How Florida's long-term care facilities are managing the COVID-19 virus
To try to stem the tide of illness and death, Florida over the summer began providing self-swab test kits to nearly 4,000 facilities, which will perform the testing on 195,000 staff every two weeks. The state has also designated 22 COVID isolation centers for long-term care residents who aren’t sick enough to require hospitalization but can’t return home.
The Division of Emergency Management, meanwhile, has been working with the National Guard since March to get PPE supplies to facilities. By the end of June, it had delivered more than 10 million face masks, 1 million gloves, 500,000 face shields and 1 million gowns to providers. “We’re running an operation three times the size of a Category 5 (hurricane) response,” Jared Moskowitz, the state emergency management director, told nursing home operators in a June phone call.
But some say the state has fallen short when it comes to COVID testing. The emergency order to test long-term care workers every two weeks didn’t go in effect until July, when outbreaks were already widespread, and it didn’t include everyone who enters facilities. Contractors, vendors and even state inspectors aren’t required to be tested before entering — and many in the industry worry that testing at two-week intervals is not frequent enough to halt an outbreak.
In late July, CMS announced it would send rapid, point-of-care testing machines to all skilled nursing facilities and will require weekly testing in nursing homes in states with a 5% or greater positivity rate. Brian Lee, executive director of Families for Better Care, a nonprofit that advocates for nursing home residents and their families, says his group has been pushing for rapid testing for months and believes it's the "only effective solution" to getting a handle on COVID. “If you don’t have it in place in the facility, on site, you have no idea what’s going on with the virus,” he says.
The costs of the pandemic are also weighing on the industry. Brookdale Senior Living, a $4-billion company that operates more than 75 senior communities in Florida and hundreds more around the country, reported $10 million in additional facility operating expenses preparing for and responding to the pandemic through the end of March, according to a quarterly Securities and Exchange Commission filing.
The company says it has had to spend more on equipment, sanitation and disposable food service supplies. Labor costs are also higher — and Brookdale anticipates increased expenses related to workers’ compensation, health insurance, as well as COVID-19 testing of residents and staff that’s not covered by the government. Knapp, of the Florida Health Care Association, says one round of testing in a building can cost up to $24,000. At the same time, occupancy rates have dropped — falling 6.5% in skilled nursing facilities across the nation, according to a year-over-year analysis by the National Investment Center for Seniors Housing & Care (NIC), a non-profit that provides data and analytics on the industry.
For the time being, government subsidies have helped. Under the federal CARES Act, an emergency fund administered by the Department of Health and Human Services has made grants available to health care providers for health care-related expenses or revenue lost because of the pandemic. Brookdale received $29.5 million through the program. The company reported another $85 million under Medicare’s Accelerate and Advance Payment Program, which was temporarily expanded to provide loans to impacted health care providers.
Genesis Healthcare, which operates hundreds of skilled nursing centers and assisted living facilities across the country, has received about $220 million in state and federal funds and an additional $160 million in accelerated and advanced Medicare payments, according to B.J. Hauswald, the company’s senior vice president for strategic development. During a July 9 industry webinar hosted by NIC, Hauswald said about 8,000 residents (60%) of its facilities had tested positive or been presumed to have been infected with COVID-19, and approximately 20% of those infected died. State data show seven deaths at the company’s five Florida facilities.
Ultimately, she says the sector’s recovery is dependent on its ability to “get occupancies back up.” Before COVID, she says, Genesis was on track to have its “best year ever” with 88% occupancy. But after hospitals began canceling elective surgeries, referrals fell to 80% of what they were pre-COVID, admissions dropped by half and overall occupancy fell to 75% across its portfolio of properties. She says the company recently completed its second budget for the year and was planning to roll out new incentives that balance growing admissions with the demands of infection control.
“It will be all hands on deck to get our facilities back on line,” says Hauswald, who remains optimistic that business will eventually bounce back. “The good news is that when you’re in such a big hole, the first 5% to 10% comes back relatively easy. It’s going to be that last 5% that’s going to be a little but more difficult.”