Nearly all Massachusetts nursing homes have tested virtually every resident and staff member for the coronavirus, state officials said Wednesday. But nursing home operators and public health experts cautioned far more testing will be necessary if the facilities are to curtail future outbreaks.
The baseline testing, which 350 out of 360 nursing homes in the state have now completed, is a good first step, the operators and experts said. But they worry about a second outbreak in the fall, and believe only routine, repeated — and expensive — testing can prevent another disaster.
“I would say the worst of this surge has passed for now, but we are going to remain ever-vigilant," said Rich Bane, CEO of BaneCare nursing homes, based in Braintree. “The new normal is intense vigilance on infection control until we can have a vaccine.”
State public health officials asked all long-term care facilities to test 90 percent of their staff and residents in order to qualify for a share of $130 million in additional MassHealth funds the state allotted to cover pandemic costs. The state paid for the one-time testing, but experts said facilities will need even more funding going forward.
More than 20,000 residents and staff of long-term care facilities in Massachusetts have tested positive for the virus, according to the state, which on Wednesday released site-specific data on testing compliance. But the state has not reported what percentage of all long-term care residents and staff that number represents. Officials said they were still compiling the results and plan to report that figure in the future.
Long-term care residents now make up 62 percent of the 6,640 total deaths in the state; the figure does not include those in assisted living facilities. The crisis has put many facilities under financial strain as they struggle to pay for tests, protective equipment, and emergency staffing. Industry advocates say facilities will need even more funding to perform the repeated testing necessary to truly control the virus.
“Without surveillance testing, all of the baseline testing and resources will be for naught,” said Tara Gregorio, president of Massachusetts Senior Care, a trade association that represents long-term care facilities.
Last week, nursing homes received additional funding from the federal government, which appropriated $112 million in COVID-19 relief funds to facilities in Massachusetts, or about $50,000 per facility, plus additional money depending on the number of beds.
Nursing home advocates said even more funding is needed. The American Health Care Association and the National Center for Assisted Living estimated that it would cost $672 million to test every resident and staff of assisted living facilities and nursing homes nationwide just once, and $17.5 million in Massachusetts.
An initial lack of testing was a major barrier to nursing homes’ efforts to combat the virus. Early on, tests were difficult to secure, and results took days to come back. In mid-April, the state offered to provide testing to all nursing home residents and staff through its mobile testing program, with help from the National Guard. This increased availability and sped up the results.
Assisted living facilities may request testing through the state’s mobile testing program, paid for by the state, but they are not eligible for the additional state funding because, in general, they do not receive Medicaid money. Assisted living advocates, however, are pushing for access to government funding, saying they have been equally struck by the crisis.
“Shortages of testing and PPE continue to be a challenge nationwide, and because assisted living communities are not medical facilities, they have not been prioritized for testing or supplies,” said Scott Tittle, executive director of the National Center for Assisted Living.
Michael Mina, an epidemiology professor at the Harvard T. H. Chan School of Public Health, called baseline testing of residents and staff a first step that now needs to be converted into a program of efficient and routine testing of those who initially tested negative in order to identify those who later test positive or develop antibodies.
“Testing is absolutely crucial,” said Mina, who is also associate medical director of the clinical microbiology laboratory at Brigham and Women’s Hospital. “You have to know who is infected at any given time in order to create expectations of who might be infected next.”
He said nursing homes will continue to be at serious risk as long as the virus is present in the population. But, he said, authorities may be able to relax testing at facilities if they are not seeing many COVID-19 cases in the community, and then increase testing if cases pick up in order to prevent a major outbreak.
“One of the major predictors of when outbreaks are happening in nursing homes is through community transmission of the virus,” Mina said.
He said health officials will likely focus on creating safeguards to prevent the virus from entering nursing homes by closer monitoring of staff and visitors.
Simon Johnson, a professor at the MIT Sloan School of Management and cochair of the COVID-19 Policy Alliance, a faculty-led group focused on senior care facilities, said the state has taken a step in the right direction in requiring everyone to be tested once, but he said the one-time testing is "quite expensive, thoroughly impractical, and will not achieve the desired goals.”
Johnson said the state should expand its program to include serology testing, which is much cheaper and could indicate how many people at a facility have antibodies because they have already been exposed to the virus. Baker said during a briefing Thursday that the state’s approach going forward will include both viral testing and serology testing at long-term care facilities, but didn’t provide any details.
Bane, whose company operates 11 facilities in the state, said he initially worried about testing all his staff, for fear many would test positive and need to quarantine, but in the end only a few did.
“The intense focus over the last eight to 10 weeks has worked,” he said.
At one point, eight of his company’s buildings had positive cases but now only four do, he said late last week.
But Bane and other operators are worried for the fall, when experts predict there could be a second outbreak of the deadly virus.
“Our focus now is on how to make sure we don’t have a resurgence, especially because people are out and about more, because our folks are still the most vulnerable,” said Bill Bogdanovich, president and CEO of Broad Reach Healthcare who runs a nursing home and assisted living facility in North Chatham.
Bogdanovich said that during the crisis just two of the 180 residents in those facilities tested positive, and both have recovered, he said. No staff have tested positive, he said.
The Williamstown Commons Nursing & Rehabilitation Center, in Western Massachusetts, was one of several facilities that saw an early spike in cases in late March, but now has only about seven positive cases, with everyone else having recovered or tested negative.
“They definitely are on the downswing,” said Lisa Gaudet, the facility spokeswoman, "unless we get some sort of a reemergence.”