Virus Testing in Nursing Homes is Still a Stumbling Block, Experts Say

Testing every nursing home resident and staff member in the U.S. just once for the coronavirus would cost nearly $440 million, a level of expense that is unsustainable without additional federal and state government funding, according to groups that represent the facilities.

The American Health Care Association and National Center for Assisted Living released the cost estimates on Wednesday. They said if nursing home facilities were to follow a recent recommendation from the Centers for Disease Control and Prevention to test all staff on a weekly basis, it would cost more than $1 billion every month.

“We have been advocating for expanded and priority testing in nursing homes to protect our residents and caregivers, but this is a significant undertaking and cost for nursing homes to shoulder on their own,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center of Assisted Living.

Earlier this month, the groups sent a request to the U.S. Department of Health and Human Services and the Federal Emergency Management Agency, asking for $10 billion in federal funding to help nursing homes and other long-term care facilities cover testing and other virus-related costs, like additional staffing and personal protective gear.

The group’s cost estimates for testing were based on a per-test price of $150.

Nursing homes have proven to be trouble spots for the coronavirus. People who are older and have pre-existing medical conditions are among those who are more susceptible to falling severely ill from Covid-19, the respiratory illness the virus causes. 

Research shows that a disproportionate number of deaths from Covid-19 are occurring in nursing homes and other assisted living facilities.

Several states have launched investigations into whether nursing homes did enough to contain the spread of the coronavirus, while others have raised questions about whether states did enough to monitor what was happening in the facilities. 

Early on in the pandemic, federal and state officials banned nursing homes from allowing people to visit residents. To reopen, federal health officials have said frequent testing should be part of the approach. But experts say testing rates continue to fall short. 

“Testing, while it’s better than it was a month ago, is falling behind and not really able to meet some of the rhetoric going around that there be multiple testing of patients and residents of these facilities throughout, say, a week,” said Nathan Boucher, a professor in the Sanford School of Public Policy at Duke University, in North Carolina.

Even if the capacity for more frequent tests were available, there can be difficulties getting the results back quickly, Boucher added during an event Duke held Wednesday that was unrelated to the release of the report on testing costs.

Boucher said data for 38 states as of last week show there are upwards of 150,000 coronavirus cases tied to long term care facilities, along with over 30,000 deaths in 35 states.

An analysis the Foundation for Research on Equal Opportunity, a right-leaning think tank, published earlier this month found that residents of nursing homes and assisted living facilities accounted for about 40% of reported deaths in the U.S. from Covid-19, even though the 5.1 million people living in these facilities make up only about 1.6% of the nation’s population.

Nursing homes typically provide 24-hour supervision and care to residents who have health problems and who need assistance with routine activities. Assisted living facilities are similar, but residents generally don’t require full-time care or medical attention on site.

The Foundation for Research on Equal Opportunity analysis shows alarmingly high proportions of Covid-19 deaths in nursing homes and residential care facilities in many states. In at least 22 states, the data show that half or more of the fatalities occurred in the facilities.

In Minnesota, the share of deaths in the facilities was highest, at around 81%, or 472 of the 578 deaths captured by the analysis. In Pennsylvania, nearly 68%, or 3,137 of 4,624 Covid-19 deaths occurred in the facilities. And in Rhode Island, 75%, or 314 of 418 fatalities.

Boucher pointed to some of the challenges that settings like nursing homes pose when it comes to controlling the spread of the virus. “These facilities are not closed systems. There’s a constant flow of shift workers in and out of these systems, every hour, every shift.”

Donald Taylor, another Duke professor who participated in the event on Wednesday, said he couldn’t think of any other place with such a concentration of infections, besides prisons and possibly meatpacking facilities, where there’ve been outbreaks.

“It’s going to take focused, I think, federal effort, at least with money, to help get to the level of testing we're going to need,” he said. “And then I think each state probably should be responsible for working out the approach of how testing will work in that state.”

“We probably will not be able to get control of this in nursing homes without asymptomatic testing,” Taylor added. An aspect of Covid-19 that makes it particularly nefarious is that some people can have it and can be asymptomatic, without any obvious signs of the illness.

Taylor pointed out that experts are still trying to determine the best protocol for conducting tests in nursing homes when it comes to what types of tests should be used and how often. “We desperately need evidence,” he said. “If we don’t manage to control the epidemic within nursing homes, we’re not going to control it in the United States.”