Feds send nursing homes quick-test kits, but with rules that deter their use; so do other factors, chief nursing-home lobbyist says

By Melissa Patrick
Kentucky Health News

Testing is one of the few tools nursing homes have to keep the novel coronavirus out of their facilities, and the Trump administration has tried to help by sending them equipment to conduct tests that give quick results.

But while they were sent with good intention and are appreciated, the head of the state nursing-home association told Kentucky Health News that they are largely not being used in Kentucky right now.

Betsy Johnson

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, ticked off several reasons: concerns that the tests are less accurate than laboratory-based tests; the state is paying for more accurate lab-based tests through the end of the year; the tests come with daily reporting obligations; and nursing homes get only two free test kits per employee, with concerns about how to get more.

The idea behind this aggressive testing strategy was to be able to identify people who had the virus but didn't have symptoms, but the problem is that these point-of-care antigen tests are not designed to do that. 

Kaiser Health News reports that the two manufacturers that have received authorization to provide the test, Becton, Dickinson and Co., (known as BD) and Quidel, say their tests are intended to be used for people within the first five days of showing symptoms. The federal Centers for Disease Control and Prevention estimates that as many as 40 percent of infected people may be asymptomatic.

Kaiser also reports that the rates of false negatives, which show someone isn't infected when they actually are, are about 15% for BD's product and 3% for Quidel's. 

Meanwhile, Politico reports that nursing homes have been told that it could be weeks before they will be able to buy more supplies for the rapid test. 

On top of that, Johnson said the federal requirements are much more onerous than the state's guidelines, which are not mandatory and require only testing every other week. She said the federal rules have "caused us a lot of heartache." 

Federal rules require nursing homes to test staff based on the overall positive-test rates in their county. If the rate is less than 5%, they must test once a month; between 5-10%, once a week; and above 10%, twice a week. The guidelines do not require them to use the antigen testing, but say that any off-site testing must have a turnaround of less than 48 hours. 

For the week ending Sept. 2, according to Centers for Medicare and Medicaid Services data, 29 Kentucky counties had positive-test rates of less than 5%, 41 were between 5% and 10%, and 50 were above 10%. 

Johnson said some long-term care facilities are confused because CMS reports one rate and the state reports another for the same county. She said they're working to resolve these discrepancies. 

Johnson stressed several times that her association supports increased testing, but said they need to find a way to make it simpler.

"We don't oppose ongoing testing as important for protecting not only our residents, but our staff," she said. "But I think we need to make sure there's a common-sense element and that we're not just testing for the sake of testing, that it makes sense for every community, and that we have reliable data to determine when that testing should occur."

Dr. Steven Stack

Health Commissioner Steven Stack told legislators on the Program Review and Investigations Committee Thursday that the federal rules are "very demanding" and stressed that they must follow them under threat of penalty from the federal government for their conditions of participation as a nursing home. 

"If you lose your ability to bill Medicare or Medicaid, you can't run a nursing home," he said. 

He also noted that if they use the testing equipment sent to them by the federal government, they essentially become laboratories with all of the daily reporting requirements that other laboratories now have around covid-19. 

“These are facilities that haven’t used machines like this before and don't know how to use them . . . at least 280 of these nursing homes in the state.” Stack said.

Johnson expressed concern that such rigorous testing schedules would cause staff to quit facilities that are already struggling to maintain an adequate workforce. 

"We are concerned, especially in our counties with high positivity rates, that, you know, that we're going to have some staff leave because they just simply either cannot get to the facility to get tested due to child-care issues or other personal obligations or transportation, or they simply just, you know, get exhausted with it all," she said.

"It's just so many moving parts," Johnson told Kentucky Health News.

Speaking more bluntly to Politico, she said, "It's a complete and utter mess." 

A Kaiser Family Foundation report shows that infections in Kentucky's long-term care facilities are on the rise, increasing from 4.5 new cases per week per 100,000 people in May, to 5.1 in June; 5.3 in July and 8.4  in August. Deaths, however, do not appear to be increasing, down from 0.5 per 100,000 people in July to 0.3 in August. 

The state's daily long-term care report on Sept. 12 showed the homes have 516 residents and 351 staff with active cases of the virus and 593 resident and five staff deaths from it, making up 57% of the state's covid-19 deaths.

The pandemic has brought a new focus on "skilled-nursing facilities and long-term care," Johnson said. "And although it's been uncomfortable at times, I think we need to continue to have this conversation because it's so important, and we need to figure it out -- because we need to make sure that we as a nation, and we as a state are doing everything we can to protect and care for elders. They deserve that."