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“Our experience continues to show that rapid and wide-scale testing in response to a new case in a setting of the nursing home is the best way to limit the transmission,” Robert Redfield, M.D., told nursing home stakeholders in September.

The federal government in late August announced new regulations that mandate nursing homes routinely test staff members for COVID-19 as part of an effort to identify asymptomatic people who could spread the virus.

Redfield said health officials want to “underscore how important it is to conduct comprehensive testing as part of outbreak investigations. 

“There can be a substantial increase in the number of individuals that actually become infected based on delays of even several days. It’s critically important in these settings to have follow-up, repeated rounds of testing until no new cases are identified,” Redfield explained. 

The document offered direction to the Centers for Medicare & Medicaid Services on everything from improving testing turnaround times and ensuring adequate personal protective equipment to refining cohorting procedures. 

But beyond delivering action items for the agency in response to the COVID-19 pandemic, the report also alerted the agency to the need for comprehensive reform of the long-term care system. It discussed a fragmented payment regimen, severely underpaid workforce and outdated facilities.   

“The time has come for a turning point in nursing home care,” report authors wrote. “The Commission envisions a person-centered, resilient system of care that is better for the next generation — one that more deeply values and respects older adults and people with disabilities as vital to the fabric of American society.”

CMS established the 25-member commission in April.

Payments are being based on facility performance regarding infection and mortality rates as a means to ensuring better outcomes, federal officials said.

This “will help support quality care, slow the spread of the virus and save lives,” HHS Secretary Alex Azar said. 

Community-level federal data based on where the facility is will be used to quantify the key performance measures. 

For those who qualify, the funding may be paid for any or all of four periods: September, October, November and December. The government will make $500 million available each month.

Speaking at the United Nations in Geneva, Mike Ryan, M.D., called for policymakers worldwide to “fundamentally rethink the relationship we have with older generations and the way in which we provide care for that generation.”

“We need to see the needs of our older generation as a rights issue,” Ryan said.

“It’s unlikely we’ll have a definitive answer” by Nov. 3, Fauci said during an appearance at a virtual research conference. A better bet, he said, is that a vaccine might be approved for distribution by the end of the year. 

He made the remarks after two pharmaceutical companies, AstraZeneca and Soriot, temporarily paused trials for vaccines after participants showed adverse reactions.

“Today’s action will expand the use of rapid point-of-care antigen tests to slow the spread of COVID-19 and continue safely reopening America,” Admiral Brett Giroir, M.D., HHS assistant secretary for health, said in a prepared statement on Aug. 31.

HHS took this action as part of the Public Readiness and Emergency Preparedness (PREP) Act. The department explained that it preempts any state and local law that prohibits or effectively prohibits those workers from administering the tests authorized by the U.S. Food and Drug Administration to individuals at those facilities. 

HHS added that testing to screen for infections is a key part of the overall effort to combat COVID-19. It also noted that the Food and Drug Administration and Centers for Medicare & Medicaid Services have each released guidance on the use of the testing devices in congregate settings.

Earlier in August, CMS disclosed new routine staff testing requirements for nursing homes. Per the guidance, routine testing correlates with the positivity rate in the county over the past week.

The study used de-identified visitor data at nursing homes from 26 states. Researchers noted that because the data is de-identified, total traffic to nursing homes is inclusive of staff, vendors and visitors.

Experts said that better visitor insight might have been provided if the numbers were stratified by type of visitor.

“While this data does show the significant drop in visitors, it does not quite fully convey that there was almost a 100% decrease in [nonessential] visits that bring great joy to our residents — visits from their family and friends,” Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, told McKnight’s.

She noted that “most providers took the guidance very seriously and had even put in place restrictions prior to [Centers for Medicare & Medicaid Services] requirements.”  

“The isolation our residents have felt is heartbreaking, but necessary to keep them safe from a virus that has been so unkind to our residents,” Hennessey added.

A: The report highlights the pandemic’s tremendous impact on older adults and aging serv

ices, particularly nursing homes. Testing is critical to protecting older adults and care workers, but providers still are unable to access needed supplies and rapid results. It is expensive and a complicated process for providers, particularly with new CMS regulations.

Q: The report found that testing could cost up to $15,000 a week for large nursing homes. How much of a hardship is this?

A: $15,000 a week is not affordable nor sustainable for most providers. Testing costs vary depending on staff size and frequency of testing (based on community COVID-19 rates). Providers are having to pay out of their own pockets for test supplies, staff time and [personal protective equipment] used during testing. With no end to the pandemic in sight, the financial impact is disastrous.

Q: What should facilities take from a report like this?

A: There is an urgent need for robust federal support to support care for older Americans. Without help, many providers will be unable to sustain operations at the current pace for another year.

Investigators analyzed weight data from residents in a 240-bed suburban Chicago facility from December 2019 through April 2020. The operator ceased all nonessential visits and replaced group meals with in-room delivery beginning in March, following guidelines from the Center for Medicare & Medicaid Services and state health officials. 

From February to April, two-thirds (67%) of residents lost weight, and nearly a quarter lost more than 5% of their body weight, reported Margaret K. Danilovich, Ph.D., from Northwestern University’s Feinberg School of Medicine.

Several disruptions may have had an effect on residents’ food intake, researchers said. For example, residents requiring assistance ate with a nursing assistant at staggered times. Also, uneven intervals between meals resulted in reduced appetite and consumption. In addition, group activities ceased, and residents were encouraged to stay in their rooms. These changes reduced social interactions, which are known to support meal consumption. Finally, family visits ceased, so residents did not receive outside food. 

A peer-reviewed article has been published as a pre-proof in JAMDA.