Bloomberg Law
May 29, 2020, 9:16 AM

Regular Tests a Costly Must-Have for Virus-Wracked Nursing Homes

Tony Pugh
Tony Pugh

Regular Covid-19 testing for nursing home staff and residents is the only way to contain the spread of the respiratory disease that wreaks havoc on older people.

But lack of funds and access to testing supplies are hampering that goal, nursing home executives say.

A 100-bed facility with 100 employees should test all staff and residents every two weeks “at a minimum,” said George V. Hager Jr., CEO of Genesis HealthCare, one of the nation’s largest nursing home operators, on a recent earnings call.

If each test costs $75, as Hager suggested on the call, facilities would end up paying about $30,000 per month to conduct 400 Covid-19 tests. That’s on top of the extra cost for additional cleaning; more expensive personal protective equipment; and increased staffing costs for overtime, bonus pay, and replacement workers.

The Trump administration has called for all nursing home residents and staff to be tested, but it has largely left individual facilities and states to handle the logistics. That has created a patchwork of inconsistent testing policies at the nation’s 15,000-plus nursing homes. Depending on their resources, the facilities are using a mix of state and federal grants and loans—and even support from the National Guard—to get adequate testing.

Testing all nursing home employees and patients just one time would cost $440 million, according to the American Health Care Association, the leading nursing home trade group.

But the results would “give us a false sense of security as this virus continues to spread,” the group said in a statement to Bloomberg Law. “Repeated, ongoing testing will be needed, and long term care providers cannot do this alone.”

Access remains a problem, said Richard Feifer, chief medical officer at Genesis. Some 1,500 residents at the company’s 361 facilities in 25 states have died from Covid-19, the company said. Another 6,700 patients and residents and more than 2,500 Genesis employees and clinical staff have tested positive for the coronavirus.

In a 1st-quarter earnings call on May 27, Feifer said the “continued shortage of testing availability, specifically swabs, and a lack of sufficient lab capacity to quickly process the current volume of tests” will make it harder to get quick results when more facilities increase testing in order to reopen their doors to visitors.

Some State Plans Fall Short

“The importance of regular and repeated testing with quick turnaround times cannot be underestimated,” Feifer said. “It is one of the best weapons to manage and limit the virus’ spread, which is why we continue to advocate aggressively for a sensible national-directed and funded approach to frequent universal testing in nursing homes.”

In response to the White House call that states test all nursing home residents, Feifer said “some states have planned just one round of testing, which is completely insufficient.”

Nursing homes account for at least one-third of the nation’s more than 100,000 Covid-19 deaths—and more than half the total in 14 states, according to data compiled by the Kaiser Family Foundation.

The nursing home industry had been pushing the Department of Health and Human Services to create a $10 billion fund to help provide more testing, protective gear, and staffing.

The department met them halfway, announcing $4.9 billion in nursing home assistance last week. The money will provide $50,000 per facility plus $2,500 for each licensed bed. A facility with 120 beds would receive $350,000. But the money would also be used for other Covid-related needs in addition to testing.

In April, operating expenses for Genesis grew by $21 million due to the pandemic, the company said. Similar costs are expected for May.

Genesis, which has received $181 million from the CARES Act Provider Relief Fundand $158 million in federal Medicare loans during the pandemic, is better able to absorb the cost of regular testing during the outbreak.

But for smaller facilities with limited resources, ongoing testing may not be feasible without more financial assistance.

States Urged to Step Up

The AHCA wants public and private sector help to make the testing happen. It has called on states to provide more funding “especially with the $11 billion in federal assistance they have received from the Administration,” the AHCA said in its statement to Bloomberg Law.

Since visitations were stopped at U.S. nursing homes in March, the virus is entering facilities mainly through employees, new admissions, and when residents return from essential outside medical visits, like dialysis and chemotherapy, Feifer said.

Large facilities with lots of foot traffic and those located in high-density areas are most susceptible to outbreaks, Feifer said.

The Centers for Medicare & Medicaid Services has issued guidance that recommends all nursing home staff be screened each day for respiratory symptoms and to be tested each week before the facilities could begin to reopen to visitors.

“The guidelines to open up nursing homes, to universally and proactively test residents and staff, and the cost of that, I believe, will continue to be one of the ongoing issues that we discuss” with state and local officials and the HHS, Hager said.

States have, so far, committed about $27 million in assistance to the company.

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Brent Bierman at