Jul. 21--TALLAHASSEE -- As state officials focused their attention for the last three weeks on the rising COVID-19 case numbers among younger Floridians, the number of infected residents and staff at elder care facilities has more than doubled, and on Monday, the trade association for nonprofit nursing homes unleashed a cry for help.
"For months we have been sending out a warning to the federal government that this crisis is not over," said Katie Smith Sloan, president and CEO of LeadingAge which represents 5,000 nonprofit nursing homes and assisted living facilities, on a teleconference with reporters Monday. "We need real solutions now, not a patchwork of policies that allow the pandemic to grow more deadly and dangerous."
She called the rising case numbers a "category five-level emergency bearing down on millions of older adults in Florida and across the United States," and urged Congress to reject President Donald Trump's call to block funding for states that invest in more testing and contact tracing.
"What kind of message is that to older adults who are so vulnerable to COVID-19, and to their families?" she asked.
According to data released by the Florida Agency for Health Care Administration, the surge in new infections among residents at nursing homes and assisted facilities rose by 153% or 2,868 cases between June 30 and July 20, while the increase among staff rose 126% or 3,784 cases. Of the 5,072 deaths in Florida, 2,400 had been residents or staff at long-term care facilities, the agency said.
In May, the state launched a crash program to test for COVID-19 at Florida long-term care facilities that has provided a window into the spread of the virus throughout the state's 3,800 nursing homes, assisted living facilities and rehabilitation centers.
Visitors have been banned since March, so most of the 4,736 residents who have been infected with the coronavirus have gotten it from "staff and vendors" who have become infected because the virus is continuing to spread in their communities, said Steve Bahmer, president and CEO of LeadingAge Florida, which provides lobbying and policy support for Florida members.
"Our members have been screening and implementing very strict protocols for the better part of five months now, and they continue to double down on that effort, ever vigilant, to try to prevent it from getting in," he said. "But the truth is what happens in our towns and cities happens inside our long-term care communities as well. And so, as folks have gone out in public without masks, without practicing social distancing, we've seen the result of that in terms of a spike in cases."
Because older adults often have preexisting health problems that make them more vulnerable to health complications from COVID-19, they also account for nearly half of all COVID-19 deaths in Florida. That calls for a coordinated solution, Sloan said.
It's all about testing
Testing at nursing homes and ALFs is central to containing the virus in the state's most vulnerable population. The federal Centers for Medicare & Medicaid recommends that nursing homes test staff at least every week and the Centers for Disease Control and Prevention recommends that for testing to be effective, nursing homes must obtain results within 48 hours.
Although Florida requires that all staff be tested every two weeks, the results normally take at least 72 hours, said Jay Solomon, CEO of Aviva, a nonprofit senior care community in Sarasota. But with the surge in cases, "there is that concern that it's going to take longer" and "if it's going to take more than 72 hours to get the results, then we kind of defeated the purpose."
Since the onset of the crisis, Florida has taken a piecemeal approach to testing at nursing homes. In May, Gov. Ron DeSantis rejected a suggestion by the White House Coronavirus Task Force and its coordinator, Dr. Deborah Birx, that all residents and staff at long-term care facilities be tested immediately.
He said at the time that the state didn't have the resources to conduct the same kind of widespread testing that was occurring in other states, so state officials distributed tests to homes that wanted to conduct testing on their own and encouraged other facilities to send workers to the state-run drive-through and walk-up testing sites offered in large metropolitan areas.
By late May, Florida Surgeon General Scott Rivkees required all long-term care facilities staff submit to testing supplied and financed by the state. Residents would be subject to voluntary tests. And at the end of June, state officials announced they would require that all staff be tested every two weeks, with financing provided by the state until September.
"There is no way to keep staffing as safe unless testing is readily available with quick results," Sloan said. "We are looking for a federal response and for Congress to take concerted action."
Bahmer and Solomon said that state testing has been welcome but insufficient to tamp down the outbreak that is spreading from staff and vendors to vulnerable residents.
Solomon also noted that federal promises to supply personal protective equipment has resulted in PPE that has been either of such shoddy quality it is unusable, or it never arrives.
And Sloan said that because "there was no coordinated federal response, there was no prioritization of the most at-risk citizens."
LeadingAge issued a report that summarized the extent of the crisis in Florida:
-- More deaths: Older adults account for 47% of all COVID-19 deaths statewide -- and as high as 60-75% in some counties, including Pinellas, Manatee, Hillsborough, Sarasota, and Polk. If current trends continue, 19,285 Floridians will have died from COVID-19 by Nov. 1, likely including an estimated 10,000 older Floridians.
-- PPE shortages: Although supply has improved, "providers are still facing significantly higher-than-normal prices, creating significant financial pressures."
-- Staffing woes: With more staff members testing positive, staffing levels are increasingly strained, driving up the cost for overtime and replacement workers. Also, as homes have to dedicate staff to COVID-19 isolation units for infected residents, it increases the burden on staff in other areas.
-- Financial strain: COVID-19-related increases in costs for staffing, testing and disinfecting are driving operating losses to many providers from $100,000 per month to $3 million per month. If the state and federal government stop paying for bimonthly testing of staff, it will cost facilities, depending on their size, $25,000 per month to $300,000 per month.
Solomon said that absent federal assistance, homes will have to make a choice between testing residents to see if they are infected, or testing staff members to see if they are infecting residents.
"No provider should have to make such tough decisions as whether to test staff this week, or residents," he said. "Someone who provides instant tests told me last week that if I were to place an order Friday, I could hope to have equipment on site sometime in October."
Sloan and Bahmer called on Congress to step in with emergency help.
They sent a letter to Florida Sens. Marco Rubio and Rick Scott, asking them to support a relief package that help them direct resources to the testing and staffing needed to protect their residents.
"Many aging care providers are struggling to keep up, and they're hurtling towards a fiscal cliff," Bahmer said. "The only hope we have of getting ahead of this is repeat, rapid, routine testing. The need is not going down and costs are not coming down, so federal resources are absolutely necessary."
Their concerns provide a different perspective than the one offered by DeSantis, who says at nearly every news conference that the number of deaths among Florida's oldest citizens would be worse had the state not acted aggressively early in the crisis. State regulators restricted visitors to all regulated long-term care facilities in March and required that hospitals not be allowed to transfer patients to nursing homes unless they tested negative for COVID-19.
At a news conference in Apopka last week, the governor said the state also sent "massive shipments of PPE" to long-term care facilities, and deployed the National Guard to test staff and residents at facilities where outbreaks were occurring.
"I guarantee you, had we not done that, we would have had thousands of more of our most vulnerable would have passed away," he said. "Had we done policies like were done in some of the other states where they were forcing the nursing homes to have infectious patients, it would have been way,way worse. And so I think the efforts have been targeted. I think the efforts have definitely saved lives. We're not out of the woods obviously and I think it's a difficult situation."
Mary Ellen Klas can be reached at [email protected] and @MaryEllenKlas
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