By Celia Llopis-Jepsen – Kansas News Service
Phillips County Retirement Center got a coronavirus testing machine this month from the U.S. Department of Health and Human Services.
But it will run out of the sample-collecting kits that came with the device on Monday, just one week after turning it on.
“It’s been a really big struggle just to even try to find out who knows where it is,” said Teresa McComb, who runs Logan Manor Community Health Services.
A new federal rule promises to protect nursing home residents from COVID-19 by requiring all workers to undergo testing up to twice a week. Homes should either use machines sent by HHS or find labs that can deliver results within 48 hours.
But weeks into the new requirements, many nursing homes in Kansas are still scrambling to make that happen. They’re either biting their nails and hoping a machine will arrive soon, or else equally stressed trying to buy kits to keep them running.
They worry the new rules to keep people safe could actually push the facilities toward financial ruin because tests, and especially private labs, cost so much.
“They might as well have told me to land all my residents on the moon as to come up with that amount,” said Joe Ewert, the CEO of Brewster Place in Topeka.
The struggle to get tests
In Phillips County, the coronavirus struck Logan Manor at the end of June. Two dozen residents and 15 employees tested positive. Eight people died.
“I’m not opposed at all to testing as often as they think we should,” McComb said. “I don’t want to get COVID in our building again. It is horrible to have and I don’t wish it upon anybody.”
The home, an hour north of Hays, struggled to find fast testing at the time. Samples that it shuttled four hours to Wichita took nearly two weeks to return results even though the lab had promised a swift turnaround.
On a tip from U.S. Rep. Roger Marshall, the home drove the rest of its swabs five hours to a lab in Johnson County that could give answers within a few days.
Kansas gets regular updates from the federal government showing which nursing homes have received their testing machines or should soon. The latest list, from last week, shows 280 homes in Kansas. Of those, 130 hadn’t yet received them.
LeadingAge Kansas, an association of nonprofit long-term care facilities, says some homes aren’t even on the list.
The machines conduct rapid antigen tests. They are less accurate than tests conducted in most labs, but offer cheaper and faster results.
Nursing homes must test staff monthly, weekly or twice a week depending on the rate of people in their county who test positive for the coronavirus. The Centers for Medicare and Medicaid Services uses that measure to gauge the local risk of transmission.
Sixty-one Kansas counties fall under the weekly testing rule. Twice-a-week testing applies in 14 counties and monthly testing in 30.
Testing even once a week poses a challenge.
The 15-minute turnaround on the machines adds up when facilities run scores or even hundreds of samples per week. A single round of testing takes 12 hours at Phillips County Retirement Center, which has about 50 employees.
“So what you’re looking at is pulling a licensed nurse off the floor or out of the office to do this,” said Nate Glendening, the home’s administrator. “Taking away from direct care — it’s just tough.”
Nursing homes tend to run on slim operating margins with little in the way of extra staff.
At Brewster Place, with four times the staff of the Phillips center, the new machine is already straining. It powers down from time to time and Ewert, the nursing home’s CEO, worries it will break.
“The machine itself is very cool,” he said. “But in my opinion — our experience so far in just the two weeks — I don’t believe it was built to run 45 to 50 or 90 hours a week.”
When the kits run out
Both Phillips County Retirement Center and Brewster Place put in orders with vendors to buy more test kits. They were put on waitlists. One distributor told Glendening to expect the supplies in late September.
But throughout the pandemic, nursing homes have seen delivery dates delayed for all sorts of critical gear because of backlogs.
“There’s no guarantee,” he said. “I’ll be real surprised if we see them, but we’re keeping our fingers crossed.”
If kits aren’t available when a nursing home runs out, the facility must look for a lab that returns results within two days. Labs in Glendening’s region have told him they need 72 hours.
He worries he might need to go as far as Johnson County, pulling an employee off of other tasks one day a week to make the 10-hour round trip.
CMS says nursing homes that fail to keep up the pace of testing to shield against coronavirus outbreaks risk fines of $400 a day.
Yet it will cut facilities slack if they can prove that they fell behind because they couldn’t find kits or a two-day lab.
Nursing homes are unsure, though, how far away they should be prepared to send their samples in search of that service. They also don’t know what happens if they can’t afford lab prices that often run $100 or more a pop compared to rapid antigen kits that cost less than $50.
Brewster Place will run out of kits this week.
Ewert worries his facility can’t afford mass testing every week at private labs. And if Shawnee County’s positivity climbs high enough to require twice-a-week testing at the 100-resident nursing home, he says, the cost would rival his nursing payroll.
He would need to plan its closure within a year.
“We’ve promised to take care of people for the rest of their life,” he said.
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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