“There never will come a time when we will return to the old normal,” Kramer, the founder and president of Nexus Insights, told Forbes’ columnist Howard Gleckman in a May analysis.

Gleckman agreed, noting that workforce demands for increased pay may substantially increase. The rise in costs also could come with a likely drop in patient revenues from Medicaid and Medicare. And providers may face “enormous regulatory and consumer pressure” to maximize infection control, and a “massive wave of lawsuits,” he wrote. n

The commission, which the federal government announced at the end of April, is tasked with conducting a comprehensive assessment of the overall response to the COVID-19 pandemic in nursing homes. Its report is expected by Labor Day and will inform immediate and future actions  regarding virus protections.  

An independent contractor solicited commission nominees from health industry professional, clinical, advocacy and consumer organizations known for their nursing home focus and expertise, CMS said. The names of chosen panelists were scheduled to be announced at the end of May.

Also last month, Sens. Susan Collins (R-ME) and Kyrsten Sinema (D-AZ) recommended the commission include a state ombudsman and address how facilities can access adequate personal protective equipment. They also suggested further data collection and reporting of residents’ and staff members’ infections to increase transparency.

The CARES Act stimulus funding began flowing May 22. Each certified nursing home with six or more beds was to receive a base payment of $50,000 initially, augmented by an additional $2,500 per bed.

The amount is less than half of the $10 billion that the American Health Care Association had been lobbying for, but AHCA President and CEO Mark Parkinson and LeadingAge President and CEO Katie Smith Sloan expressed gratitude for the dedicated funds. 

They also immediately began a push for additional testing, personal protective equipment or funding for a broader spectrum of providers, including assisted living operato

Officials would focus on providing a vaccine to those most at risk for suffering serious complications from the virus, Trump indicated during an interview with Fox Business in May. A vaccine might not be available for a year, though some expert estimates at press time said initial doses might be ready as early as December. 

“Our military is now being mobilized so at the end of the year we’re going to be able to give it to a lot of people very, very rapidly,” Trump said. 

Data transparency was a recommendation in a recent U. of Chicago analysis. The study also found that nursing homes with the lowest percentage of white residents were more than twice as likely to have cases or deaths as those with the highest percentage of white residents. Star ratings played less of a role, the study said.

The organization issued the warning as the Centers for Disease Control and Prevention began its mandatory COVID-19 reporting for nursing homes. Operators should give an “accurate picture of staffing and [personal protective equipment]” to the federal government, AHCA said. 

Meanwhile, a majority of nursing homes across the United States have successfully enrolled in the National Healthcare Safety Network to report their COVID-19 data to the CDC. 

“That’s definitely a milestone that’s worth celebrating. Congratulations to you all,” said Jeneita Bell, M.D., NHSN, long-term care lead for the CDC, during a weekly stakeholder call in May. 

Testing every nursing home resident and staff member just once would cost about $440 million nationwide, according to data released in May by the American Health Care Association/National Center for Assisted Living in May. The data also revealed that testing workers weekly would cost more than $1 billion per month. 

“For months now, we have been advocating for expanded and priority testing in nursing homes to protect our residents and caregivers, but this is a significant undertaking and cost for nursing homes to shoulder on their own,” AHCA/NCAL President and CEO Mark Parkinson said.

Among states where testing is most expensive, the effort would cost about $36.3 million in California and $33.9 million in New York. Among the least-expensive states, universal testing in Wyoming and Vermont would cost about $658,000 and $925,000, respectively, AHCA said.

A:In an ideal world, we’d test every person coming in the building and get instantaneous results on the spot. It exists, but not in the quantities we need. That’s the only surefire way we can keep COVID out of buildings.

Q: What about personal protective equipment?

A:PPE is a region-by-region and operator-by-operator issue. Thankfully, there are now some operators that have the equipment they need, but there are some that don’t. We are encouraged that the supply chain from China is operating. We think by mid-June the supply chain will resolve itself.

Q: Are you troubled by the negative nursing home publicity?

A:We’ve been very concerned about the impact of negative stories, primarily on the workers in the buildings but also on the sector as a whole. I’ve really felt like the press has shifted away from blaming nursing homes to instead a realization that this was an unprecedented virus that really couldn’t be controlled. Nursing homes and assisted living buildings have done everything they could, and if given what they need, they can battle this virus. We’ve seen a shift in the media toward understanding this wasn’t our fault. 

Its analysis found that 82% of all surveyed nursing homes were cited for having an infection prevention and control deficiency in one or more years between 2013 and 2017.

Nearly 50% of facilities were cited in consecutive years during that same time period; 35% had deficiencies cited in three or four consecutive years; and 6% had deficiencies in all five years.

“This is an indicator of persistent problems at these nursing homes,” the report’s authors wrote.

But the report also found that of the deficiencies, nearly all of them (99%) were classified each year by surveyors as not severe. Also, 67% were classified as not severe and did not have any enforcement actions imposed or implemented. Nearly one-third (31%) had enforcement actions imposed but not implemented.

The GAO did not make any recommendations. The agency said it planned to release future reports on infection prevention and control and emergency preparedness in nursing homes.

Also, prior to reopening, state survey agencies are required to inspect nursing homes that have experienced a significant COVID-19 outbreak. Overall, CMS recommends that nursing homes be among the last to reopen within community. 

The agency noted in its guidance that decisions to relax restrictions in nursing homes should factor in the following: the case status in the local community and the facility; if a provider has adequate staffing and access to testing; whether social distancing measures can be followed, including having face coverings for residents and visitors; local hospital capacity; and if the facility has enough personal protective equipment. 

CMS Administrator Seema Verma has urged states to use “extreme caution” in making the decision to reopen nursing homes to visitors. 

The guidance said that visits can happen during phase three of the president’s three-phase plan to open the country. Providers are encouraged to spend a minimum of 14 days in each phase of the administration’s reopening plan.