A previous version of this story incorrectly stated the requirements imposed on nursing homes by the Centers for Medicare and Medicaid.
TOPEKA, Kansas — Residents and patients in under-resourced nursing homes, where outbreaks have fueled more than half of Kansas’ coronavirus deaths, will likely pay the steepest price for the state reopening its economy.
Nursing homes, assisted living centers and similar state-licensed facilities don’t have enough protective gear or testing to shield the people who are most vulnerable to COVID-19, experts say. And even if the facilities stay on lockdown, the state’s decision to lift stay-at-home orders could lead to more asymptomatic staff unwittingly carrying the virus to work.
“The more you open up the economy, the more you're going to have these rippling effects where staff members may be going home to other family members who are interacting with other parts of society,” said Carrie Henning-Smith, a professor of health policy and management at the University of Minnesota.
As of Friday, Kansas’ more than 450 long-term care facilities accounted for fewer than 1 in 10 of the state’s confirmed cases. Yet the 22 clusters of coronavirus linked to them are the single largest source of deaths from the pandemic with 85. One cluster in Johnson County has sickened nearly 60 and killed nine and another in Coffey County has had similarly tragic results.
Here’s what nursing homes, health policy analysts and academics say needs to happen in order to save the lives of older people in Kansas and nationally.
Where are the tests?
COVID-19 testing has become more common in Kansas in the past few weeks. Yet limited supplies mean testing remains largely reserved for people with symptoms or known exposure. Overall, the state has lagged most of the rest of the country in ramping up access.
Experts say places that care for older adults should test all staff regularly — once a week or more — regardless of whether they have symptoms. But that remains a distant goal for Kansas and the U.S.
“We're nowhere near that,” Henning-Smith said. “Any routine testing would be an improvement over what we have.”
Nursing homes and similar facilities rely on sending samples to external labs, but could better protect residents with rapid on-site testing.
“We could test any and everybody,” says Monte Coffman, executive director of Health Management of Kansas, which runs skilled care centers in Coffeyville and Iola. “That's how we (could) keep the virus out of institutional care.”
Where are the masks and gowns?
Staff at many long-term care facilities have spotty access to professional-grade protective gear. Instead, nursing home administrators say, they wear home-sewn fabric face coverings to help save surgical masks for critical times, like bedside care or serving newly admitted, temporarily quarantined residents.
Prices for professional gear spiked after the pandemic hit. Vendors who were slammed with orders sold to bigger buyers. LeadingAge Kansas, the state’s association for nonprofit aging services, looked into bulk purchasing for its members, but struck out.
CEO Debra Harmon Zehr said the market appears to be improving, and she welcomed the federal government’s decision to send two weeks of surgical masks, gowns and eye protection to nursing homes.
But, she said, it’s “too little, too late.”
“We don't have adequate testing, adequate funding, adequate supplies, and yet you've got this wolf in the chicken house,” she said, and “(we’re) expected to keep it at bay.”
Are the rules consistent at facilities?
Kansas is among 26 states that recommend but don’t require assisted living facilities to keep visitors out during the pandemic, according to the Kaiser Family Foundation. Nor has Kansas adopted requirements for staff to undergo daily coronavirus screenings and don protective gear.
Those steps are important, the health organization said, because the federal guidance on these measures is only for homes under their regulatory control, such as nursing facilities. Much long-term care falls under state control, such as assisted living centers.
The lack of requirements in states like Kansas is “shocking” given the risks of coronavirus spreading in a facility, said Joseph Ouslander, a professor of geriatric medicine at Florida Atlantic University and the executive editor of the Journal of the American Geriatrics Society.
“It can be like a tinderbox,” he said. “It’s a perfect storm.”
While screening workers daily, donning protective gear and banning visitors can’t guarantee a facility will be outbreak-free, Ouslander sees them as basic steps that shouldn’t be decided facility-by-facility. States can require these measures, he said, without penalizing facilities that simply can’t get enough protective gear to fully comply.
A spokeswoman for the Kansas Department for Aging and Disability Services said in an email that adopting the extra state requirements would take resources. And right now, she said, the agency’s staff is focused on infection-control efforts under guidance from the Centers for Medicare and Medicaid.
Why aren’t outbreaks being disclosed publicly?
Many states publicly report a raft of details about coronavirus outbreaks in long-term care facilities, the Kaiser Family Foundation said, but, again, not Kansas. Kansas doesn’t publicly list which nursing homes have COVID-19 cases and deaths.
Some local health departments have, like in Johnson County, where COVID-19 outbreaks at long-term care facilities have killed 25 people. The county discloses case counts and deaths by facility on its website.
Advocacy groups want the information made public so communities can stay informed on the toll coronavirus is taking and demand better resources and care. Researchers want the data to scour for patterns, such as links between outbreaks, staffing levels and other measures of care.
Recent federal guidance will push nursing homes to report cases and details directly to the Centers for Disease Control and Prevention.
“So we would expect to see some form of public data available at some point,” said Priya Chidambaram, a Medicaid expert at the Kaiser Family Foundation. “We don't have a timeline yet.”
Will there be more money?
Kansas nursing home advocates say they plan to make their case to Gov. Laura Kelly that elder care in the state needs more funding, something they’ve pressed in the Legislature year after year.
Low Medicaid reimbursement payments to nursing homes makes it hard for them to keep up quality in the best of times, advocates like LeadingAge argue. During a pandemic, it means homes can’t afford inflated prices for protective gear and other increased costs.
This week, a national trade group called on the Trump administration to dole out $10 billion in stimulus money to nursing homes, but they’ll have to compete with hospitals and other health care providers jostling for more of that pot, too.
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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