The final report from the Coronavirus Commission for Safety and Quality in Nursing Homes contained plenty of ideas on how to keep residents and staff safer should COVID-19 resurge or if another pandemic hits the United States.

While some of the onus falls on the federal government, nursing home operators must also raise the bar on safety — from rapid testing and reporting to adequate supplies of personal protective gear to creative approaches to visitation.

Are nursing homes prepared to do their part, or is the commission asking too much — or too little — of owners and administrators?

Several executives who served on the commission spoke with Skilled Nursing News about what they described as an effort of “shared accountability and responsibility” among stakeholders.

“There were different viewpoints, but overall I think each one of the commissioners had the same angle, and that was to make dramatic improvement in nursing homes’ ability to fight COVID in the centers in which we operate,” Neil Pruitt, CEO of the Georgia-based PruittHealth, told SNN. “Obviously operators have a different opinion than maybe some others with different background, but ultimately, I felt like everyone was coalesced around a common goal.”

Pruitt was one of 25 commission members, a group that included facility owners, policy experts, elder advocates, and other stakeholders. Not every commissioner endorsed every recommendation in the report, with 13 signing off on the full report, and another 11 supporting different portions. One member refused to endorse it at all, saying not enough responsibility was put on nursing homes to ensure safety and quality of life for residents.

Although consensus was not always reached, the majority raised valid points around what can be done to improve the situation around COVID, according to Camille Rochelle Jordan, senior vice president of clinical operations and innovation for Signature HealthCARE in Louisville, Ky.

However, Janet Snipes, executive director of Colorado’s Holly Heights Nursing Home, suggested that those who are critical of the skilled nursing owners and operators should come and spend a week working in one of their communities, seeing the challenges they face every day with staffing, visitation, PPE testing, and operations.

She pointed out it’s even harder to obtain qualified staff now than before the pandemic. Worse, nursing homes were not prioritized by the government during the initial response, and there hasn’t been enough support for direct caregivers.

“I think their opinions might be different if they saw all the trials and tribulations, we face on a daily basis,” she said.

Snipes was one of the commission members who endorsed the report, with some reservations.

“If CMS takes this roadmap, I think what happened early on in the pandemic will never happen again,” she said. “I believe if the recommendations are followed it will prevent situations that happened early and early on in late March and early April.”

In addition to recruiting qualified staff and providing ongoing training and education, other major challenges for owners have to do with requirements for testing and reporting. CMS sent rapid test kits to the vast majority of nursing homes across the country, but lab processing and prompt turnaround time is still a challenge for many — and states have raised doubts about the efficacy of the point-of-care systems.

Pruitt said his company is actually in the process of setting up its own lab, to avoid the type of backlog many operators currently face.

“It is an out-of-pocket cost, and it’s very expensive, but timeliness is very important,” he said.

Pruitt views this process as a necessary cost, but one that will provide needed information about the spread of COVID-19 among residents and staff — another tool in their arsenal to fight the disease.

Pruitt believes the biggest challenge the industry faces, along with public health officials and public policy officials, is the recommendation around physical plants.

Many nursing homes were designed to be very efficient physical structures, not to combat a pandemic.

“I think we need to look at the capital structure of reimbursement systems to incent providers to create private rooms,” he said.

Facilities should also have an ability to have positive and negative air pressure in at least in a portion of patient rooms, and be able to quickly set up isolation units.

”We have to learn from history and we can’t be in this position in the future,” he added.

All of these changes come at a cost.

“A lot of recommendations should not come without some type of funding to the industry,” Jordan said. “Given the population we serve, both the state and federal government should take some ownership in the ongoing support for funding for the care of our elderly population.”

The three commission members described their experiences as “invaluable,” “intense,” and highly educational. All agreed that sharing different opinions and perspectives was an eye-opening experience that should result in improved preparedness, more realistic expectations, and a better game plan to tackle the next major health crisis.

Written by SNN Contributor Liz Seegert