With 40% of COVID deaths, post-acute care sites get funding, scrutiny

• Post-acute care facilities had 42% of the total COVID-19 deaths in 38 states reporting.
• HHS has started distributing $4.9 billion to skilled nursing facilities.
• Mandatory transfer policies caused problems in some states.

Amid reports that two of every five deaths from COVID-19 have been post-acute care patients, the Trump administration is providing new funding and Congress is calling for more research.

The toll of the coronavirus in post-acute facilities, long unclear due to a lack of official statewide or federal reporting, remains cloudy. But emerging data has painted an increasingly dire picture.

For instance, a May 21 update of a Kaiser Family Foundation tracker found 174,381 COVID-19 cases reported at 7,732 long-term care facilities in the 43 states where it was able to obtain data. Those facilities also had 42% of the total COVID-19 deaths in 38 states providing information.

Similarly, Sen. Elizabeth Warren (D-Mass.) said at a May 21 hearing of the Senate Special Committee on Aging that more than half of the COVID-19 deaths in her state were linked to long-term care facilities.

“Nursing homes have become the epicenter of the crisis,” Warren said at the hearing.

Senators, researchers and clinicians at the hearing agreed that a lack of data on COVID-19 infections and deaths at long-term care facilities has hampered efforts to understand the scope of the challenge and the need for additional resources.

CMS this week required nursing homes to begin reporting such data for the first time and planned to begin publicly releasing it to the public by the end of May. However, other long-term care facilities are not required to report such data, senators were told.

Warren and other senators urged more long-term research to understand the threat posed by the coronavirus to those served by long-term facilities.

Funding released to SNFs

To address the challenge, the U.S. Department of Health and Human Services (HHS) on May 22 released nearly $4.9 billion to skilled nursing facilities (SNFs) adversely affected by COVID-19.

The funding is part of a combined $175 billion allocated to providers in the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.

“In allocating these funds, the Administration is working, among other things, to address the economic impact of COVID-19 on providers and doing so as quickly and transparently as possible,” an HHS release stated.

Adverse financial effects from COVID-19 on SNFs, as cited by HHS, included:

• Up to a 6% decline in patient populations since the beginning of 2020
• Increased labor costs
• Costs of meeting testing requirements
• Increasingly costly personal protective equipment

The funding will be based on SNFs’ fixed and variable costs, including:

• $50,000 as a fixed distribution
• $2,500 per bed as an additional distribution
• Targeted distributions for all certified SNFs with six or more certified beds

The payments will require recipients to attest to terms and conditions, some of which have raised concerns among hospitals.

The funding was welcomed by post-acute care advocates, but more likely is needed.

“Given the gravity of the situation we are facing with this deadly virus and its impact on our vulnerable residents, long-term care facilities require additional support and funding from state and federal governments to reduce its spread,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said in a written statement.

AHCA/NCAL previously requested $10 billion to address facilities’ COVID-19 needs.

The funding comes out to roughly $325,000 for each of the 15,000 SNFs, nationwide, said Bill McGinley, president and CEO of the American College of Health Care Administrators.

But just meeting local, state and new federal testing standards for patients and staff twice a week “can be hundreds of thousands of dollars, alone,” McGinley said in an interview.

He noted that such funding was not provided to other post-acute care providers caring for similarly vulnerable patients.

Systemic issues facing SNFs

One challenge to SNFs during the pandemic has been the requirement of some states that they accept COVID-19 patients discharged by hospitals. Industry officials worried that not all such facilities were equipped to provide needed care and to keep those patients from infecting other vulnerable patients or staff.

“It was a huge blunder to make that requirement,” McGinley said, referring to one such requirement, in New York.

New York Gov. Mario Cuomo, a Democrat, on May 9 rescinded his order that nursing homes accept COVID-19-positive transfers from hospitals — after the order had been in place for 48 days during the height of the state’s outbreak.

Meanwhile, CMS has stayed silent on the transfer issue and has instead aimed to make it easier for hospitals to keep such highly contagious patients within their more advanced facilities.

For instance, the agency recently issued new flexibilities that authorized hospitals to increase capacity for coronavirus patients by either adding more beds or transferring non-COVD patients to alternate care sites.