LeadingAge NY Calls for Comprehensive and Collaborative Approach to Combating COVID-19 in Nursing Homes

Responding to recent directives from the Department of Health (DOH) to nursing homes, LeadingAge NY called on the Commissioner to initiate a collaborative, multi-pronged effort to contain COVID-19 in nursing homes. That effort must include on-site testing and re-testing of all residents and staff, sufficient personal protective equipment (PPE) consistent with sound infection control practices, and financial assistance and other supports to enable adequate staffing. In the absence of these critical resources, the association noted in a letter to the Commissioner, the directives are likely to have little effect on the spread of COVID-19 in nursing homes and may actually do more harm than good. "With the lives of vulnerable individuals at stake, health policy must be based on real world, practical conditions, formulated through collaboration not vilification, and implemented with appropriate planning and resources," the letter stated.

The directives, which were included in two Dear Administrator Letters (DALs) (available here and here), mandated cohorting of COVID-19-positive residents and assigning separate staff to those residents, and extended the work exclusion period for COVID-19-positive and symptomatic staff from 7 to 14 days. More information about the DALs is available here. The cohorting DAL instructs nursing homes to transfer residents within a facility, to another facility, or to a non-certified location if they are unable to successfully “separate out residents.” The DAL further notes that facilities that are unable to meet infection control standards must suspend admissions. According to the DAL, a failure to adhere to these requirements will result in civil monetary penalties and/or a license revocation.

In its letter to the Commissioner, LeadingAge NY pointed out that these requirements are likely to be infeasible and ineffective. COVID-19 testing is not readily available to nursing home residents or workers and certainly not on a regular basis. Absent a point prevalence survey of all residents and staff in a nursing home and regular re-testing, “unknown” asymptomatic residents and staff will continue to transmit the virus, and cohorting is likely to be ineffective. LeadingAge NY also noted that access to PPE remains inadequate and inconsistent, and that many facilities face staffing challenges that will interfere with assigning separate staff to COVID-19-positive residents. These challenges are only exacerbated by the extension of the work exclusion period. Furthermore, the requirement that nursing homes transfer residents, when the facilities are unable to cohort or assign separate staff, appears to apply regardless of the preferences of residents and does not offer any guidance regarding resident refusals.

LeadingAge NY will continue working with DOH to ensure that policies are informed by facts on the ground and supported by the necessary resources.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838