Sun Sentinel Palm Beach Edition
Nursing homes still face testing challenges
Many facilities lack necessary resources for widespread action
As Florida prepares to reopen its economy, the state’s nursing homes and assisted-living facilities are facing challenges in conducting the widespread testing needed to find and isolate hidden carriers of the disease that can cause deadly outbreaks.
The Florida National Guard has dispatched 50 “strike teams” to test nursing home staff members and residents. That has provided much-needed help to facilities trying to contain outbreaks.
But testing varies immensely across the industry, and many facilities still don’t have the resources to test all workers and residents even if they aren’t showing symptoms, said Chris Laxton, executive director of The Society for Post-Acute and Long-Term Care Medicine. That’s despite more than 300 coronavirus deaths being linked to nursing homes and other long-term care facilities in Florida alone.
Catholic Health Services, which operates three nursing homes in South Florida, has been “begging” for test kits for residents and staff in recent weeks,
said spokeswoman Mary Ross Agosta.
“We need help,” Agosta said. “We need to have these patients tested. They are the most vulnerable.”
Last week, the National Guard tested all 216 employees at St. Anne’s Nursing Center in Miami-Dade County, but only 18 of the facility’s 200 residents, Agosta said.
The National Guard plans to return on Wednesday to test the remaining residents at St. Anne’s, which has four residents and 11 staff members who have tested positive, she said. The National Guard is also planning to visit St. John’s Nursing Center in Lauderdale Lakes, which has had a staff member and a resident who was transferred out of the facility test positive.
The state’s assistance is appreciated, but ideally, all residents and staff would be tested every 14 days, Agosta said.
Laxton said nursing homes face a variety of challenges in testing at that level.
Swabs and other testing supplies are often prioritized for hospitals. Nursing homes with small staffs don’t have enough workers to do the tests. Overwhelmed labs have limited capacity, and it can take days if not over a week for results to be returned.
Some nursing home owners are reluctant to test people without symptoms because they fear it will make their facilities look bad because they will have more cases, Laxton said.
“Nursing home owners are often quite reluctant to create that sense that the building is sick,” he said. “They think it is going to create fear and panic in the community. I don’t think that is the right approach. The more data you have, the better you can control an epidemic.”
Testing will take on even more importance with Gov. Ron DeSantis announcing his reopening plan on Wednesday. His monthlong stay-home order runs through Thursday.
State leaders should mandate a regimen that tests nursing home and assisted-living facility workers regularly for the virus, said Jeff Johnson, AARP’s Florida state director.
“Reopening other parts of the economy will expose long-term care workers, and by extension residents, to more opportunities to contract the virus and spread it within facilities unless preventive measures are taken,” he said.
Laxton said he doesn’t think the pandemic’s curve has flattened for vulnerable residents of nursing homes and assisted-living facilities.
“I don’t think we’ve stopped the surge in nursing homes,” he said. “We haven’t hit the peak yet.”
Hidden carriers who aren’t showing symptoms are spreading the disease in assisted-living facilities and nursing homes, according to the Centers for Disease Control and Prevention. That can have deadly consequences. At least seven residents of the Atria Willow Wood assisted-living facility in Fort Lauderdale have died of the disease.
Testing of staff and residents of all nursing homes and assisted living communities is essential, said Lindsay Peterson, a research professor at the University of South Florida’s School of Aging Studies.
“It is the only way to stay on top of the virus,” she said. “It does not help to perform testing after a positive case has emerged in a nursing home or among staff who work there. By then, it may be too late.”
DeSantis said he has worked hard to ramp up testing in nursing homes, assisted-living facilities and other senior-care centers, calling it one of his administration’s top priorities. That strategy includes doing “sentinel” testing to find hidden carriers, he said.
“We need to be on offense as much as we can with the long-term care facilities,” DeSantis said.
The Florida National Guard has visited more than 33 facilities and tested more than 5,500 people, according to the Florida Department of Health. Florida has 691 licensed nursing homes with more than 84,400 beds, along with more than 3,000 licensed assisted-living facilities with more than 106,000 beds.
Despite a ban on visitation enacted in mid-March, 411 nursing homes, assistedliving facilities and other long-term care facilities in Florida are dealing with more than 1,200 COVID-19 positive residents and another 1,200 positive staff members, according to a state report.
State Rep. Emily Slosberg, D-Boca Raton, sent a letter Monday to DeSantis expressing frustration over a lack of testing at St. Andrews Estates, which has reported several cases in its skilled-nursing unit.
Staff members were told to make an appointment for drive-thru testing, rather than being screened on site, she wrote.
“Unfortunately, there has not been adequate testing of residents or staff at the St. Andrews Estates facilities, which is leading to additional cases of COVID-19 infections in vulnerable senior citizens,” she wrote. “I find this greatly concerning.”
After her letter arrived, a strike team was dispatched to the nursing home, Slosberg said.
Brian Lee, executive director of Families for Better Care, said testing has been too limited, and universal testing is the only way to adequately protect residents, he said.
“Officials are slowly catching up to what should be done for residents in these facilities,” said Lee, whose group advocates for nursing home residents and their families. “It’s been a slow painful process that is resulting in people dying.”
Florida initially resisted naming long-term care facilities with confirmed coronavirus cases. Under pressure from advocates and media outlets, state agencies have provided more information, including a breakdown of active coronavirus cases in longterm care facilities.
The state, though, still is not releasing a breakdown of which nursing home and assisted-living facilities have reported deaths. Nine news organizations, including the South Florida Sun Sentinel, and the First Amendment Foundation filed a lawsuit Monday seeking more information, including a breakdown of staff and resident deaths by facility.
New federal guidelines will also require nursing homes to notify residents and families of a confirmed coronavrius case within 12 hours.
Some senior-care homes did test all residents and staff relatively early in the epidemic.
Sonata Senior Living tested 1,850 staff members and residents at its 11 communities in mid-March, including those in Boca Raton, Boynton Beach, Coconut Creek and Delray Beach, said Shelley Esden, chief operating officer.
Thirty-six residents and staff who had not showed symptoms tested positive and were isolated, according to the company.
“You’ve got to identify and then you contain,” Esden said “It is strategy working for Sonata. Until we come up with a vaccine, it’s the only thing we can do.”