Hello Nelson – Below is a letter sent this morning to the National Governors Association (NGA) and state governors from the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) warning states of imminent outbreaks at nursing homes and assisted living facilities given the major spikes in new cases in several states across the U.S., combined with serious personal protective equipment (PPE) shortages and significant delays in getting testing results for long term care residents and caregivers. Here is a link to a pdf version of the letter.
July 14, 2020
National Governors Association
444 North Capitol Street, NW
Washington, D.C. 20001
Re: Urgent Attention Needed to Prevent COVID Outbreaks in Long Term Care Facilities With Major Spike in New Cases; Urge Caution and Thoughtful Approach In Reopening Facilities
Thank you for your leadership in response to this unprecedented health crisis and the action your administrations have taken to prevent the outbreaks of COVID-19 in nursing homes and assisted living communities to protect our residents and dedicated caregivers.
However, with the major spikes of COVID cases in many states across the country, we are very concerned this trend will lead to a dramatic increase in cases in long term facilities.
Recent independent research by Harvard Medical School, Brown University’s School of Public Health and University of Chicago showed the level of COVID cases in the surrounding community was the top factor in outbreaks in nursing homes.
In fact, our own analysis found that approximately three-quarters of all nursing homes cases of COVID-19 resided in counties with greater than a 3.59 per 100,000 seven-day average rate of new cases of COVID-19.
Given the fact that the level of COVID in the community surrounding a nursing home is a leading indicator of cases in the facility, the major spikes of COVID cases in many states comes at a very challenging time as many states plan the reopening of long term care facilities and return of visitations from loved ones.
Reopening long term care facilities is important for our residents’ wellbeing and caregivers and providers recognize the importance of visitations of family and friends. To accomplish this goal, nursing homes and assisted living communities need additional support from federal and state public health agencies in order to protect residents and caregivers.
Nursing homes and assisted living communities cannot stop the virus by ourselves – not without testing, personal protective equipment (PPE), staff support and funding, and not without support from the public health sector.
On behalf of the long term care industry, we would like to request urgent attention and support from governors across the U.S. in these specific areas:
1. Direct state public health agencies to expediate lab processing time and a solution for on-site testing with reliable and rapid results.
AHCA/NCAL recently conducted a survey of its members on the issue of COVID testing showing the amount of time it is taking labs to process tests of residents and staff at nursing homes and assisted living communities is becoming a major concern for providers.
Nearly nine in 10 (87 percent) nursing homes and assisted living communities said obtaining test results back from the lab companies is taking two days or longer (63 percent – two to four days, 24 percent five days or more).
Among nursing homes and assisted living communities, 56 percent said lab processing was the top barrier for access to testing (cost of testing was second major barrier).
The amount of time it is taking to receive testing results is hurting the ability of long term facilities to fight the virus. Regular testing of nursing home and assisted living staff is a vital step in controlling the spread of COVID-19, but is not effective without obtaining timely test results.
For nursing homes and assisted living communities to protect residents and staff, we need on-site testing with reliable and rapid results. With a recent uptick in COVID-19 cases among the general population, we are concerned labs will get overwhelmed and receiving results for long term care residents and staff will take even longer to obtain.
We are asking governors and public health agencies to help expedite the delivery of test results and work towards a solution to provide on-site testing with rapid results.
2. Direct state public health agencies to provide additional support on PPE supplies – especially N-95 masks.
An efficient and targeted PPE supply chain is needed to keep health care workers safe, while treating and interacting with residents with and without COVID-19.
Currently, nearly 20 percent of nursing homes report to CDC that they either do not have or have less than a one-week supply of PPE, and more than half of assisted living communities have less than a two-week supply of N-95 masks and gowns. N-95 masks are still not available and were not included in the FEMA shipments to nursing homes.
Given the fact we are several months into the response of this pandemic and the lack of PPE supplies is still an issue is very concerning. We request governors and state public health agencies help secure and direct more PPE supplies to nursing homes and assisted living communities.
3. Direct state public health agencies to work in close coordination with long term care providers on reopening facilities to visitations.
Providers are eager to welcome back family and friends to our facilities, but the health and safety of our residents and staff will always be our top priority.
With major spikes in cases in several states as well as significant upticks in many counties across the country, we are very concerned about reopening many long term care facilities. In order to protect our residents and caregivers, state public health agencies must work closely with long term care providers to ensure they have the supplies, testing and staffing to reopen safely.
We applaud states that have worked closely with our providers in taking a thoughtful approach to reopening facilities with strategies, such as:
• Prioritizing long term care to ensure all staff, residents and visitors wear adequate PPE, including face masks and source control masks.
• Ensuring screening and monitoring residents, staff and visitors. Temperature checks, symptom screening, and access to hand washing stations or hand sanitizer upon entering and exiting the building.
• Resuming group activities thoughtfully and with caution. Engaging residents in outdoor activities when possible, while maintaining a social distance of at least six feet apart and ensuring that residents, visitors and staff are wearing appropriate PPE. Limit the number of family members (i.e. one to two per visit) and schedule visits for a set amount of time (likely not more than 30 minutes) with their family member socially distanced at least six feet apart. Limit movement of visitor to only essential area for visit.
We request that state public health agencies work in close coordination with our providers to ensure every facility has the PPE supplies, testing and staffing in place to safely reopen.
Again, we appreciate your leadership and the support from your state public health agencies in helping long term care facilities respond to the unprecedented public health crisis.
We urge governors and state health departments to closely monitor the situation in the general population county by county to determine if long term care facilities need additional resources and if visitations should be halted temporarily for the safety of residents and health care workers.
We know our collective priority is the wellbeing of our long term care residents and caregivers, and by working together, we can protect them through this pandemic.
President & CEO
NCAL Executive Director
cc: State Governors, Territory Governors, Mayor Muriel Bowser