Update from the Health Facilities Association of Maryland |
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Thank you for your leadership during these unprecedented and historic times. We appreciate all that you do to serve Marylanders and advocate for your constituents. We are writing today to give the latest update on Maryland skilled nursing and rehabilitation centers and assisted living campuses. This message includes updated information on:
Healthcare Heroes
Resources
COVID-19 in our Sector
Testing
Funding
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Due to the medical needs of the people in our care, and the often-chronic conditions of the healthcare heroes providing care, nursing homes have been at the epicenter of the COVID-19 pandemic.
As we shared in our earlier Legislative Update, more lives are being saved than lost from COVID-19 in Maryland skilled nursing and rehabilitation centers thanks to the dedication of the healthcare heroes who have gone above and beyond to ensure the health, safety, and happiness of residents and patients in their care. Long-term and post-acute care professionals continue to do all they can to provide quality care and save lives.
In Maryland, across the country and the world, people are experiencing fatigue in our fight against the virus. Our long-term and post-acute healthcare heroes are no exception. They too are exhausted, tired of constantly wearing PPE, and remain fearful of the virus— both at and away from work.
This is why on Thursday, September 3, we plan to come together in a socially distanced way to honor frontline healthcare heroes. We appreciate all the sacrifices that healthcare teams have made and continue to make during this crisis. While every healthcare worker truly deserves praise and recognition, we want to celebrate a handful of our frontline heroes – this will be the start. Click here to view our healthcare hero nomination form.
As we’ve said all along, we will be fighting this virus until there is a broadly available vaccine. We know people with pre-existing conditions, diverse communities, and older people are most at risk. We also know that if a community has a high positivity rate, so will skilled nursing and rehabilitation centers and assisted living campuses in that community.
Going forward, our sector will continue to face unprecedented and unknown challenges. We need continued support to ensure adequate testing, funding, PPE, and staff support as healthcare heroes in our centers save lives and provide quality care to those most in need.
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RESOURCES
We were fortunate to have recorded a video with Dr. Morgan Katz to talk about PPE, testing, and to offer reassurance to our teams providing care. Morgan Katz, M.D., MHS, is an Assistant Professor of infectious disease at Johns Hopkins Hospital. Her research has been devoted to making infection prevention practices feasible and effective in the long-term care setting. At the beginning of the pandemic, she was named the long-term care incident commander for the COVID-19 response in the Johns Hopkins Health System, and served on the Maryland state strike team to provide testing, cohorting, and infection control guidance to facilities across Maryland.
She is now serving as a member of the Independent Nursing Home Commission to guide the Centers for Medicare and Medicaid in their response to Coronavirus in post-acute and long-term-care. We can’t thank Dr. Katz enough for doing this video, and for all she does.
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As you know, the first surge of COVID-19 in Maryland skilled nursing and rehabilitation centers and assisted living campuses was from mid-March to late April. During that initial surge, the majority of nursing homes across the state had cases; many were double-digit hotspots. From our frequent communication with nursing homes, we estimate that about 60 centers had isolated (single-digit) cases of COVID-19 outbreaks in June. Within two weeks following the July 4 holiday, we estimate that outbreaks (single-digit cases) dramatically increased – perhaps in 180 of the 227 centers in Maryland. |
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It has been a growing trend across the country that as communities begin to reopen and COVID-19 cases increase in communities-at-large, cases also increase in skilled nursing and rehabilitation centers and assisted living campuses.
Based on independent scholarly analyses, we have known since June that the biggest indicator of an outbreak in a long-term care setting is the geographic location of that center and that there is a strong correlation between positive cases in the community and positive cases in skilled nursing and rehabilitation centers in that community.
In Maryland, the number of cases is nowhere near what it was during the peak in March and April when the vast majority of centers were hotspots with a high number of staff, residents, and patients testing positive. This was during a stage of the pandemic when we were not testing and before we knew about the largely asymptomatic nature of the virus. As a sector, we have become more and more successful in containing the virus— our healthcare heroes, PPE, testing, and emergency federal grant funding all play a role in our successful push against the virus.
Going forward we must remain vigilant to prevent and contain additional surges this fall and winter with the coming Labor Day holiday and the opening of schools and universities. As we know, the biggest indicator of an outbreak in our setting is the geographic location of a center and there is a strong correlation between positive cases in the community and positive cases in nursing homes.
