“It’s still preventable but it will require the public to do something that it has been unable to do until now, which is to show the discipline needed to stop the virus from spreading,” Parkinson said, urging people to “just wear a mask.”
Parkinson said he also expects Congress and state legislatures will evaluate the funding plan for skilled nursing facilities in an effort to make them more stable.
“I think there will be a good look at funding for skilled nursing facilities. We’ve been underfunding through Medicaid in many states,” he said.
Nursing homes are slowly reopening for visitors or for residents to temporarily leave and visit family. But, with Thanksgiving next month, those newly lifted restrictions will be tested as more people gather.
Health care workers themselves face major challenges in preventing the spread of the disease.
“In virtually every community in the country there’s a lot of COVID in the general population and when our workers go home at night or go into the community … our workers are exposing themselves to the possibility that they could catch COVID. Every single day in a nursing home is a major test,” Parkinson said.
Community spread to nursing homes comes from various sources, Brill noted.
“Kids are giving it to their moms or dads who are nursing home staff, or grandkids are giving it to grandma or grandpa — those are both risks that exist,” Brill said, adding facilities also need to be vigilant about staff-to-staff infection.
He noted the importance not only of testing but rapid testing in nursing homes, in addition to wearing masks and social distancing as key to curbing spread of the virus.
The Trump administration in August announced a new requirement that nursing homes must test staff for COVID-19 and will face financial penalties if they don’t comply.
COVID-19 cases at nursing homes are currently declining despite a rise in cases across the U.S. The mortality rate is also declining from the original rate of 20 percent in nursing homes, Parkinson noted.
He attributed the decline in mortality to testing, therapeutics and clinical practices like turning a patient onto their stomach to help their breathing.
A vaccine is expected to be available earlier to high-risk individuals, older Americans and health care providers. AHCA/NCAL has been working with the administration to ensure this distribution plan.
“We’ve had really good success in that area and we’re really excited,” Parkinson said.
The CARES Act, which Congress passed in March and added to in April, included a $175 billion Department of Health and Human Services Provider Relief Fund that was accessible to all health care providers impacted by COVID-19.
Less than 20 percent, which is under $35 billion, is left unspent from that funding. Overall, health care providers are advocating for an additional $100 billion to be added to that fund. AHCA/NCAL said long-term care providers, including nursing homes and assisted living communities, would need at least $20 billion of a $100 billion injection.
In July, the National Center for Assisted Living, American Seniors Housing Association, LendingAge and Argentum teamed up to request increased funding to keep senior living residents and staff safe.
The groups noted at the time that the financial impact of the coronavirus on the industry could be up to $57 billion over 12 months.