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Florida Steps Back From Long-Term Care Policies

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screen grab from The Florida Channel video library

TALLAHASSEE --- Florida, which embarked on an aggressive strategy to limit the spread of COVID-19 in nursing homes and assisted living facilities, is stepping back from some efforts that Gov. Ron DeSantis has touted as keeping down the number of deaths and serious illnesses among seniors.

In recent days, the DeSantis administration has announced it is eliminating state-supported every-other-week testing of workers in long-term care facilities and that it is shuttering 23 COVID-19 nursing facilities dedicated to residents who are battling the virus and cannot be properly isolated in facilities where they normally live.

The argument is that the policies are no longer necessary, even as nursing homes, assisted living facilities and other congregate living centers reopen their doors to visitors.

The Agency for Health Care Administration sent an email Friday to nursing homes and assisted living facilities announcing that it had canceled a contract with the company Curative, which provides self-administered tests to long-term care facilities.The agency also scrapped rules that required staff testing.

The email followed a similar announcement agency Secretary Mary Mayhew made on a regularly scheduled weekly phone call with long-term care industry officials.

Mayhew said the rules were no longer necessary because the federal government is requiring nursing homes to test staff members under a rule it issued Sept. 2. The federal government also is supplying the facilities with rapid testing kits.

But there are no federal or state requirements for the state’s 3,111 licensed assisted living facilities that offer more than 110,504 beds across the state.

The decision to eliminate state-supported testing comes after DeSantis said Sept. 1 he was lifting a five-month ban on visitors at long-term care facilities. Under an executive order, facilities can open visitation to members of the general public who agree to socially distance and wear masks, so long as the facilities have not had any new COVID-19 cases for a 14-day period.

The Agency for Health Care Administration did not comment on how assisted living facilities will discern whether new cases have occurred during a a 14-day period. The change in testing policy was sharply criticized by Jeff Johnson, AARP Florida state director.

“Rapid-result testing of elder-care staff, visitors and residents, in assisted living facilities and group homes as well as nursing homes, is absolutely critical to allowing families and friends to visit frail elders again. We look forward to learning more about the details of changes in contracts and regulatory requirements,” Johnson said in a prepared statement. “But this much is already clear: Frail older Floridians and their families have borne far too much of the pain and loss caused by this pandemic. To protect them, long-term care staff and the communities in which they reside, we need more testing, not less.”

Gail Matillo, president and CEO of the Florida Senior Living Association said she was not aware of the contract cancellation until Mayhew’s remarks during Thursday's phone call with the long-term care industry.

“It was news to us,” Matillo said of the cancellation of the Curative contract and elimination of the testing requirements.

Matillo said assisted living communities will review how best to continue providing COVID-19 testing options to staff members.

“There are many, many options for still getting a test,” she said adding that some communities may choose to contract directly with companies to provide on-site testing or ask workers to go to nearby testing sites.

Curative CEO Fred Turner told The News Service of Florida on Tuesday that testing long-term care staff in Florida facilities has been successful and that staff positivity rates have been reduced from 3 percent to 1 percent. Turner maintained that the testing mandates have helped save thousands of lives.

Turner said Curative could continue to provide testing to long-term care staff members who have health insurance, without any costs to the employees under a provision in the federal CARES Act. But in order to do so, he said, the state would need to deem the testing as medically necessary.

Curative could provide tests for free to uninsured long-term care staff under a pot of money that the federal government made available. But, again, that would hinge on the state’s willingness to deem the testing medically necessary, he said, adding that the designation could be issued in a public health order or by the state insurance commissioner.

“It’s doable and a number of states have done this very successfully and have reduced their positivity rate,” he said, adding that New York, New Jersey, Virginia, California, Maine, West Virginia and Washington D.C., have issued such orders. “Florida has not yet passed that, and for us to continue this program …. we need Florida to get that done. This program can continue. It just needs this simple health order to be issued.”

Meanwhile, Mayhew on Tuesday announced that the state is phasing out agreements with 23 nursing facilities across the state that serve as COVID-19 dedicated isolation centers. She said the homes are no longer needed, given an improving COVID-19 environment and the health-care delivery system’s ability to provide treatment.

Among the 23 isolation homes, 18 have fewer than 100 beds. Mayhew said those facilities will stop accepting COVID-19 positive residents on Friday and will discharge all residents they accepted under terms of isolation agreements with the state by Oct. 2.

Mayhew said the five larger dedicated facilities will stop accepting residents with COVID-19 on Oct. 1 and will discharge all residents accepted under terms of the state agreements by Oct. 15.

The state has 8,373 long-term care residents infected with the coronavirus. About 65 percent of them, or 5,419 people, have been transferred out of their nursing homes or other facilities and sent to hospitals or dedicated isolation centers.

The state established the dedicated facilities to help alleviate the stress at hospitals during the height of the COVID-19 pandemic.

During press events across the state, DeSantis routinely held up the establishment of the dedicated facilities as outside-the-box thinking that helped the state manage the spread of the virus.

“We remain confident in terms of the numbers we are seeing that individuals who are COVID positive in our long-term care facilities can be safely, appropriately supported in those long-term care facilities or in partnership with our hospitals,” Mayhew said.