White House scrambles on nursing homes as COVID-19 surges

COVID-19 Coronavirus test tube

WASHINGTON (AP) — Fearing another grim wave of nursing home deaths as COVID-19 cases rebound, President Donald Trump on Wednesday announced his administration will provide $5 billion to help facilities counter the virus.
The move follows Democratic presidential candidate Joe Biden’s recent unveiling of a family caregiver plan that aims to greatly expand and subsidize alternatives to institutional care for frail older adults. Both men are competing for seniors’ votes against a backdrop of eroding political support for Trump among older Americans.

“I want to send a message of support and hope to every senior citizen,” Trump said at the White House. “The light is starting to shine and we will get there very quickly.”
The $5 billion announced Wednesday is part of a package, including efforts to facilitate ongoing testing of nursing home staff, providing states a weekly list of facilities with increased COVID-19 cases, and offering additional training and support for the homes. Nursing homes in hotspots will get priority for the new funds.
Advocates and industry have been pressing the administration and Congress for weeks to provide more financial assistance and support for nursing homes. An earlier White House recommendation to test all residents and staff has had mixed results. Nursing homes already have received $4.9 billion from pandemic relief funds approved by Congress.

The American Health Care Association, an industry group, welcomed the White House announcement but said more aid is needed for nursing homes as well as other long-term care facilities.
Experts have testified to Congress that once the coronavirus is spreading within a community, it’s just a matter of time before it enters nursing homes. Staffers can be the unwitting carriers.
Once inside, the virus encounters ideal conditions to propagate among medically frail residents living in close quarters. States like Florida and Arizona now seeing an increase in COVID-19 cases are trying to head off a repeat of high numbers of nursing home deaths earlier in states like New Jersey and Massachusetts.
Elderly housing facilities account for a disproportionately large share of U.S. deaths from COVID-19, more than 37,000 fatalities among nursing home residents according to federal estimates, and more than 57,000 in an ongoing tally by The Associated Press, which also counts other long-term care facilities, and staff as well as residents. Both estimates were updated early this month. The AP’s count would represent about 40% of more than 142,000 U.S. deaths. Nursing home residents account for only about 1% of the U.S. population.
“As cases surge across the country, it has never been more important for nursing homes to maintain a sturdy defense against the virus,” said Seema Verma, head of the federal Centers for Medicare and Medicaid Services, or CMS, which sets safety standards and pays much of the bill.

Two months ago the White House urged governors to test every nursing home resident and staffer within two weeks and then to have staff members retested on a weekly basis. It was a request — much like the president’s push for a return of in-person schooling — that many states shrugged off.
The latest White House initiative would also:
— Build on an announcement last week that the administration is distributing point-of-care tests — 15-minute tests — to all 15,400 nursing homes in the country. On Monday, Vice President Mike Pence told governors in a private conference call that the administration was in the process of purchasing and distributing the equipment and supplies.
CMS said Wednesday it will issue regulations requiring all nursing homes in states with an overall positive testing result of 5% or more to test staff weekly, as well as visitors. Pence said tests will be shipped on a priority basis to where the need is greatest and the goal is to get them all distributed in roughly the next five weeks.

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— Report weekly to states on states on “high risk” nursing homes in their jurisdiction that are seeing an increase in COVID-19 cases. The idea is to target inspections and remedial efforts to those facilities. Three or more cases will trigger an inspection.
— Provide additional training and support for all nursing homes on best practices for infection control and strategies to keep the virus out.

Older people are a key election-year constituency and many have direct experience with nursing homes. Some have had a short-term nursing home stay for rehabilitation following a hospitalization, and many have friends and loved ones who are living permanently in such facilities. Many nursing homes have been closed to visitors since March.

Associated Press writer Alan Suderman in Richmond, Virginia, contributed to this report.