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ed-living and other senior-care facilities need a greater
share of the COVID-19 relief funding as well as priority test-
The American Health Care Association estimated the cost of
ing and equipment, advocates said. Although long-term
testing every nursing home and assisted-living community
resident and staff person just once would cost $672 million.
care facilities have been the most susceptible to the out-
break, they were among the last groups to get personal pro-
tective equipment, testing and funding, said Terry Fulmer,
Total cost to test
Total cost to test
president of the John A. Hartford Foundation, which works
all nursing
to improve care for older adults. “We love to say we know
homes
facilities
$439.7 $232.3
someone who is 100 years old, but we as a society look the
other way in ensuring we provide quality care.”
Taking a longer view, advocates are pushing for a com-
million
million
prehensive investment in public health, an improved pay-
ment structure, a redesign of physical space, a revamped
regulatory framework and a more cohesive care continu-
States with highest
Nursing homes
um. “Our entire healthcare system is set up to do transac- Just one test all assisted-living
estimated total cost
Assisted-living facilities
tions as efficiently as possible because they all follow the ($ in millions)
money, whether you are for-profit or not-for-profit,” said California $36.4 $32.4 $68.7
Vincent Mor, professor of health services, policy and prac- Florida $25.3 $18
tice at Brown University’s School of Public Health. “The $43.3
virus has shown all the flaws that are apparent in a maxi- New York $34 $9.3 $43.3
mally efficient, transaction-based healthcare system.” Texas $29 $12.7 $41.7
Ohio $25 $9.2 $34.1
Susceptibility Pennsylvania $22.2 $10.8 $33
Cross-sector partnerships have helped, but they haven’t
been a panacea. Hebrew Home at Riverdale teamed up with Illinois $21.4 $5.6 $27
New York-Presbyterian to help the long-term care provid- Minnesota $9.9 $10.1 $20.1
er equip its COVID-19 recovery building. During the early North Carolina $12.2 $7.7 $19.9
days of the pandemic, New York-Presbyterian provided ad- Michigan $12.3 $7.3 $19.6
ditional PPE, allowing Hebrew Home to convert an entire
0 $10 $20 $30 $40 $50 $60 $70
building to accommodate about 150 COVID-19 patients.
Having a trusted hospital affiliate has been critical, said Note: Numbers are rounded. Total costs assume $150 per test
multiplied by the number of tests needed.
Reingold, noting that the virus knocked out about 30% of
Source: American Health Care Association and National Center for
the workforce. “To have a big brother to help us with PPE, a Assisted Living
partner that has the confidence that they have a high-qual-
ity long-term care facility to discharge to, is huge,” he said.
Residents account for about a quarter of COVID-19 relat- a priority for supplies and help. We need adequate testing
ed deaths even though less than 0.5% of the U.S. population and PPE. We need help with finding more staff. And we
live in one. In some states like Massachusetts, that share need it now.”
exceeds 50%.
It is such an insidious threat because workers and pa- Little relief
tients can carry the virus without symptoms, and then it The relief provided nursing homes seems low relative
spreads quickly through these communal settings. to their value, according to industry backers. “These are
“The level of intensity and severity of the virus is different some of the lowest-paid workers, who despite having re-
than anything we have seen before; its unpredictable na- ally dangerous jobs, they are going to work, caring for in-
ture is hard to prepare for and respond to,” said Alice Bon- dividuals and doing the best they can under challenging
ner, director of strategic partnerships at Johns Hopkins’ circumstances,” said Dr. Maria Torroella Carney, chief of
Center for Innovation Care in Aging who started working geriatric and palliative medicine at Northwell Health in
in nursing homes when she was 19 years old. New York’s Long Island. “You’re not hearing heroic stories
Although nursing homes have been some of the hard- of how they stayed with patients when they were dying.”
est-hit facilities, the federal government didn’t directly In terms of funding, HHS began sending nearly $5 billion
send masks, gloves, gowns and other PPE until late April. in grants to skilled-nursing facilities on May 22 to help im-
Senior-care advocacy groups argue that it’s time that the prove their cash flow as revenue dried up and COVID-19-re-
country rallies around long-term care residents. “Just like lated expenses surged. But SNFs only received $3.2 billion
hospitals, we have called for help. In our case, nobody has of the $100 billion in Medicare advanced payments that
listened,” the American Health Care Association and Na- CMS sent to providers. Acute-care and critical-access hos-
tional Center of Assisted Living, wrote in an email to Mod- pitals had received more than $80 billion as of May 2.
ern Healthcare. “Plain and simple, whether it’s federal, COVID-19 testing distribution has also lagged, said David
state or local health agencies, long-term care needs to be Parker, president of the senior-care division of ProMedica,
June 8, 2020 | Modern Healthcare 13