Nursing Homes, Long-Term Care Facilities Cite Testing, PPE, Cost as Challenges During Pandemic
of nursing homes, assisted-living facilities, and other long-term care
facilities Wednesday told lawmakers of the challenges they have been facing
since the COVID-19 pandemic began, best practices they have been using, and
areas where they could still use some help going forward.
House Aging and Long-Term Care Committee has been holding hearings on the
effects of the coronavirus on the industry, and on Wednesday, lawmakers heard
first-hand stories of those challenges, as well as some models that could be
used going forward.
Brod, the president and CEO of LeadingAge Ohio, said that despite early data
showing that the coronavirus has a disproportionate effect on the elderly,
nursing homes and congregate care facilities were told to prioritize testing
and personal protection equipment (PPE). If a test was needed, the health
department would do only one or two tests, and if there was a positive result,
the facilities were told just to assume everyone is positive. She said the
problem was that meant needing more PPE to keep it from spreading, but with a
shortage, that was unattainable.
said that in response, the chief medical officer at one of the group's members
helped to mobilize with other members to create the Post-Acute Regional Rapid
Testing Program (PARRT), which was designed to assist central-Ohio long-term
care facilities with testing needs.
the program, a team would bring test kits to a facility and swab anywhere from
one to over 400 staff and residents. Completed tests were taken to laboratories
either at the Ohio Department of Health (ODH) or Ohio State University (OSU)
said they found that this kind of testing at bedside is critical with a frail
population, especially since they did not want to put residents in transports
to medical facilities. They also found that testing employees requires
significant administration. It is a 24 hours a day, seven days a week
operation, and getting every employee in one place at one time can be
difficult. Processing and billing for the tests can also be very challenging.
program also highlighted how testing is a one point in time process because
everyone at a facility could test negative today and there could be a positive
test tomorrow. She said they need to understand that and go back and test
results are also critical. And once results are available, it can lead to
staffing challenges for facilities.
told Rep. Mark Fraizer (R-Newark) that they were able to streamline results by
working with one lab at OSU, which would lead to results within 24 to 48 hours.
She also said solutions need to include the local health department and taking
advantage of labs that have testing capacity, but also relies on timeliness and
told committee Chairman Tim Ginter (R-Salem) that it took about two and a half
weeks to get the process set up. Currently, it takes about 24 hours to get a
team out to test when a facility places a call to the program's hotline.
told Fraizer that the cost is an evolving process, and they have also looked
for private funding to help pay for the program. They have also looked for
donations of PPE.
was joined by Judy Budi, president and CEO of Graceworks Lutheran Services in
Dayton and Mike Ray, president and CEO of Greenhills Community in West Liberty.
compared his facility's coronavirus response and its cost to driving with your
eye on the gas tank, driving at 90 miles an hour, and questioning when you will
run out of gas. He said the response of his and other facilities has been to
try to work together and share ideas to bring solutions.
said funding has also been a challenge, especially since long-term facilities
did not see help in the early days of the pandemic as attention was put on the
hospitals. He said there is a huge financial impact, noting that N95 masks that
used to cost less than $1 each now cost $5-7, while gowns that were 25 cents
each now see some distributors charging $9. He asked the lawmakers to consider
increasing reimbursements to the nursing
facility and assisted living waiver per diem rates to offset the high costs of
PPE, increased staffing, and added communication technology.
testing challenges, Budi said there needs to be a rapid test that can be done
at the site and can be done daily. She said the current nasal swab that
"has to go into the brain" is not something most staff want to go
through on a daily basis.
Cindy Abrams (R-Harrison) asked the witnesses what success would look like for
them. Budi said a test that is a simple as a finger prick and has results in
10-15 minutes, as well as cost-effective PPE with about a 90-day supply.
told Fraizer that taking on residents discharged from a hospital has been a
challenge, as they must treat them as positive cases for at least 14 days,
which causes them to burn through PPE. Budi said that Montgomery County
hospitals recently started testing patients 24 hours from discharge, but her
facility still isolates those patients.
Albertoni and Susanne Crisp of Public Partnerships LLC spoke to the committee
on self-direction. Crisp said self-direction empowers individuals to manage
their own services and supports. She said it is more about the daily functions
of life such as dressing and grooming and not skilled nursing care. She said
empirical evidence of the model so far has been positive.
the COVID-19 issue, we have found that self-direction has been a huge boon in
providing access to services that people need," she said. Individuals have
a say in who is hired to come into their home, so they have a person that they
know and trust. Noting difficulties home health agencies have in hiring to
provide home care, she said self-direction can relieve that burden of finding
individuals to go into a home.
a person is able to hire whom they wish, they can hire friends, family and
neighbors. For people who have lost their jobs, this is a God-send. What we
have seen is many people have been hired for services in the home, and that
relieves the unemployment for citizens," she said.
