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Nursing Home Leaders Raise Testing, Workforce Concerns To CMS Administrator

Seema Verma turns head to talk during discussion
Marissa Moss Photography / BayCare
The Florida Channel
CMS Administrator Seema Verma met with nursing home leaders and other health providers on Thursday at BayCare Health System in Clearwater.

Some nursing home administrators in Florida say they're struggling to meet the federal government's requirement to test staff weekly in hotspot areas for COVID-19.

They voiced concerns about government regulations, staff burnout and other challenges to Centers for Medicare and Medicaid Services Administrator Seema Verma during a meeting in Clearwater on Thursday.

Providers say demand for supplies is making it hard to test as frequently as they're supposed to.

A community’s positivity rate determines how often a nursing home in that area must test its staff. In hard hit areas like Miami-Dade and Broward Counties, facilities must do so twice a week, while facilities in the Tampa Bay area have to once a week.

The federal government is distributing rapid antigen testing machines to nursing homes and included an initial supply of test kits with each machine, but some facilities say that barely covered the first round of tests. Now they’re struggling to order more in time as supply chains are backed up nationally.

Anita Faulmann, a regional vice president for Consulate Health Care in the Tampa Bay area, said the frequency also places a burden on staff. She said even rapid tests that can be processed in about 15 to 20 minutes still take a lot of resources each week for facilities that have hundreds of workers.

"Cumulatively the amount of time to complete the testing takes away from our ability to actually react and be able to provide the appropriate care," she told Verma during the meeting hosted by BayCare Health System.

Verma said the government is trying to provide facilities funding and supplies to ensure they're capable of following the mandate, which is meant to help keep COVID-19 from making its way into homes, particularly through unsuspecting staff who don’t display symptoms.

"And we're going to continue to work through that, you know, there's going to be bumps in the road and maybe the standards need to be adjusted," she said.

Fines for not meeting the testing requirements can be as high as $8,000, and homes that repeatedly fail to comply risk losing their eligibility to participate in Medicare and Medicaid.

The coronavirus has killed nearly 4,900 residents and staff at long-term care facilities and infected more than 9,000.

But Emmett Reed, President of the Florida Health Care Association, said during Thursday’s meeting that right now 97 percent of nursing home residents and 98 percent of staff were COVID-free.

Faulmann ultimately credited frequent testing as one of the main reasons for that progress.

"Supportive" inspections

Providers said other regulatory measures are also posing challenges.

Nicole Francis, director at Orchard Ridge, a nursing home in New Port Richey that is operating a COVID-19 isolation unit, said repeat inspections from infection control regulators, while helpful, were taking up a lot of staff resources.

In an interview with Health News Florida after the discussion, Verma said the state and federal government have to keep doing inspections to protect patients. She cited as an example a facility that seemed to be following all the safety guidelines until inspectors saw staff eating lunch together.

"And so by doing those in-person visits we can help brainstorm with the nursing home about things that they may be doing inadvertently that are contributing to the spread,” she said.

Francis, who said infection control surveyors found no issues with her facility during their most recent visit, commended the agency for providing “supportive” inspections rather than “punitive,” suggesting her facility has not been penalized greatly for any errors that may have been found during previous visits. She asked that surveys continue in that manner.

But advocates for nursing home residents say the government isn't doing enough oversight and are calling for harsher punishment for facilities that fail to provide safe care.

Staffing shortages

Staffing was another issue raised during Thursday’s event. Nursing home leaders praised the hard work their employees are doing to reduce the spread of COVID-19 in their facilities, but said there just aren’t enough of them.

“We have people wanting to leave our industry now,” said Tricia Robinson, CEO of the Avante Group. The organization runs more than a dozen long-term care facilities in Florida, most of which are treating COVID-19 patients, which Robinson said require more intensive care. “When we have people out, let’s say ten have gone out sick, two of the ten aren’t returning to our industry,” she said.

Robinson said that is forcing facilities to turn to outside agencies to acquire more staff and hike up their pay rates.

“An average CNA wage was $12 an hour, right now we’re having to pay CNA’s, and that’s certified nursing assistants $25 to $35 an hour to come into our facilities. Nursing wages were on average $30 to $35 an hour for a nurse, we’re paying $50 to $70 an hour now, so it continues to be a struggle for us now to find the workforce.”

Robinson acknowledged staffing was an issue in nursing homes before the pandemic. Long-term care experts have said inadequate wages and the demands of the job are largely to blame for high turnover.

Administrator Verma pointed out the federal government has already allocated more than $10 billion for nursing homes to use for whatever their needs may be, whether staffing or supplies. But providers say more financial assistance is needed in the future as this pandemic continues to strain their budgets.

Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters, WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.