Arkansas nursing homes, long-term care industry hit hard by COVID-19, face long recovery

June 15-21, 2020

By Daily Record Staff


One segment of the healthcare sector that faces a long road ahead in Arkansas and across the U.S. is the nursing home and long-term care industry that includes assisted living facilities.


Not only has industry faced withering criticism about its response and preparation for COVID-19, but related deaths from the virus have raised concerns about the health and safety of the nation’s 1.4 million mostly older residents living in these facilities.


In Arkansas, only two days after the first positive COVID-19 was reported in Pine Bluff on March 11, the state Health Department (ADH) issued its first guidance aimed at limiting the spread of the virus among residents at nearly 400 nursing home and long-term care facilities across the state.


“[The] coronavirus disease adversely affects older adults and persons with underlying health conditions or compromised immune conditions. This population is at greater risk for severe illness from this virus,” ADH officials said in a March 13 statement. “Due to the vulnerability of residents in long-term care facilities, it is of utmost importance to limit possible exposure to COVID-19.”


At the time, Arkansas’ Health Secretary Dr. Nate Smith, who will be taking a job at the U.S. Centers for Disease and Control (CDC) on Aug. 28, directed all nursing homes and long-term care facilities to prohibit visitations unless medically necessary with exception of law enforcement, emergency personnel, or state and federal health regulators.


Among the early restrictions at the Arkansas nursing home facilities was an ADH directive to screen and question all visitors and employees that had contact with someone with a confirmed COVID-19 diagnosis, were investigated for the highly contagious virus, or had contact with a person with a respiratory illness. 


Nursing home staff, among several things, were also required to screen all visitors and employees for signs or symptoms of a respiratory infection, such as cough, shortness of breath, sore throat, and fever by measuring their temperature. Despite those precautions, less than ten days after the first confirmed coronavirus case, the Arkansas Health Care Association (AHCA) issued a statement regarding the first cluster of positive COVID-19 cases at nursing homes across the state.


“Our association is aware that three of our member nursing homes have reported positive COVID-19 diagnoses. Affected homes are in Benton, Jefferson and Pulaski counties, “said AHCA Executive Director Rachel Bunch, who oversees the state’s largest organization of long-term care providers that representing 93% of the licensed nursing home facilities in Arkansas. “The patients in all facilities are receiving the medical care they need and those who were diagnosed have been isolated from others.”


Since that notice on March 20, the number of COVID-19 cases and deaths at nursing home and long-term care facilities across the state have continued to increase. As of June 10, ADH data shows there are 10,080 confirmed positive diagnosis of the coronavirus with 3,044 active cases and 165 deaths. Of that total, 66 deaths or 40% are related to nursing home care, while 117 of the deaths include persons over the age of 65.


In a May 20 report by the U.S. Government Accountability Office (GAO), analysis of federal data from U.S. Centers for Medicaid and Medicare shows that infection prevention and control deficiencies were the most common type of shortcomings cited in surveyed nursing homes prior to the nation’s first coronavirus cases in late 2019.


Using CMS data from 15,500 nursing homes nationwide, the government watchdog agency found that infection prevention and control deficiencies were cited in at least one year from 2013 through 2017 at 13,299 nursing homes, or 82% of all surveyed homes. 


“In each individual year, we found that about 40% of surveyed nursing homes had infection prevention and control deficiencies, and this continued in 2018 and 2019. About half — 6,427 of 13,299 (48 percent) — of the nursing homes with an infection prevention and control deficiency had this deficiency cited in multiple consecutive years from 2013 through 2017,” said the 15-page GAO report. “This is an indicator of persistent problems at these nursing homes.”


Today, as the number of COVID-19 cases across the U.S. has surpassed 2 million with more than 115,000 deaths, GAO officials said the government watchdog agency plans to examine CMS guidance and oversight of infection prevention and control in a future report. The federal investigative body that reports to Congress, has also provided a draft copy of its report to HHS, which houses nearly a dozen federal human services and health-related agencies including CMS and CDC.


Despite the damning report, the American Health Care Association and National Center of Assisted Living on May 27 issued its own communique noting that the struggling industry is overburdened with the unsustainable expense of COVID-testing. The two national trade groups estimated that the combined cost to provide coronavirus testing and personal protective equipment (PPE) for every resident and staff of assisted living communities and nursing homes would amount to $672 million.


In Arkansas, the AHCA-NCAL projects the costs to provide COVID-19 tests and PPE for every nursing home and assisted living community resident and staff in the state would add up to nearly $7.5 million. Today, there are 17,465 residents and 22,380 staff at the 226 nursing homes in Arkansas, the trade groups states. 


“For months now, we have been advocating for expanded and priority testing in long term care facilities to protect our residents and caregivers, but this is a significant undertaking and cost for them to shoulder on their own,” said Mark Parkinson, president of AHCA-NCAL, which includes the Arkansas affiliate.


At the 153 assisted living centers in Arkansas, which offer person-centered care to individuals who need some assistance with daily activities but who do not require round-the-clock skilled nursing care, there are 7,530 residents that are cared for by 2,158 workers, according to data from the two industry trade groups.


“With seniors among those most susceptible to the virus, the assisted living profession, in particular, is facing historic challenges when it comes to our most sacred charge – the health and safety of our residents,” said Scott Tittle, executive director of the National Center for Assisted Living. “Unfortunately, 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.”


To date, the $2.2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act has provided $200 million to CMS for emergency relief. Of those funds, Congress has directed CMS to use at least $100 million to mitigate the spread of the virus at nursing home facilities nationwide. In addition, HHS has taken other steps to help the industry since the pandemic began, including providing new guidance for nursing homes, ramping up infection prevention and control inspections, and enhancing reporting of viruses and illnesses.


Parkinson said while nursing homes have received federal funding, PPE supplies and testing priority, assisted living communities were left out of direct COVID-19 funding and assistance from HHS. In a June 9 letter to HHS Administrator Alex Azar, the AHCA-NCAL requested an additional $5 billion from CARES Act funding to help assisted living communities respond to COVID-19


“While building on support received from HHS, we are asking for additional consideration for all long-term care facilities, whether it be in regard to additional testing, personal protective equipment, or funding,” he said.