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“I actually think going forward it may get much worse, especially going into the fall if we see another surge,” Grabowski told
McKnight’s Long-Term Care News in late September. “Existing workers are leaving the workforce but also potential workers that you might recruit (will stay away). We just haven’t been able to grow this workforce during the pandemic.” 

Multiple studies have linked quality of staffing to how well nursing homes fare with COVID-19. Grabowski added that Harvard research has suggested that about 1 in 5 facilities nationwide were reporting severe worker shortages.

“Our direct caregivers haven’t been supported going back really to the beginning of the pandemic, in terms of either pay or personal protective equipment and testing. I think at some point, they’re going to evaluate their options,” Grabowski said.

The Pharmacy Partnership for Long-Term Care Program is being facilitated through an agreement between the Departments of Health and Human Services and Defense, and pharmacy retailers CVS and Walgreens, which will administer the vaccines. 

HHS officials noted that the government has already funded the costs of producing and distributing the vaccines. This new arrangement allows CVS and Walgreens to bill insurers, Medicare or Medicaid for the cost of administering the vaccine. 

Federal regulators also said that long-term care providers can opt to use their previously contracted pharmacists, taking advantage of existing relationships and familiar personnel who are well-versed in treating the elderly.

“Seniors will be the first in line for the vaccine and we will soon be ending this pandemic,” said President Donald Trump, during a campaign stop in Florida. 

Regular delivery of 1 million weekly tests were to swiftly resume, and last through at least the end of 2020, Mark Parkinson, head of the American Health Care Association/National Center for Assisted Living, confirmed.

The stakes are high because the federal government’s decision to send the devices to various needy nursing homes and assisted living operators has been “a game-changer,” AHCA CEO and President Parkinson said.

“As long as they continue to [send test devices to needy counties], we can comply with the testing requirement and financially be OK,” Parkinson said. “Once they stop sending those tests, we have a real problem.”

Investigators examined the number of infections in these states following enactment of the Families First Coronavirus Response Act in March. The act called for two weeks of paid employee sick leave as part of an effort to curb the virus’ spread.  

The results translated to about one prevented COVID-19 case per day per 1,300 workers who were newly able to take paid sick leave. 

At year six, investigators evaluated over 2,000 participants in the Health, Aging, and Body Composition study for self-reported symptoms of apathy, distinguished from depression and anxiety. Volunteers were then grouped according to level of apathy. 

Over the  nine-year study period, dementia developed in 381 participants. Findings, which appeared in Neurology, were adjusted for demographics, cardiovascular risk, genetic risk and depressed mood. 

In October, CMS released an updated tip sheet on the SNF QRP program that detailed the agency’s strategy regarding data submissions during the COVID-19 public health emergency. In a March memo, CMS made it optional for SNFs to submit QRP data for the 2019 fourth quarter, while providers were expected to submit data for the first and second quarters of 2020. 

It will now hold the 2020 data constant. The site will remain frozen through October 2021. Public reporting will resume in January 2022 and a normal refresh will happen in April 2022. 

While the suspension of the release of data may seem like a reprieve for skilled nursing operators, that is not necessarily the case, according to one expert. 

“The impact of the freeze is that if your measures are not favorable, they will remain until the refresh in January 2022,” Amy Stewart, vice president of education and certification strategy at the American Association of Post-Acute Care Nursing, told McKnight’s. 

She added that the “important message here is that the work the facility is doing today will impact future publicly reported measures.” 

The warning came after Nevada public health officials issued a directive to providers to immediately discontinue use of the tests until further notice due to concerns about false positive results. HHS later sent a letter demanding the state rescind its directive, which it did. 

“Under federal law, Nevada may not prohibit or effectively prohibit such testing at congregate facilities,” HHS Assistant Secretary Admiral Brett Giroir, M.D.,  said. 

“I encourage all nursing homes in Nevada and throughout the country to adhere to [Centers for Medicare & Medicaid Services’] standards for testing your staff, and if you need to use point-of-care antigen tests to do that, you should proceed,” he added. 

Other states have also expressed skepticism about the testing equipment. A report found that multiple states are primarily using polymerase chain reaction (PCR) testing in long-term care facilities due to the associated challenges with the point-of-care tests. 

A: It’s definitely a hit. These are Medicare fee-for-service Part A patients. This is [SNFs’] lifeblood. They depend on that business to cross-subsidize Medicaid business, which is by far the largest part of their business. They typically run at some loss, in some states worse than others. [They] count on the short-stay [business] to offset those losses.

Q: Is there any sign of a recovery over the next few months? 

A:There’s a challenge ahead. It’s our expectation that these volumes start to return but not any time soon. For some of those facilities for whom the relief funds are running out, they are going to have a cash crunch, no doubt about it. 

Q: What other trends do you see?

A: I think it’s interesting that the Centers for Medicare & Medicaid Services took $2 billion and tied it to pay-for-performance for nursing homes. I think that’s a harbinger of things to come, in terms of connecting payment to facilities to performance. You can see this under either administration: an effort to tie payment to facilities demonstrating … that they are effectively managing COVID and keeping the case volume and mortality down. 

Investigators examined agitation in 30 nursing home residents aged 60 to 85 years at the Hyde Park Convalescent Hospital in Los Angeles. The findings were presented during the American Psychiatric Nurses Association 34th Annual Conference, which wrapped up in early October.

Caregivers played familiar calming music such as ballads and lullabies through a speaker while residents ate lunch for approximately 30 to 45 minutes. The intervention took place over an eight-week period, punctuated with three weekly sessions. 

Compared with residents who did not receive music therapy, the 30 residents who participated in the study exhibited fewer agitated behaviors at the end of the eight weeks. Similar reductions were seen in physical, aggressive behaviors such as hitting, biting and making sexual advances.

“Music intervention can be regarded as a safe and cost-effective approach in managing dementia symptoms of elderly patients,” said researcher Pedro Estrada Morante. 

“This method promises great potential in replacing antipsychotic drugs to manage aggressive behavior brought about by dementia in elderly patients,” he concluded.