Because of these disparities, experts are encouraging the families and representatives of long-term care residents to seek information on how their specific facility is handling cases and using that as a basis for decision-making. Here are some key considerations.
Is the facility regularly testing residents and staff?
Before a facility can respond to a COVID-19 case, it has to know of it. And that can happen only through testing. “If [facilities]are not testing, saying they have no positive cases doesn’t mean very much,” Sweeney says.
The Center for Medicare and Medicaid Services (CMS) issued guidance for weekly testing of nursing home residents and staff, but states have been granted flexibility on deciding how the guidelines are implemented. The result has been “patchwork” testing across the nation, says Elaine Ryan, vice president of state advocacy at AARP.
Most states missed the White House’s May deadline for universal baseline testing in nursing homes, Ryan says, citing an Associated Press report. Whether logistics, access, costs or staff issues are to blame, the overall response has been “woefully inadequate,” Ryan says, with many states still weeks away from universal baseline testing. For assisted living facilities — which, unlike nursing homes, are regulated by states rather than the federal government — it’s even more unclear where testing rates stand.
Given the variances, it’s important to investigate your facility’s testing protocols, checking to see whether it aligns with the CDC’s testing guidance for nursing homes.
Jennifer Schrack, an associate professor at the Johns Hopkins School of Public Health who specializes in the epidemiology of aging, recommends focusing on staff testing in particular, because “they are one of the key ways that COVID-19 will enter a facility now.” Although the CMS recommends retesting staff on a weekly basis, Schrack says, “if the supplies are available, it’s not unreasonable to think that staff should be tested every day; they are the ones who come and go on a daily basis, so even if they test negative one day, they may be positive the next.”
Is the facility being transparent?
While confirmation of a COVID-19 case in a facility can be frightening, receiving this information can actually be a positive sign. “It means there’s transparency,” says Sweeney, “which is key; families can’t possibly make the right decisions for their loved one if they are dealing with incomplete information.”
Although the CMS has ordered nursing homes to alert its residents and their families or representative of a COVID-19 case within 12 hours of confirmation, some facilities are missing that deadline. And state-regulated assisted living facilities and other long-term care units may not be under the same requirements as nursing homes.
A lack of communication is a warning signal, says Dwayne J. Clark, founder and CEO of Aegis Living, which operates 32 assisted living and memory care units across Washington, California and Nevada. Aegis has experienced 38 positive cases, more than half of which occurred in an early outbreak, in March, at a facility in Washington.