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From the December 2020 Issue of McKnight’s Long Term Care News

“We have two hard months ahead of us, maybe three,” said former FDA Commissioner Scott Gottlieb in November at Leading-
Age’s annual meeting and expo. 

“We’re in sort of the final stages of the acute phase of this pandemic. I liken it to being in sort of the seventh inning of the acute phase of the pandemic. The next couple of months are going to be hard.”

His advice: “Don’t let your guard down, continue to be vigilant, and be even more careful because this is probably going to be the most dangerous phase of the pandemic.”

Gottlieb added that he didn’t think nursing homes would have an issue ensuring their workers get doses of a COVID-19 vaccine, once one is available. 

“People are going to make the informed judgment to get themselves vaccinated, especially people who are medical workers,” he predicted.

“Every flaw and crack in our system has been exposed. The fractures are too great to [just] patch back together,” Sloan said. “While we clearly need to remain focused on today’s crisis, now is the time to consider what we may be. We need imagination now more than ever.”

Despite the horrors that the COVID-19 pandemic has brought, Sloan said that operators should seize an opportunity to band together and create a better post-pandemic future.

“Our progress must be measured in actions taken, policies changed and lives lived,” she added. “Our objective is deep systems reform and we must be the ones to define success.” 

That future could include such changes as developing a better system to pay for long-term services and supports in a fair and rational way, setting reimbursement rates that cover basic needs, and ensuring the industry workforce is adequately paid and that seniors have access to services that fit their needs, she said. 

The Department of Health and Human Services distributed additional Abbott BinaxNOW tests to nursing homes in “yellow” counties, along with those in “green” counties, Adm. Brett Giroir, M.D., assistant secretary for health of HHS said at a media conference last month. Yellow and green are code designations for counties with lighter positivity rates and which, therefore, require less staff testing.

HHS announced the distribution of the BinaxNOW tests in early September, with the first shipments going to providers with higher positivity rates.

Overall, more than 36 million testing supplies had been delivered to nursing homes across the United States at press time.

The PrecivityAD test can detect the presence of biomarkers for amyloid beta, a hallmark of the disease, and is consistent with the results of a diagnostic brain scan. 

“While the test by itself cannot diagnose Alzheimer’s disease … the test is an important new tool for physicians to aid in the evaluation process,” C2N Diagnostics said.

It is available in 45 states, Washington, D.C., and Puerto Rico. 

The coverage will be available to beneficiaries who live across a variety of healthcare settings, including nursing homes, at no cost during the public health emergency. 

The agency added that Medicare will cover and pay for the antibody infusions “the same way it covers and pays for COVID-19 vaccines,” once approved and ready for distribution. However, the federal program will not pay for products that providers receive for free.

The Proposed Physician Fee Schedule Rule for 2021, disclosed by CMS in early August, includes an approximate 9% reduction in payments for physical and occupational therapy. CMS would use the revenue from these cuts to offset payment increases for primary care physicians. The cuts would become effective with the start of the calendar year and comes after therapy providers took an 8% cut last year.

In a recent op-ed in The Hill newspaper, Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care (NASL), forecast a potentially dire future.

“The cuts sought by CMS are significant and deep and will have a damaging effect on nursing home residents’ access to rehabilitation, physician services and diagnostic testing,” Morton wrote. “For nursing home residents who need care, these cuts will result in less physical therapy to build up strength, potentially depriving them of the full benefit of relearning how to walk.”

The decreased payments also would reduce occupational therapy services that providers can offer, she said.

More than two-thirds of executives for senior housing and skilled nursing operators reported that they were using the outside resources to fill vacancies, the National Investment Center for Seniors Housing & Care (NIC) found. The figure is up from mid-April, when just 36% of executives reported using a hiring agency or temporary staff to deal with workforce shortages.

The findings were from NIC’s Wave 15 executive survey. Responses came from 64 operator executives and were collected between Oct. 26 and Nov. 8. Despite the issues, 81% of respondents said they are continuing to offer staff overtime hours.

The pandemic has exacerbated already-difficult workforce issues, many providers agreed.

“Although down slightly from Wave 14 (Oct. 12-25), most respondents are continuing to pay staff overtime hours, putting ongoing strain on [net operating income],” NIC senior principal Lana Peck explained.

A:This is a really good defining moment for long-term care, and for rehab. If our model has to change, it has to change. People don’t get better without rehab. We have to remember that. 

Q: What do you think about telemedicine?

A:There’s a necessity to human touch. We learn about it in nursing school. I mourn that. I understand the reality of not being able to do that. I hope we can get back to the time we can touch somebody and say, “I’m here to help you,” versus [through] a TV screen. 

Q: Your thoughts on the Patient Driven Payment Model?

A:PDPM has rewarded nursing homes for the nursing care. Having RUGS overshadowed what nursing did for a long, long time. People paid too much attention to the minutes and forgot about the basic nursing care that occurred every day, seven days a week. 

Q: How should facilities approach this new wave of the pandemic?

A:Honestly, I think this is a wonderful practice run for the flu. I believe this was a wake-up call to say we should wear masks, wash our hands, take care of each other, be respectful of our distance, and we can stop a lot of this. 

The investigation centered around more than 600 Ontario nursing homes that housed about 78,600 residents. Of those residents, 36.9% were located in single rooms, 37.3% were in double rooms and 25.8 lived in quadruple-bedded rooms. Also, 6.6% of the residents contracted COVID-19, while 1.8% died of the disease.

Researchers discovered that COVID-19 mortality rates were 2.7% in high crowding nursing homes, compared to 1.3% in low crowding nursing homes. “Our findings align with a prior systematic review demonstrating that the risk of a respiratory infection in occupants of two-bed rooms was double that of those in single-occupancy rooms. Physical barriers, such as walls separating bedrooms, predict deposition patterns of viral droplets more than absolute distances between beds in a shared room,” researchers concluded.

There also were nine reported outbreaks involving more than 100 residents in high crowding facilities, compared to just one outbreak in low crowding nursing homes, the study found.