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From the archives 2020

Thousands of deaths later, Pa. finally mandates universal testing in nursing homes, but not for another month

by Aneri Pattani of Spotlight PA |

The Wolf administration has been criticized for its slow response to the coronavirus in Pennsylvania nursing homes, and is only now mandating universal testing.
DAN NOTT / For Spotlight PA

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HARRISBURG — Three months after the coronavirus began infecting and killing nursing home residents — who account for a large majority of all deaths in the state — the Wolf administration on Monday ordered facilities to test all staff and residents once by mid-summer.

The order applies to all 693 nursing homes in the state, requiring them to complete the tests by July 24 — a pace and timeline many criticized as glacial amid continuing infections and an ongoing pandemic that calls for an urgent response.

“That’s really incredibly slow,” said Charlene Harrington, a professor of sociology and nursing at the University of California San Francisco. “It’s dangerous because every day you delay testing, the residents are more vulnerable to getting the infection.”

In Pennsylvania, advocates, family members, nursing home associations, and public health experts have been pushing for mandated widespread testing for months. They say it is the key to identifying asymptomatic residents and staff and preventing them from unknowingly spreading the virus to others.

Last month, the administration appeared to make such a move, announcing a “robust” and “universal” testing plan for long-term care facilities. Gov. Tom Wolf touted the effort as “fairly radical” and noted the goal was to test all staff and residents weekly.

But a closer examination by Spotlight PA found the plan fell far short of official claims. And as of early this month, only 75 facilities — or 12% of those reporting positive cases and just 4% of all long-term care homes in the state — had voluntarily completed widespread testing.

» READ MORE: Pa. sold nursing home testing plan as ‘universal’ and ‘radical’, but advocates say it’s optional and insufficient

Monday’s announcement addressed one of the main holes in the previous guidance by making testing mandatory rather than optional. Facilities that don’t meet the July 24 deadline could face fines up to $300. However, many other shortcomings remain:

  • The order only requires testing of all residents and staff once to establish a baseline. Without repeated testing, asymptomatic individuals could go unnoticed in the months to come, and could easily spread the infection, experts said.

  • The mandate only applies to nursing homes and excludes the nearly 1,200 personal care and assisted living homes in Pennsylvania, which have also had outbreaks.

  • Pennsylvania is already well behind other states in testing, and advocates said a deadline six weeks out does little to help residents and staff who are getting sick daily.

“It should have been done in March,” Harrington said, “so it is pretty scary that they are still delaying [the compliance date].”

To date, the coronavirus has infected more than 16,000 residents in long-term care facilities and killed more than 4,000. Throughout this time, the Wolf administration has been repeatedly criticized for its slow response and missteps in protecting these vulnerable residents.

A Spotlight PA investigation found the state had an early plan to protect nursing homes, using strike teams of medical professionals that could visit as soon as cases were detected and prevent further harm. But it was never fully implemented.

» READ MORE: Pa. had an early plan to protect nursing home residents from the coronavirus, but never fully implemented it

And last month, when the state Department of Health announced testing guidance, many wondered why it wasn’t made mandatory like in Maryland or New York. West Virginia completed baseline testing of nursing homes in early May, and New Jersey set its deadline for May 26.

“We’re three months too late, frankly,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents more than 400 long-term care facilities. “This could have been done earlier if it was positioned as a mandate, but providers need to know what’s expected of them in order to do it.”

The health department said it issued guidance in early May suggesting facilities do widespread testing. Spokesperson Nate Wardle said this week’s order was to “spur the remaining facilities to do universal testing.”

Health officials encourage facilities to complete testing prior to the deadline, Wardle added, and the department is working with human services officials, who oversee personal care and assisted living homes, to issue a mandate for testing in those facilities soon.

The varied guidance has already fueled confusion, said Margie Zelenak, executive director of the Pennsylvania Assisted Living Association, which represents more than 200 assisted living and personal care homes. She’s fielded several calls from members asking whether the mandate applies to them, and if they’ll be expected to do testing in the future.

Personal care homes are not medical facilities like nursing homes, Zelenak said. They may not have medical directors or nurses on site to do testing, so they need time to prepare for a mandate, she said.

Shamberg said even in nursing homes, questions are arising about how the testing will be implemented. Many facilities are short staffed and some are still struggling to access testing supplies or labs to process the results.

At a press conference Monday, Secretary of Health Rachel Levine said the state’s testing capabilities have grown greatly since April, and “we are very confident of our ability to do this testing now.” The state can provide some nasal swabs and process tests for “priority facilities” free at its lab in Exton, she said. But the guidance issued to nursing homes notes that “support services are limited and should be considered a last resort,” raising questions among providers about how much support they’ll truly receive.

Separately, the facilities are slated to receive millions of dollars in federal coronavirus stimulus money. In late May, Wolf signed a bill that creates collaborations between academic health systems and long-term care facilities to address testing, infection control, contact tracing, and more. But the money has not yet been distributed and the collaboratives are still in early stages, meaning they may not be ready prior to the July 24 deadline.

In the meantime, residents and staff continue to face high levels of risk, said Diane Menio, executive director of the Center for Advocacy for the Rights and Interests of the Elderly, based in Philadelphia. Many staff in long-term care work in more than one facility. Without testing, they could unknowingly carry the virus between homes.

Widespread testing is also the key to allowing visitors and ombudsmen, who have been barred since mid-March, back into nursing homes, Menio added, which is crucial for residents’ mental health.

“Baseline testing is good but it doesn’t finish the job,” Menio said. “I know it’s a big undertaking, but we have vulnerable lives at stake here and we can’t cut short in protecting them.”

“We should do better.”

Rebecca Moss of Spotlight PA contributed to this article.

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