As Officials Fear Second COVID-19 Wave Amid Reopening, Many Providers Still Dealing with First

The U.S. has begun to take tentative steps towards reopening, with states moving at their own pace out of the COVID-19-induced lockdowns — raising concerns about the risks of a possible second surge of cases.

But LeadingAge, which represents non-profit senior housing and care providers, warned starkly on Wednesday that senior living and skilled nursing providers in the U.S. are still struggling with the first wave and are in dire need of resources — both personal protective equipment (PPE) and testing — at the federal level to protect the residents and patients in their care.

“We now find ourselves four months into the worst pandemic in a century, but our country still has no more than a patchwork plan for protecting older lives,” Katie Smith Sloan, the president and CEO of LeadingAge, said in prepared remarks during a virtual press conference held on Wednesday. “For several weeks our members have been alerting us to rag-tag shipments of PPE from the federal government. Its data collection system can’t yet be relied on for accurate information. And as more older Americans die and their care providers scramble to help them, our leaders repeat declarations of victory, as if words could protect against the virus.”

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She was joined by executives from two continuing care retirement communities (CCRC) in Washington D.C., and Greensboro, N.C., who testified to the challenges of securing PPE and testing and the costs involved over the early months of the pandemic.

“COVID hit us like a brick wall in the middle of April,” said retired Col. Paul Bricker of the Army Distaff Foundation and chief operating officer of Knollwood in Washington, D.C., a CCRC serving members of the uniformed services and their families. “We watched it come across the nation. We watched it come down the Eastern Seaboard. We thought we were prepared. We had a PPE package level prepared to deal with about five or six cases of COVID.”

That ended up being nowhere near enough. Knollwood found it had its first COVID-19 case only when the medical examiner called the community from the morgue to say there was a positive. Five other residents were symptomatic, and only they could get tested by the city at the time.

That led Knollwood to implement its own plan for testing all residents and staff in the skilled nursing wing by reaching out to LabCorp — which established an account for the CCRC overnight. This was not a step that the CCRC had been encouraged to do, Bricker noted. But after administering 100 tests, the results came back 18 hours later — and Knollwood “had COVID at a level we never even anticipated,” according to Bricker.

“We were literally chasing employees down the hallway and asking them to leave because they were asymptomatic,” he said. “Seventy percent of our residents were asymptomatic. We continued to test, assisted living, independent living. And we have now been COVID-free for over six weeks. Why? Because we’ve administered over 1,200 tests. We test residents and staff in assisted living, independent living every week.”

While Bricker had high praise for LabCorp’s partnership, noting that the firm sent batches of 50 to 100 kits with tests arriving 24 to 48 hours after the request, he stressed that communities left on their own for testing are “flying clouds without instruments.”

They’re also paying for it, as Stephen Fleming, president and CEO of The Well•Spring Group in Greensboro, N.C., noted. The organization is in the midst of testing for staff and residents, with costs of $50,000 to conduct one-time testing at both its CCRCs.

Knollwood has so far invested between $12,000 and $15,000 in testing, Bricker said. The CCRC is now working with LabCorp on reimbursement, which is one area where the federal government could help.

“COVID tests should be covered at the national level,” Bricker said. “We shouldn’t have to go through a lot of paperwork to get reimbursed for testing. It’s a pandemic. One of the ways you can flatten the process is just: Any COVID testing is covered. I think that needs to happen.”

Fleming echoed the need for testing and support for senior living, decrying the use of resources to professional sports and universities when from long-term care facilities account for the substantial proportion of COVID-19 deaths.

Well•Spring has had to develop its own consortiums for PPE, he noted, relying on “our parking lot guy” for equipment — though in a different form than that of the mysterious vendor supplying the Jewish Home Family in Bergen County, N.J.

“Ours have been more well-known vendors that we’ve tried to beg, borrow, and steal from,” Fleming said. “We’ve come together to borrow supplies if we have to, especially when we’re going through testing, or if we have cases. This is what we’ve had to do. There’s been no coordinated effort. There’s been no funding.”

The shipments of PPE from a local area agency on aging included two boxes of surgical gloves in sizes “small” and “extra-small”; gowns remain by far the most challenging piece of equipment to obtain, according to Fleming.

The N.C.-based group has also, like Knollwood, had to secure its own testing, using both LabCorp and a smaller provider. It had to pay for this initiative on its own, according to Fleming, who echoed Bricker’s call for the federal government to clarify the testing requirements and make life easier for staff.

From his perspective, the problems are the result of years of bad decisions on multiple levels of government.

“The real issue here for all of us is we’re reaping what we sow in the United States,” Fleming said. “This is 40 years, 50 years of neglect of America’s aging population. And the United States can do better than that.”

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