Amid calls for widespread testing in nursing homes, Florida’s governor has hesitated.
The White House recommended it. Experts have called for it. Nursing homes have begged for it. Gov. Ron DeSantis, however, has stepped back, saying elder-care facilities can decide on their own whether to test residents and staff for COVID-19 — but the state won’t mandate it.
Florida doesn’t have the resources, he said at a May 15 news conference in Doral. Instead, he encouraged long-term care facilities to get their staff tested at different drive-thru and walk-up sites, according to the Sun-Sentinel.
But experts and advocates agree: to contain the pandemic, and quell the death toll of Florida’s most vulnerable residents, nursing homes need a massive testing rollout.
“If you know that a very high percentage of the people in your state are dying in nursing homes, then you want to get out to every single one,” said U.S. Rep. Donna Shalala, D-Coral Gables, who is co-sponsoring a bill in Congress aimed at protecting nursing homes from the virus. “We’re trying to save lives here. We cannot waste any time.”
Coronavirus has ravaged long-term care centers across the state, with about 46 percent of deaths tied to the facilities, according to state data. As of Friday, 1,043 deaths in the state were from these centers. In Tampa Bay, about 61 percent of the area’s deaths are from long-term care facilities, with 196 dead, according to state data.
Tampa Bay is home to the deadliest outbreak in the state: the retirement community Freedom Square of Seminole, where 31 residents and one employee have died so far.
As of Thursday, 537 long term care facilities in Florida reported at least one positive test among residents or staff.
In Florida, testing employees of long-term care facilities is only mandatory when conducted by a National Guard strike team deployed there.
While Florida lags, states such as Pennsylvania, Texas and West Virginia have announced plans to test all employees and residents of nursing homes. Arizona’s governor coordinated a public-private partnership to achieve universal testing at all long-term care facilities. New York put the onus on nursing homes, requiring each facility to submit a plan for how they will test employees twice a week.
A spokeswoman for DeSantis did not respond to multiple requests for comment. The governor briefly touched on long-term care facilities during a news conference Friday in Jacksonville.
"If you just continue working with these long-term care facilities, that really does seem to be where most of this ball game is," he said, "and I think from the very beginning, we put a lot of emphasis on that."
Advocacy groups say federal and state funds could be diverted to help fund a widespread testing effort, though they differ on the best way to get there.
Two of the largest advocacy groups representing nursing homes this week estimated that testing all of Florida’s nursing home residents and staff just once would cost more than $25 million for about 169,000 tests. The American Health Care Association and the National Center of Assisted Living based their estimate off one test costing $150, and called for $10 billion in additional federal funding to pay for extra staffing, testing and protective gear in the coming months.
On Friday, the federal government allocated an additional $4.9 billion to nursing homes to help with labor shortages, testing capacity and other pandemic-related expenses. But Mark Parkinson, president and CEO of the industry lobbying groups, noted that assisted-living facilities, which also house vulnerable seniors, had not yet received direct federal aid.
“We are asking for additional consideration for all long term care facilities, whether it be in regard to additional testing, personal protective equipment, or funding,” Parkinson said in a statement.
Families for Better Care, an advocacy group run by the former ombudsman for Florida’s long term care facilities, said the trade groups’ estimate is inflated. Brian Lee, the former ombudsman, said it would be more cost-effective to use the more than $225 million federal officials have already collected in nursing home fines to install rapid testing machines at every facility, allowing staff and residents to get tested frequently.
“We could do it a whole lot cheaper — really for free — for the taxpayer,” Lee said.
The fines are collected by the federal Centers for Medicare and Medicaid Services and can be deployed for initiatives that help long term care facilities better support their residents. During the pandemic, the fund has already been directed to nursing homes to buy tablets and web-cams so they can connect residents with their families during lockdown.
“CMS could do the same for rapid testing machines,” Lee said. He estimated Florida’s fund could purchase at least 3,000 testing machines.
Florida’s Agency for Health Care Administration said it is discussing this possibility with federal officials.
The Florida Health Care Association, which represents nursing homes across the state, agrees that testing would be a good use of the fine money, said spokeswoman Kristen Knapp.
Facilities don’t take on any of the cost when the Department of Health gets involved, Knapp said. But if they want to take on testing themselves, cost becomes an impediment. The association estimated that just a week’s worth of $150 tests for every nursing home employee in the state would cost about $14 million, she said. That figure only multiplies for ongoing testing.
But Shalala said there’s no reason that tests should have to cost that much. To drive the cost down, she said the federal government should negotiate purchasing on behalf of all nursing homes nationwide.
"If you're going to let them (nursing centers) out on their own and send them each a check, it's going to cost a lot of money,” she said. “It's the perfect responsibility for the response of the federal government."
Shalala this week co-introduced a bill, the Nursing Home COVID-19 Protection and Prevention Act, that would allocate $20 billion to help fund additional testing and personal protective equipment for nursing homes, among other initiatives. The federal CARES Act, passed in response to the pandemic, also provided $200 million to support nursing home infection control and $100 billion to reimburse health care providers for expenses and lost revenue connected to the coronavirus, some of which could be deployed to nursing homes.
“There is plenty of money that the United States of America is prepared to spend on testing,” she told the Tampa Bay Times. “Whatever the price tag is, it’s not too high to protect our loved ones.”
Michael Barnett, a professor of health policy and management at the Harvard T. H. Chan School of Public Health, said testing every resident and staff member is vital to containing the pandemic — but it can’t happen just once.
“It's not going to do anything for the situation three months from now,” he said.
The state banned all visitors to elder-care facilities on March 15. DeSantis has said he’d like to allow visitors to return. Barnett said frequent testing of everyone in long term care facilities could pave the way. But he said introducing visitors without widespread testing could be dangerous and spur more deadly outbreaks.
“That only makes sense if, collectively, Floridians and the government have decided this is a battle they can’t win,” he said.
Barnett said the argument that testing is too expensive is disingenuous. If tests cost too much, he said, there needs to be a way to make testing cheaper — not just accept that fewer people can be tested.
“What are we capable of doing if we can’t actually come up with a coherent, systematic plan for nursing homes?” he said. “Literally, the most vulnerable population.”
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