Together, we will be fighting COVID-19 until there is a broadly available vaccine. Because of the chronic medical challenges of the people we serve and often the healthcare heroes providing care, people in our sector are at higher risk. Given the often-asymptomatic nature COVID-19, timely testing and contact tracing in the community-at-large are both critical to limiting the repeated exposure of the virus into skilled nursing and rehabilitation centers and assisted living campuses.
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The State coordinated universal testing in our sector has been among the longest-running in the nation and has helped to save lives. While comprehensive and chronological testing data for skilled nursing and rehabilitation centers showing the positivity rate have not been publicly released, we believe that Maryland data from May 2020 to today would show a successful concerted effort of the State and our sector in our fight against COVID-19.
During the State-funded and coordinated universal testing period, the vast majority of skilled nursing and rehabilitation centers participated and fully adhered to State testing and reporting requirements. There were a small number of centers that did not fully participate and an even smaller number of centers that did not at all test sufficiently.
The State stopped the funding and coordination of testing on August 15 and required all skilled nursing and rehabilitation centers and 50+ bed assisted living centers to contract with a State-approved lab and share their testing plans and results with the Maryland Department of Health (MDH).
We are very concerned in the near term about demand outpacing commercial lab capacity. It currently often takes several days to get test results from commercial labs; it can take 72-96 hours to get results back even from labs that claim a 48-hour turnaround time. According to physicians, COVID-19 test results received beyond 48 hours are not as clinically actionable, and testing 100 percent of residents and staff in our sector is not helpful if it takes days to get results.
Going forward, there will continue to be cycles in this testing capacity challenge, where demand exceeds even the most ambitious standing up of new capacity. We fear this will be the case as schools and universities begin the fall semester.
The Centers for Medicare & Medicaid Services (CMS) has committed to providing every skilled nursing and rehabilitation center in the U.S. with Point-of-Care (POC) rapid testing machines. So far, we estimate twenty-three centers in Maryland have received these machines from CMS, and they are prohibited by State order from using them if they have an outbreak of a single case. These machines are commercially available and are currently being used in Maryland urgent care clinics and hospitals.
Now is the time to learn from our testing experience, plan for ever-increasing commercial lab testing demand, and to pivot towards a testing strategy that includes both rapid result POC testing and commercial testing-- before the Labor Day holiday.
The bottom line is that overall centers have gotten better at testing since the beginning of this pandemic and that universal testing has saved lives. Skilled nursing and rehabilitation centers have been testing weekly since May. Assisted living centers have also been testing, but for a shorter period. It is the smaller assisted living centers with less than 50 beds who have fewer resources and funding that we should be most concerned about. We are 100 percent for clinically, data-driven testing that is sustainable; the current testing requirement is a $100 million per year unfunded mandate for skilled nursing and rehabilitation centers in Maryland.
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As you may know, the U.S. Department of Health and Human Services (HHS) shared decisions relating to the additional $5 billion in COVID-19 relief funds set aside for skilled nursing facilities. HHS announced this funding on July 22 and we recently learned more details about the plans for distributing funds. Thanks to the leadership of our colleagues at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), every provider will receive funds and also has the opportunity to receive critical additional money in the coming months.
While exact details on distribution are still unknown, here are a few key points:
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$2.5 billion is going out to every provider. HHS is directing that providers spend the money on testing, PPE, and/or staffing.
- $2 billion is going out to buildings that keep COVID rates low in September, October November, and December.
- HHS will award $250 million to facilities that set up isolation wings or COVID-only buildings.
- The final $250 million will go to special efforts to work with outside groups on stopping the spread of the virus.
This funding is critical and we are grateful for it. However, given the costs centers have incurred due to increased labor, PPE, testing, and lost revenue from decreased census throughout this pandemic, our sector will need additional support and financial assistance.
It is important to note that the $2.5 billion going out to every provider for testing, PPE, and/or staffing will at best cover ONE of those expenses for less than 8 weeks.
Adequate Medicaid funding for Maryland skilled nursing and rehabilitation centers and assisted living campuses (and frankly all Medicaid providers) has always been critical to protect quality care for Marylanders in need and to protect healthcare jobs. It is now especially important given the critical role that skilled nursing and rehabilitation centers continue to play as the pandemic evolves.
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Again, thank you for all you do for a better Maryland. We look forward to our continued work together to protect quality care and build a stronger long-term and post-acute care sector for the benefit of all Marylanders. Despite the challenges we face, we have a once-in-a-lifetime opportunity to reform and rebuild our sector for a stronger, healthier Maryland. |
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Visit our website to view all HFAM COVID-19 sector updates, as well as
guidance and resources from our partners.
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