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Testing Nursing Home Staff Is Costly And Uncertain, Here’s Why

Dave Wurtzel
Connecticut Public
An employee at nursing facility Kimberly Hall South in Windsor visits with a resident through her window in May.

As coronavirus cases continue to surge nationally, more questions have been raised about Gov. Ned Lamont’s decision to modify testing requirements at nursing homes. And now, three legal aid organizations have signed on to a letter expressing concern on behalf of nursing home residents, arguing Lamont’s decision could lead to more nursing home infections and deaths. 

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In June, Lamont issued an executive order requiring weekly testing for nursing home staff. But a few days later, the governor scaled that back, saying testing staff wasn’t necessary if the facility was COVID-free for two weeks. 

In a joint letter to Lamont, three legal aid groups say the modification is out of step with federal guidance from the Centers for Disease Control and Prevention, which recommends testing all nursing home staff, and says weekly testing for asymptomatic workers without known exposures should continue unless there is “minimal-to-no community transmission.”

“We don’t want to see what happened to nursing home residents be repeated,” said Kevin Brophy, an elder law attorney with Connecticut Legal Services, one of the groups that signed on to the letter.

Brophy said the change has his clients -- nursing home residents and their families -- scared. 

“What we’re concerned about is that you have staff that don’t live in the nursing home. They work in the community, and they could, unintentionally, bring COVID-19 into the nursing home,” Brophy said. 

Infection rates at nursing homes have dropped significantly. But more than 2,700 nursing home residents have died from COVID-19 complications, according to state statistics, which accounts for more than 60% of the state’s death total.

Understanding The 'Toughest' Testing Standards For Nursing Home Workers

During a media briefing July 9, Lamont said he believes Connecticut has “the toughest testing standards at nursing homes, probably in the country.”

But in fact, neighboring states have handled the issue of testing nursing home staff more aggressively. 

In New York, where more than 6,000 nursing home residents died from the virus, Gov. Andrew Cuomo adopted stricter requirements. 

“Nursing homes and adult care facilities located in regions that have entered Phase 2 of reopening (at this point, that is every region of New York State), must test or arrange testing for staff once a week,” Jill Montag, a spokesperson for the New York State Department of Public Health, said in an email.

In Massachusetts, state officials are requiring nursing homes to conduct new baseline testing of their staffs no later than July 19. 

After that, weekly or biweekly testing is required at varying degrees of intensity, even if a facility is COVID-free, Ann Scales, a spokesperson with the Massachusetts Department of Public Health, said in an email.

Sara Parker McKernan, a legislative and policy advocate with New Haven Legal Assistance, which signed on to the letter questioning Lamont’s order, said the CDC is specifically calling for weekly testing for asymptomatic workers. 

Lamont’s order says weekly testing must resume if a resident or worker at a “COVID-free” facility is identified as having “a new case of nursing home facility-onset COVID-19.” 

But McKernan said any pause in testing is wrong. 

“The CDC specifically calls for weekly testing with the provision that ‘state and local officials may adjust the recommendation for weekly viral testing of [workers] based on the prevalence of the virus in their community,’” McKernan said in an email.

Deidre Gifford, acting commissioner of the state Department of Public Health, said Lamont’s modification was in line with CDC guidance. 

When asked about the change Thursday, she said it wasn’t a loosening of testing standards. And she rejected any assertion that the change was based on testing cost.

“We didn’t relax the standards. We just clarified,” Gifford said. “It wasn’t a decision based on cost. It was a decision based on coming into alignment with the federal guidance.” 

Who Pays The 'Extraordinary' Cost Of Testing Nursing Home Staff?

Right now, a combination of state and federal dollars is paying for staff testing at nursing homes around Connecticut, according to the state Department of Public Health.

But that money runs out at the end of August. 

Beyond that, who pays remains an unknown. 

“The federal government has been unclear regarding its commitments to paying for testing, an issue our state and many other states are facing,” Av Harris, a spokesperson for the state Department of Public Health, said in an email.

“This isn’t a Connecticut issue, this is a national issue,” said Mag Morelli, president of LeadingAge Connecticut, which represents not-for-profit aging service providers, including nursing homes, in the state. “We’re really looking for some funding on the national level to be able to provide the testing that’s needed,” Morelli said. 

In the past two weeks, at least 20,000 nursing home staff have been tested via Lamont’s executive order, according to Lita Orefice, senior adviser to the commissioner of the Department of Public Health. 

So what are those tests -- and their associated materials, time and sample work -- costing? 

Right now, the state refuses to release exact pricing information on how much it is paying at least seven vendors to process samples collected from nursing home staff across Connecticut. 

But it has disclosed an average for each test and its associated lab work. 

That price tag is $117, which means the cost of running those 20,000 tests for nursing home staff topped $2 million.

“The cost of weekly testing can be extraordinary,” said Matt Barrett, president and CEO of the Connecticut Association of Health Care Facilities.

“Those would be … unsustainable costs to expect nursing homes to bear,” Barrett said. “Especially … coming off of, and … not really being on the other side of, the COVID-19 pandemic in Connecticut.” 

Jesse Martin, with SEIU 1199 New England, a union that represents workers at about 70 nursing homes in Connecticut, said he thinks Lamont modified his executive order because of the price of running those COVID-19 tests. 

“We think it is cost,” Martin said. “Right now the state is only set to pay for nursing home staff testing through the end of August … it is going to be a fiscal cliff that many nursing homes are going to face come Sept. 1.”

Morelli said that throughout the ever-evolving pandemic staff have continued to show up to work, caring for residents despite having to navigate guidelines that seem to be forever in flux. 

And that’s part of what makes mapping out any certain future for COVID-19 testing in Connecticut so difficult, she said. Everything is changing.  

“I don’t look at it as the door being shut on [Aug. 31],” Morelli said. “But we really, really need to have the federal government step in and help us out. Help the state out and help us out with this cost.” 

Connecticut Public Radio’s Frankie Graziano contributed to this story.

Patrick Skahill is a reporter and digital editor at Connecticut Public. Prior to becoming a reporter, he was the founding producer of Connecticut Public Radio's The Colin McEnroe Show, which began in 2009. Patrick's reporting has appeared on NPR's Morning Edition, Here & Now, and All Things Considered. He has also reported for the Marketplace Morning Report. He can be reached at pskahill@ctpublic.org.

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