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Testing shortages reach nursing homes, home health agencies

Problem is compounded by worsening staffing crisis, as surge in cases from the omicron variant is forcing more staffers to call out of work

A mobile COVID-19 testing van travels down H Street Northwest near the White House.
A mobile COVID-19 testing van travels down H Street Northwest near the White House. (Bill Clark/CQ Roll Call file photo)

Nursing homes and other elder care providers are grappling with the current shortage of rapid COVID-19 tests, with reports emerging of low supplies as the administration mounts a massive effort to boost the country’s manufacturing capacity.

The testing shortage is compounded by a worsening staffing crisis. The industry lost hundreds of thousands of workers since the beginning of the pandemic, and the surge in cases from the omicron variant is forcing more staffers to call out of work.

The issue is raising questions about care for seniors nationwide and whether the administration’s effort to ship 1 billion tests directly to households is further undercutting supplies for providers, which are already competing with a surge in demand from the general public. Nursing home residents are particularly at high risk from the virus, accounting for around 142,700 of the roughly 860,000 total U.S. COVID-19 deaths — 17 percent, despite making up less than 1 percent of the population.

Centers for Disease Control and Prevention Director Rochelle Walensky told lawmakers in January that the Biden administration is sending around 2.8 million tests directly to long-term care facilities each week. But major industry groups like LeadingAge and the American Health Care Association/National Center for Assisted Living are reporting that many members are struggling to find tests.

The Centers for Medicare and Medicaid Services requires skilled nursing facilities to test staff at least once a week when community transmission is considered moderate, and twice if it’s considered high. Many facilities have arrangements with labs to conduct PCR tests, but turnaround times can stretch into several days as demand surges.

Roughly one-third of LeadingAge members are struggling to find rapid tests, according to a January survey of 752 members — including nursing homes, home health agencies, assisted living communities and affordable housing groups. Additionally, many respondents who said they have enough tests on hand warned that their supplies would soon be running low.

LeadingAge spokesperson Lisa Sanders told CQ Roll Call that the numbers are probably already worse, because this is “a very fast-moving situation.”

“I would say now we’re getting into a situation where the need is growing,” she said. “Definitely growing.”

The AHCA/NCAL recently asked the administration to increase testing shipments and retain priority for long-term care.

“There has been soaring demand for tests among the general public and among other industries across the country due to the Omicron surge,” the group said. “So as a result, many long term care facilities are having difficulty acquiring tests and/or experiencing delays in getting back PCR test results.”

A Department of Health and Human Services spokesperson said the department is in “constant communication” with nursing homes and other elder care providers, and is working to increase allocations.

At least one test manufacturer, Abbott, shut down production last year amid a drop in demand before the U.S. made a $3 billion, 13-month commitment to the testing industry in the fall.

Assistant Secretary for Preparedness and Response Dawn O’Connell testified to the Senate Health, Education, Labor and Pensions Committee in January that federal contracts for the first 500 million of the administration’s 1 billion test initiative include protections against interfering with current market supply.

But at least the initial shipments of rapid tests are coming from existing market product. The departments of Defense and Health and Human Services struck at least four deals with non-manufacturers Medea Inc., Atlantic Trading LLC, Goldbelt Security LLC and Revival Health Inc. to procure tens of millions of existing tests.

A spokesperson for HHS said the contracts prohibit diverting or delaying any tests already committed to other purchasers or interrupting any other testing programs.

“HHS will be doing rigorous oversight to ensure the new purchases do not pull from other testing programs,” she said. “The administration is working with states experiencing supply issues to ramp things up and ensure health departments meet their needs.”

Other elder care providers are struggling to access tests, too. National Association for Home Care & Hospice President William Dombi said that home health agencies were cut from the weekly HHS allocations last year.

“The home care companies are having an extraordinarily difficult time finding tests,” he said. “We’ve reached out to manufacturers like Abbott and they say, ‘Sorry, we don’t have anything.’”

Dombi quickly acknowledged that congregate settings like nursing homes should have first priority for limited supplies. But home care providers also tend to some of the oldest and most vulnerable patients, and health aides are frequently forgoing testing.

“They’ll look, just like they did when we couldn’t find masks,” Dombi said. “They were knocking on doors of tattoo parlors and nail salons and carpentry shops to get N95 and KN95 masks. So they’ll keep doing it.”

Staffing issues

The supply constraints come amid a severe staffing crisis exacerbated by the omicron variant.

Nursing home employment plummeted by 420,000 workers, more than 12 percent, from January 2020 to December 2021, according to the Bureau of Labor Statistics.

Last month, two patients were found dead at a North Carolina nursing home at which just three staffers were caring for 98 residents.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants, which represents the certified nursing assistants doing much of the day-to-day care in nursing homes, said members are reporting dire situations daily. One aide recently reported being the only person on site, with no nurse to administer medications for hours.

“The president should call a national emergency, and anything that can be done to save these old people should be done,” Porter said. “Because they’re terrified.”

Two of NAHCA’s board members also recently left their jobs after succumbing to an unsustainable workload, Porter said.

Calls are growing to implement pass-through funding requirements in Medicare and Medicaid to boost pay for aides like certified nursing assistants, who make around $13 an hour. Right now, federal dollars are nearly impossible to track through the labyrinth of vendors and limited liability companies operated by many nursing home businesses.

Democrats’ domestic spending bill includes provisions to boost pay and recruit more caregivers for home and community-based services under Medicaid. The legislation stalled in the Senate because of objections from moderate Democrats, but President Joe Biden recently voiced confidence that Congress could still pass “big chunks” of the social spending and climate legislation.

Porter blames the federal and state governments for allowing the systemic problems to fester, given that the vast majority of nursing home revenue comes from Medicare and Medicaid. Two weeks ago, she launched an online CNA certification and mentoring platform with workforce management company ShiftMed to boost industry recruitment after being rejected for a CMS grant.

Dombi agreed that it will take more than money to solve the staffing issues, which he said are “beyond crisis levels.”

“You can’t go to Best Buy and buy a 3D printer to create a nurse or home care aide,” he said.

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