A heavy price for free testing devices
High supply costs, rules and inaccuracy hurt nursing homes
After months of enduring a dearth of protective medical gear and staggering death tolls from the coronavirus pandemic, nursing home operators and employees across the United States experienced something close to elation as rapid-result test machines paid for by the federal government began arriving in August at 14,000 residential facilities that serve the elderly.
The hand-held devices, which spit out results in as little as 15 minutes, were intended to quickly diagnose and isolate patients, and alter the deadly calculus of a contagion that has taken the lives of 77,000 nursing home residents and workers, more than 40% of the nation’s fatalities from COVID-19.
But relief has been overtaken by frustration as nursing homes have discovered that they must pay for test kits — and that the machines are less accurate than lab-based diagnostics.
Because the devices come with a modest starterset of test supplies that only last a few weeks, facilities, many of them buffeted by financial losses from the pandemic, must pay roughly $32 for each additional test. In communities with high rates of infection, a typical nursing home can churn through hundreds of tests a week.
Many nursing home operators also say they have been overwhelmed by new federal reporting rules, fines and financial incentives that are associated with the program.
“My initial happiness over the machines has quickly turned to disillusionment,” said Ben Unkle, chief executive of Westminster-Canterbury on Chesapeake Bay, which operates a skilled nursing center in coastal Virginia.
The machine his com
pany received, made by the medical device manufacturer BD, came with 300 tests, but the new rules require Westminster-Canterbury to conduct weekly tests on its 280 nursing employees and residents. BD has said it would be weeks before they could send out additional testing supplies.
The shortages have forced Unkle to rely on an outside lab that charges $100 a test, an expense that he estimates will add $875,000 to the $1 million in pandemic-related losses that the nonprofit provider expects this year. Rather than the 15-minute turnaround, the lab results take up to four days to arrive, complicating efforts at infection control.
“As far as I’m concerned, this is an unfunded mandate that is not giving us the data we need fast enough to improve either care or protection,” Unkle said.
Federal health officials acknowledged problems with the testing initiative, and they have asked for patience as they carry out a herculean effort to provide nursing homes with the diagnostic tools needed to identify infections among their employees and residents and to tamp down outbreaks.
The Centers for Medicare & Medicaid Services, which oversees the nation’s nursing homes, said the agency would exercise discretion before imposing fines on facilities that make a good-faith effort to meet federal testing mandates.
“We understand that some facilities may experience challenges to meet the new requirements,” the agency said in a statement.
The importance of frequent testing is expected to become more critical following a recent decision by CMS to lift restrictions on
nursing home visitors.
Last week, President Donald Trump announced a plan to supply nursing homes with 18 million rapid-test kits manufactured by the medical device company Abbott. The tests do not require a separate reader, but some experts have voiced concern over their accuracy, and a typical nursing home testing its employees twice weekly would likely run through those supplies in a few weeks.
Even as they expressed appreciation for the free machines, which cost about $300, many nursing home operators said they are overwhelmed by the financial and bureaucratic demands of the testing program, which include up $10,000 in fines for facilities that fail to meet daily reporting rules that sometimes conflict with those from state or local health agencies.
Health departments in some states said they were still trying to figure out how to gather what they described as a tidal wave of new testing data.
“There’s no mechanism in place for reporting,” said Kim Schilling, vice president of health services at Friendship Haven, which runs a nursing home in rural Iowa. “We were on the phone yesterday trying to figure this out with the department of public health, and it was very overwhelming for them, too.”
David Grabowski, a health care policy expert at Harvard Medical School, described the federal rapidtest program as “a positive step but late in the game,” and said Washington should do more to address the systemic financial and staffing problems that have long bedeviled the industry’s efforts to shield vulner
able residents from infectious pathogens.
Because federal reimbursements do not cover the full cost of care in much of the country, nursing home operators who serve predominantly Medicaid patients say they often lack the money to hire enough skilled workers willing to take on a grueling job that the pandemic has made increasingly stressful and fraught with risk.
“I don’t have a problem penalizing nursing homes guilty of gross negligence, but my sense is that most of the facilities out there have been doing their best despite dealing with sick workers, a lack of resources and poor guidance from the f e deral government,” Grabowski said. “Putting efforts into training workers on infection control, boosting wages and offering paid sick leave would be a better approach.”