said a person who is in Medicaid long-term care might be in an institution like
a nursing home or the person might get their services through a home or
community-based agency. Under the model a person who needs personal care
services can use an agency, or the person can self-direct.
decide you want to be the employer of this yourself. You want to pick your own
worker, maybe a neighbor or somebody you know. The reason it is important is
you are bringing in somebody to your home that you trust," he said. "Somebody
who is going to bathe you, dress you, getting to pick that worker is an act of control
and self-determination. It's especially important during a pandemic because you
are not having an agency worker go from home to home and potentially transmit
the virus. So this a solution for the pandemic."
said in Ohio only about 1 percent self-direct, while in other states it is 10
to 15 times that amount.
asked the witnesses if there is a way to streamline the process while
maintaining checks and balances. Crisp said Ohio has a step-by-step process. One
way to streamline it is to make it more of a concurrent process, she said, and
it would not take legislation.
DiMarco of Interim HealthCare spoke on how the pandemic has impacted home
health and hospice agencies in the state. He also spoke on issues with
obtaining PPE for his industry, saying it was almost impossible. His
organization has spent more than $572,000 in purchasing PPE. While PPE has
become easier to obtain, pricing has remained high.
also said patient services were put on hold do the lockdown. His group has been
able to do telehealth services, though Medicare has not allowed the use of
telehealth as a means of providing care except for hospice.
HeathCare's Medicaid business "has been a breakeven at best scenario,"
noting reimbursement rates before PPE costs are factored in. He urged lawmakers
not to slash funding Medicaid for home care funding any further.
Russell for the Ohio Council for Home Care and Hospice made similar arguments.
He said Medicaid skilled home health reimbursement rates are the same as they
were in 1998, and the pandemic has put home health agencies in a position to
have to worry more about money than patient care.
raised concern that the lower rates could lead to more poor Ohioans being
forced into an institutionalized environment.
said his group recommends allowing home health and hospice agencies to use
telehealth services past the pandemic period, and is continuing to advocate for
more testing. He also advocated for improvements in state Medicaid policies.
about a 35-minute time limit, Russell said it was something that was put in
place in the last administration. He said in their industry, there is a
reimbursement base rate and a unit rate that is based on the length of the
appointment. The change and addition of the time limit has made Ohio one of the
most complicated models in the country, and it has caused some vendors to leave
the state. He said it is very difficult to know which rate a vendor will get.
Laubert, the Department of Aging ombudsman, gave the committee stories of how
the pandemic has affected facilities, residents, and families. In lieu of
visits, regional ombudsman representatives have been contacting residents,
families, and providers by phone and video, and has spoken to over 6,000
individuals since visitation restrictions began.
said residents and their families have told them of the impacts on quality of life
and quality of care and they are working to address those problems.
Representatives of her office have received about 2,230 complaints since the end
of February, lower than the number received in a similar period last year.
discharge is the most frequent complaint her office handles year after year,
but during the pandemic, hearing officers have had to hold hearings virtually.
concerns are second, with complaints not just being able to visit, but the way
restrictions are being handled. She noted one son was in the middle of a visit
with his mother on the day guidance was issued and told the leave the facility
immediately. One daughter reported her father's nursing home prohibited
"window visits," and when Laubert visited, she noticed no visible
problems that would have prevented families from talking with residents from a
complaints have been about end of life, an exception provided in the public
health order. She said homes have turned away families unless the resident was
Doug Green (R-Mt. Orab) asked Laubert what enforcement authority her office has
if it finds a violation. She said her office does not have authority and works
on making the regulations work for consumers. Representatives of the office do
a lot of educating and notification, but if they do find something egregious,
they can work with the attorney general's office, the Ohio Department of
Medicaid, or other enforcement agencies to make sure regulations are carried
out in the way they were intended.
said he is troubled by what Laubert presented to the committee.
Stephanie Howse (D-Cleveland) asked about stories were ombudsmen were not
allowed access to facilities. Laubert said most facilities have been
cooperative, and there have been facilities where the ombudsman was able to
tour it virtually through a staff member walking through with an iPad, handing
it to residents to speak.
Thompson testified on behalf of the Ohio Assisted Living Association. She said
that while assisted living and nursing homes aren't the same, they both care
for high risk populations in congregate settings during the crisis.
said assisted living has not received any of the federal money for financial
support to skilled care facilities, and said her group hopes future
distributions by the state and federal government will include assisted living
facilities. Assisted living facilities have also not received direct
distribution of PPE from the federal government.
also said that 126 facilities have reported that they have begun allowing
visitation under guidelines issued by the DeWine administration, and said it
has overall been going well, although one community said it had some families
that were not up to date on social distancing policies.