A COVID Winter: Nursing homes look for funding, liability protection as cases rise in holiday season

Nov. 27--In the spring, long-term care providers tried to mitigate or contain the spread of COVID-19 with few resources. There was a shortage of PPE, scientists were still trying to figure out details of the disease, and testing capabilities were dependent on the state's Exton laboratory, if kits were even available.

Now, there are more resources, but there are also more cases on the doorsteps of those facilities.

"Any time there is community spread, there tends to be more cases in long-term care facilities," said Anne Henry, senior vice president and chief government affairs officer at LeadingAge PA in Silver Spring Township, an association for long-term care providers.

Throughout the pandemic, the state Department of Health has said something very similar, noting that cases in the community can make their way into vulnerable populations.

"We know that what happens in congregate settings is a reflection of the community around them," said Nate Wardle, press secretary for the Department of Health. "As outbreaks occur in communities, it affects employees in congregate settings such as long-term care facilities, prisons and college campuses."

This has been no more apparent than in the last month for long-term care facilities in Cumberland County. After the spring surge of COVID-19 and outbreaks at a few facilities in the county, some nursing homes were able to reopen to visitation.

Just before the holiday season, however, most of those doors were shut across the state as more facilities saw rising positives in staff and residents.

With people now more than ever trying to reach loved ones and connect over the holidays, the staff who have managed to stay on at nursing homes during the pandemic are taking on multiple tasks of caring for the residents, mitigating the disease and helping residents stay in touch with families.

"The staff have been amazing," Henry said. "About all of them have helped with Zoom or FaceTime on a regular basis."

She said some facilities have tried to open up other avenues of communication, such as allowing outdoor meetings of families when weather permitted and allowing for limited indoor meetings when visitation was still allowed.

Challenges

Some of these efforts, however, have been hampered by more than just COVID-19 cases themselves.

The Pennsylvania Health Care Association, which advocates for long-term care providers, surveyed skilled nursing, assisted living and personal care providers in August and found that most reported difficulties in keeping and recruiting staff during the pandemic. According to the survey, 50% reported serious long-term problems with staffing, and 45.45% reported serious short-term problems with staffing.

Henry said that in addition to the other tasks staff must accomplish, they're also burdened with reporting COVID-19 updates to multiple systems. Currently, nursing home staff report numbers to two state systems and also to a third federal system, which she said requires too much time for an already burdened staff.

In addition to streamlining that process, Henry said funding is a major request from long-term care providers.

"Providing care has been extremely expensive for long-term care providers," she said. PPE, testing and additional staffing have been costly during the pandemic, though Act 24 funding was helpful, she said.

The PHCA survey reflected those worries. When asked about the sustainability of business operations in light of the pandemic costs and unlikelihood of a Medicaid or rate increase, 65.57% of providers said their future is "barely sustainable," while 22.95% said it was "completely unsustainable."

One of the additional financial worries are COVID-19 claims that could be filed against long-term care providers.

"There's no insurance coverage for COVID claims," said Henry, who added that some claims have already been filed against providers.

Henry said LeadingAge PA is hopeful that Gov. Tom Wolf will sign House Bill 1737, which was presented to Wolf on Nov. 20 and gives immunity protection to a limited number of providers. According to Carlisle area Rep. Barb Gleim, who is listed as the prime sponsor of the bill, it was originally proposed by Democrats to include environmental liability protections for land banks before being amended with Gleim's agritourism protections and two senators' COVID-19 temporary liability protections. Democratic support has since dropped off from the bill, but Gleim said residents and organizations support of it.

"This legislation is great policy that has the support of the majority of the state residents and their employers," she said in a news release. "Over 75 associations, nonprofits, school and health care entities, farmers, manufacturers and small businesses have voiced the need for this legislation to be enacted."

As of Wednesday, Wolf had yet to make a decision on the bill.

Unprecedented aid

With pandemic struggles ongoing at long-term care facilities, providers have received help from what may seem like an unlikely source.

In the 24 years he's been a part of the Pennsylvania National Guard, Public Affairs Officer Lt. Col. Keith Hickox can't recall a time before the pandemic where they've been deployed to help nursing homes.

And there's a fairly good reason. Despite the multiple medical careers those in every branch of the military can pursue, Hickox said there aren't geriatricians, given the lack of older, active service members.

When the pandemic started, Hickox said he expected the expertise in that field to be lacking in the Pennsylvania National Guard as well, but Guard members also have civilian occupations, and two doctors ended up being board-certified geriatricians.

"They were very instrumental," he said. "A year and a half ago, no one would have ever thought that something like this would happen. It goes to show that the Pennsylvania National Guard is very capable and very adaptable."

The two doctors split up to educate teams of guardsmen by geographic regions of the state, and that education included more than just medical knowledge.

"It was about how to interact with elderly people also suffering from forms of dementia and Alzheimer's," said Hickox, explaining that guardsmen had to learn how to approach a situation where a resident may mistake them for a family member.

With that training under their belts, the Pennsylvania National Guard has been deployed to long-term care facilities for testing missions and for staffing support missions, including a stay at Messiah Lifeways in Upper Allen Township last week.

Hickox said help with testing can take up to two days to cover every staffing shift and test the entire population of a facility for COVID-19.

Staffing support missions can take about a week or two, depending on the size of the facility, and require a team of 10 to 20.

"The general purpose is to support staff," he said. "Their numbers get low because of the number of staff that have to quarantine or quarantine while awaiting test results."

For either mission, a facility requests help through the state Department of Health, and the department and the Pennsylvania Emergency Management Agency determines if the National Guard is deployed.

So far during this pandemic, the Pennsylvania National Guard has been deployed to at least 40 facilities for testing, with some of those being visited more than once, and there have been about 30 facilities since April that have received staff support.

With the growing number of COVID-19 cases, facilities have a growing need for help.

As of late last week, the Pennsylvania National Guard was deployed to eight facilities to offer staff support.

"Eight at one time is a bit of an increase," Hickox said. On average, they'd see deployment to about three to four facilities at a time, he said.

Email Naomi Creason at ncreason@cumberlink.com or follow her on Twitter @SentinelCreason

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