Since the disease started spreading in nursing homes and assisted living facilities in March, COVID-19 has taken 1,588 lives and caused thousands more infections in Florida’s long-term care facilities.
Wednesday, state officials issued an emergency rule requiring that all facility staff be tested for the virus every two weeks.
The emergency order does not require that residents be tested, though many of the facilities are testing residents independently. A spokeswoman for the Agency for Health Care Administration said that if a resident shows any sign of COVID-19, the facility is expected to coordinate testing of that resident.
The rules, issued by the healthcare agency, require that nursing homes and assisted living facilities use testing resources provided by the state and keep all documented test results on site. Violating the rule could get a facility’s license revoked, suspended or fined.
Staff who have already been infected and recovered from COVID-19 do not need to be tested, so long as they can show documentation.
The purpose of the rule, spokeswoman Katie Strickland said, is to provide further oversight of testing at nursing homes and assisted living facilities that employ staff who return to the community after their shifts.
Some advocates say the rule looks good on paper, but question how effective a biweekly test will be in stopping the spread of the disease. There is no detail from the state on how the tests will be distributed and what kinds of tests will be available. The rule is an emergency order, not an organized plan, which concerns some groups that represent nursing homes and assisted living facilities.
Nick Van Der Linden, a spokesman for LeadingAge Florida, an association representing about 250 mostly nonprofit long-term care facilities, said ideally, the required test results need to be available rapidly. The member facilities have seen an improvement as far as test results becoming available for both residents and staff, but certain providers say that it takes 10 days or more to see results.
“That’s just not helpful,” Van Der Linden said.
LeadingAge Florida’s president and CEO Steve Bahmer, who served on the governor’s reopening task force, wrote in his recommendations that testing must be frequent, repeated and rapid.
Brian Lee, a former Florida long-term care ombudsman who now leads an organization called Families for Better Care, agreed that without rapid testing, the rule won’t help the bigger issue of exposure to residents and staff.
He questioned whether the emergency rule is a cover to begin the process of reopening facilities for visitors. He said fining facilities for not following the rule could put an undue burden on administrators who are already struggling to keep workers and residents safe. The rule does not include specific information about how the facilities can acquire the testing kits.
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“I think this looks good on paper,” Lee said. “But the state hasn’t helped them to get the resources they need to put these [rapid test] machines in place. We have been calling for this for months.”
One assisted living facility administrator pointed out a logistical issue that was not addressed in the order. Because assisted living facilities are not all considered medical facilities, they can risk losing their licenses if they provide any service that should be done by a nurse or a doctor, she explained.
She hopes the state will pay to bring in qualified people to test the 21-person staff.
“It feels wrong that they expect us to test our own staff. We don’t have staff who are qualified,” said Kathryn Moore, of the Bay Oaks Historic Retirement Residence in Edgewater. “ALF employees are on the front line. We hope AHCA will show them respect by ensuring required testing is free, fast and easy.”
Gail Matillo, president of the Florida Senior Living Association, agreed that there will be logistical challenges and that facilities will rely heavily on local and state AHCA regulators to help staff acclimate to the new rule.
“That being said, we also understand how important regular testing is for assisted living facilities, especially as the state moves closer to allowing visitation again, and we appreciate the state shouldering the financial burden of this requirement,” Matillo said.
Workers are wary of the rule change, too,
Margarette Nerette, vice president of long-term care for 1199SEIU United Health Care Workers East, represents more than 8,000 workers in nursing homes in Florida. She said the rule change is “good but bad at the same time.”
“It’s too late ... Why now?” she said. “A lot of them already got sick, a lot of patients already died. They were supposed to make these decisions upfront, not now.”
State officials now have a clearer picture of the virus’ effect on long-term care facilities after a crash program to test for COVID-19 shows the state went from having tested at just a handful of elder-care homes to 2,215. Another 1,000 homes reported conducting their own tests of staff or residents or both, according to a Herald analysis of records supplied by the state.
In recent weeks, Gov. Ron DeSantis has tried to accelerate the testing at long-term care facilities. The state Department of Health has changed its approach to prioritize workers, and the governor has ordered the National Guard to conduct on-site tests at the facilities.
The state has also launched a mobile testing lab equipped with a rapid diagnostic testing machine that will travel to long-term care facilities, test residents and staff and produce test results in 45 minutes. For some healthcare workers in Miami and Orlando, the state is also testing for antibodies. In early May, DeSantis ordered hospitals to test patients for COVID-19 before transferring them to long-term care facilities.
In all, Florida licenses 691 nursing homes, with about 84,448 beds, and 3,081 assisted-living facilities, or ALFs, with 106,103 beds.
AARP’s Florida acting state director Dionne Polite said the order is a “positive move” by the state.
“This is a welcome step in the right direction,” Polite said. “It has been clear for some time that staff are the most common vector through which the coronavirus is getting into elder-care facilities.”
Kristen Knapp, of the Florida Health Care Association, says the facilities the association represents welcome the testing and the state’s commitment to cover the costs, which they say will be a “tremendous help” in easing the financial burden on the facilities.
She said the group hopes the testing highlights facilities that could be considered “safe” for visitation. Long-term care facilities have been closed to visitors since March 15.
“We’re hearing from concerned family members about the physical and mental toll the isolation is having on their loved ones,” she said. “It’s important we strike a balance between protecting our residents from this virus and giving them the quality of life they deserve.”
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