Operators Greet Nursing Home COVID Testing Initiative with Cautious Optimism, Pointed Questions

July 15, 2020

One day after the federal government announced an ambitious plan to send point-of-care testing units for COVID-19 to all of the nation’s more than 15,000 nursing homes, leaders in the space expressed cautious optimism — while often emphasizing that they have more questions than firm answers.

Starting next week, the Department of Health and Human Services (HHS) will begin sending testing devices — the Quidel Sofia and Sofia 2, along with the BD Veritor Plus — directly to nursing facilities, starting with 2,000 buildings identified as high-risk based on levels of community spread.

Many of the program’s logistical details remain unclear, even after a late Wednesday phone call with operators that included commentary from Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma and assistant HHS secretary Dr. Brett Giroir.

But until proven otherwise, the early consensus is that any attempt to boost the speed of COVID-19 testing at nursing homes is welcome news.

“I’m going to be positive. To me, there’s no reason to be negative,” Dr. Michael Wasserman, president of the California Association of Long-Term Care Medicine and former CEO of operator Rockport Healthcare Services, told SNN. “If the government’s saying it’s going to do what should have been done a couple months ago, I’m thrilled.”

By bringing tests directly to facilities’ doorsteps, the government hopes to alleviate the growing pile-ups at laboratories across the country, which have only worsened as case counts spike in the wake of economic reopening measures.

“As you know, the turnaround time is getting a bit longer,” HHS assistant health secretary Adm. Brett Giroir said Tuesday. “And it’s also very expensive. So what we’re talking about is a point-of-care, rapid, on-the-spot, 20 tests per hour, instrument — along with tests — to every single of the 15,400 nursing homes in this country.”

Asked for their reaction Wednesday, leaders and academics generally welcomed the news, with the caveat that details about the program remain scarce.

“The news coming out of CMS on point-of-care testing is welcomed and encouraging,” Derek Prince, president and CEO of The Woodlands, Texas-based operator HMG Healthcare, said in an e-mail. “Hearing about the availability and technology of rapid testing for all nursing facilities is something we look forward to hearing more about. For months nursing facilities have struggled with testing frequency, availability, accuracy and lag times in results. We cautiously wait for more information and direction on this new initiative.”

Erin Shvetzoff Hennessey, CEO of Health Dimensions Group in Minneapolis, echoed that sentiment.

“Knowing the devastating impact of the disease on the elderly, we hope this much appreciated support of our dedicated staff and the elderly they serve continues — from states, the federal government and the public,” Hennessey said. “We remain incredibly proud of the work of our profession and are thankful for more resources as we continue to fight COVID-19.”

But that doesn’t mean there aren’t pointed concerns. In particular, Wasserman focused on the on-the-ground logistics of regularly processing tests, which isn’t typically a part of an individual facility’s day-to-day operations.

“Reading what they said, they spent two months planning for this,” Wasserman said. “You would hope that their planning has included the ease of use and ability to integrate into a facility’s workflow.”

Christopher Laxton, the executive director of AMDA — The Society for Post-Acute and Long-Term Care Medicine, said that it can take up to a full day for staffers at a 100-bed nursing home to collect samples for testing, raising questions about whether the typical nursing home will be able to perform regular on-site tests with current — and often strained — staffing levels.

“You can’t take the clinical team away from bedside care for an entire day and expect the nursing home will continue to provide good care,” Laxton said.

For Shalom Friedland, vice president of operations at the Lakewood, N.J.-based Paramount Care Centers, any on-site testing will represent an improvement over the current system.

“Since we have been testing weekly in all facilities for the past six weeks or so, we know from trial and error what needs to be done, and we are fairly confident that the program will be significantly easier [than] what is in place currently, as the biggest challenge now has been timely results,” Friedland said via e-mail.