Inside One State’s Plan for Mandatory COVID-19 Testing at Nursing Homes — and How Others Can Follow

As the COVID-19 pandemic drags on, access to coronavirus testing has emerged as an essential but frustratingly elusive weapon for long-term and post-acute care facilities.

Simply put, operators of nursing homes and rehab centers can’t effectively fight what they can’t see, and every day without widespread testing capabilities forces leaders to make impossible decisions: None of my employees have fevers or coughs, but how can I be sure they aren’t just asymptomatic? This resident tested negative at the hospital, but how can I provide a non-COVID cohort unit for her if I’m still not able to test the people in my own building?

The state of West Virginia attempted to remedy that situation in its nursing homes late last week, when Gov. Jim Justice signed an executive order mandating COVID-19 testing for “all individuals who reside or work in the nursing homes throughout the state.”

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As in other states, Justice’s order directed the West Virginia National Guard to assist in the testing process alongside state and local health departments.

In many regions across the country, such an edict would seem daunting or impossible, but West Virginia Health Care Association CEO Marty Wright was confident that the state and operators could meet Justice’s two-week deadline for completing tests.

“The state set an aggressive goal with the intent to meet it, and facilities are doing everything they can to comply with the state’s directive,” Wright, whose organization represents about 120 skilled nursing facilities and other senior living properties, told SNN.

After Justice issued the executive order on April 17, the initial tests began to reach nursing homes Tuesday, according to Wright. Operators have two options for complying with the state’s demand: Facilities can either take advantage of West Virginia’s contract with laboratory giant LabCorp, or use their in-house labs or existing third-party partners.

The former option comes with a key advantage — operators can simply put all of the testing costs on the state’s rolling LabCorp tab. If a facility elects to handle the testing through their own channels, the exact reimbursement mechanism, if any, remains unclear.

“They can do it independently through their own established or different private lab, in which case they would not be billed back to the state,” Wright said. “Those reimbursement issues for the private option are still being evaluated at this point and time.”

The federal government last week effectively doubled the reimbursement rate for labs that employ certain types of high-volume COVID-19 testing methods, but barriers to effective coronavirus screening remain in effect across the country.

Health officials in Massachusetts were forced to temporarily suspend one part of their nursing home testing push after only 4,000 of 14,000 state-supplied kits were returned, the Boston Globe reported late Tuesday. Among the samples that did make it back to state laboratory facilities, many were leaking or unlabeled, state health secretary Marylou Sudders told the Globe.

The state will continue to send members of the National Guard to facilities through a separate mobile-testing program.

As of Tuesday, 1,059 residents of long-term care facilities in Massachusetts have died of COVID-19 infection, the publication reported; that figure represents 54% of all Bay State coronavirus deaths.

The Globe report also revealed multiple errors in the state’s recently released database of cases at nursing homes, as flagged by operators as well as residents and their families.

Despite the challenges inherent in any widespread — and frankly unprecedented — testing program at nursing homes, knowing who does and does not have the virus remains vital information for operators, residents, and their families.

Back in West Virginia, Wright characterized testing as one part of a three-pronged approach that also includes access to personal protective equipment (PPE) and general awareness about the needs of nursing homes.

“The more that we can both get testing and PPE, and put a focus on long-term care facilities, the better we’re going to be able to implement the measures necessary to protect our residents and staff,” Wright said.

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