Seniors are disproportionately vulnerable to the coronavirus and need more protection to help keep them safe, expert witnesses told the Senate Special Committee on Aging on Thursday.
Nursing home residents account for one-third of all COVID-19 deaths and seniors in general represent 80%, said Sen. Susan Collins (R-Maine), who chairs the committee.
Witnesses told the committee that nursing homes and other assisted living facilities need more oversight, more data collection, and more testing to help contain the virus and mitigate its impact. Targeted research is also needed to help develop vaccines and other therapeutics that will be effective for older adults.
While Congress has passed four bills providing $3 trillion in COVID-19 relief, more needs to be done, Collins said.
Sen. Bob Casey Jr. (D-Pa.) argued that one challenge to addressing the coronavirus outbreaks in nursing homes is the lack of timely data on cases, which leaves policymakers to battle the problem “with one hand tied behind our backs,” he said.
Without knowing where outbreaks are, it’s hard to know where to direct funding and support. While the administration has promised to release the sought-after data by the end of May, Casey appeared skeptical that it would follow through.
If the “HEROES Act” passed by the House last week were to be enacted, nursing homes and other long term facilities would be required to collect data on the impact of the virus on their residents.
The bill also includes funding for nursing homes to contain the virus and provides funding to help connect the 800,000 seniors on waiting lists with home and community services that would allow them to stay in their homes and stay out of high-risk care settings such as nursing homes.
Senate Republicans and President Trump have already panned the bill, which also includes stimulus checks for workers, raises for essential workers, and expanded health insurance coverage.
Benefits of More Data
R. Tamara Konetzka, PhD, professor of health services research at the University of Chicago, also stressed the need for more data.
Based on the limited data that is available, Konetzka told senators that even the highest quality nursing homes have been affected by the pandemic but that racial disparities, seen in other settings, are also being observed in nursing homes.
Her own research found that nursing homes with the lowest share of white residents were more than twice as likely to have COVID-19 cases or deaths.
This does not indicate that facilities with many non-white residents are doing a poor job, she clarified. It’s more of a reflection of what’s happening in the nearby communities.
“To me, it’s really about the neighborhoods in which nursing homes are located and staff going back and forth between those facilities and the neighborhoods,” she said.
Looking at the performance data from the website Nursing Home Compare of 12 geographically diverse states, demographic data on racial distribution and Medicaid use, and publicly available lists of nursing homes reporting cases or deaths from the virus, Konetzka found a consistent relationship between race and the probability of death.
Other factors including Nursing Home Compare “star ratings,” nonprofit/for-profit status, and the share of residents covered by Medicaid had little to no relationship to COVID-19 incidence.
In addition to helping policymakers decide where to channel funding, timely nursing home data can also provide signals of what’s happening in a community; enable researches to see what interventions worked or didn’t; and help resident and family members to make decisions.
Right now, she noted, families can’t easily discern which facilities have outbreaks and which don’t.
More Testing, PPE, Research
As states transition to reopening and nursing homes consider allowing visitors, routine testing will be key to keeping residents safe, Konetzka said.
Rapid testing of residents and staff can help identify who has the virus and who doesn’t and enable facilities to separate confirmed coronavirus patients from those who are healthy, she said.
She also called for direct funding to increase staffing levels and to ensure adequate personal protective equipment for staff.
Enhancing opportunities for Medicaid beneficiaries to access home-based services rather than institutional ones would also be helpful, she said. Families who wish to avoid nursing homes often need support in arranging alternative care, Konetzka noted.
Steve Landers, MD, MPH, president and CEO of the Visiting Nurse Association Health Group, said that the main reason his organization has been able to continue to provide access to care is because it was able to access personal protective equipment — masks, gowns, and gloves — but that hasn’t been easy, he said.
He noted that his organization is using roughly 3,500 N95s and about 17,000 surgical masks a week while having to pay 7-10 times more than previously for them.
Landers said the government should ensure that home health agencies have access to the needed supplies “at a reasonable price.”
He also asked for Congress’s help to find ways to reimburse telehealth in home health, as many visits are currently being conducted virtually.
Mark Mulligan, MD, who heads the Division of Infectious Diseases and Immunology at NYU Langone Health in New York City, explained that research is needed to ensure that new therapeutics and vaccines will actually benefit seniors.
Because vaccines are not always as effective in seniors as they are in the general population he’s also suggested studies of “passive immunization” in which people receive antiviral monoclonal antibodies derived from the antibodies generated by people infected with the virus.
Such antibodies may have a half-life of about a month and so passive immunization could be “an interim approach” to help protect seniors through the worst period of the pandemic.
Mulligan stressed the need to include seniors in both vaccine trials and in studies on monoclonal antibodies.
Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow