Nearly a third of skilled nursing operators reported feeling pressure to admit residents who had tested positive for the novel coronavirus, according to a recent poll conducted by Skilled Nursing News — while nearly the same percentage have seen family members take their loved ones out of the nursing home setting due to COVID-19 fears.
The decision of whether or not to accept residents who test positive for COVID-19 has become a life-or-death issue for nursing home operators, their hospital partners, and local governments as the crisis continues to unfold.
Toward the end of last month, New York State health officials made the controversial decision to prevent skilled nursing facilities from using COVID-19 testing as a prerequisite for admission, as well as barring them from denying entry to potential residents solely because of a positive COVID-19 test.
The reaction from the industry was swift and forceful: Such mandates could lead to significant numbers of deaths, as even one positive case can spread like wildfire in the nursing home setting.
“This approach will introduce the highly contagious virus into more nursing homes,” American Health Care Association CEO Mark Parkinson and chief medical officer David Gifford said in a joint statement released last weekend. “There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths.”
Individual state guidance varies, and both the federal and state governments have responded to those concerns with plans to separate, or “cohort,” patients who have tested positive for COVID-19 in dedicated facilities.
The Centers for Medicare & Medicaid Services (CMS) earlier this week waived a host of rules regarding the transfer of long-term care residents and reimbursement for nursing home care in alternate sites, while plans to move nursing home residents into virus-segregated facilities already underway in states like Connecticut and Massachusetts.
But 29% of respondents to SNN’s recent COVID-19 state-of-play poll said they felt pressure to admit a resident who had tested positive for the respiratory ailment, while about 24% indicated that they had indeed gone ahead and brought the person into their facilities.
Skilled Nursing News conducted this online survey, advertised in our daily and weekly newsletters, between March 25 and April 1.
In all, nearly 100 self-described employees of companies that own and/or operate skilled nursing facilities participated; Aging Media Network, SNN’s parent company, offered potential respondents a chance to win a $100 gift card in order to encourage industry stakeholders to answer the set of questions.
SNN acknowledges that the poll was not scientific, but it does provide a snapshot of the industry during a crucial period in the response to COVID-19.
Leaders in the space have generally advised families against pulling their loved ones out of nursing homes, citing fears about spreading the virus to the community — as well as the fact that most people in nursing homes are there because they require 24-hour supervision that cannot be provided in any other setting.
But at least according to our poll, it’s happening anyway: About 28% of respondents said family members had removed a resident from a facility explicitly because of COVID-19 concerns.
Staffing stability — for now
As the number of cases steadily rises nationwide, concerns over staffing at health care facilities have grown in turn: Operators in the nursing home space, for instance, have been screening employees daily for signs of the disease, sending home workers with high fevers or other symptoms. These employees then typically must spend 14 days in self-quarantine before they can return to the job.
For the time being, however, only about a quarter of skilled nursing operators have been forced to use supplemental agency staffing due to shortages, at least according to the SNN poll.
What’s more, 85% reported offering sick time to frontline caregivers such as registered nurses, certified nursing assistants (CNAs), and licensed practical nurses (LPNs).
Among those that do provide paid sick leave, full three-quarters of respondents said they offer at least six or more days to staffers, with 36% providing 11 or more days. Only about 25% offered five days or fewer.
Managed care flexibility
Finally, Skilled Nursing News asked respondents for feedback on how their managed care partners — including Medicare Advantage and state-level managed Medicaid plans — were reacting to the crisis.
While CMS’s blanket waivers apply to fee-for-service Medicare and Medicaid, managed care plans do not necessarily have to play by the same rules. As SNN reported earlier this week, some insurers have offered relief while others have not — and even among those that have provided special waivers and exemptions, the exact details can vary widely.
At least for respondents to SNN’s poll, flexibility seems to be the norm: More than 70% reported receiving waivers of prior authorization rules.
Do the results match with what you’re seeing on the ground — or are you looking out on a completely different landscape than the one our poll revealed? Feel free to drop editor Alex Spanko and reporter Maggie Flynn a line to provide your feedback for an upcoming follow-up story.
