To enable nursing homes to run rapid tests onsite, the U.S. Department of Health and Human Services has begun sending the facilities “point-of-care” testing systems. In conjunction with the shipments, the Centers for Medicare and Medicaid Services, the agency that regulates nursing homes at the federal level, is preparing to impose a new requirement that the facilities in COVID-19 hot zones conduct weekly checks of nursing home workers.
But HHS will provide only an initial supply of test kits, it is likely to take months for the systems to arrive in every nursing home in the nation, and the rapid-result systems come with a high rate of false negatives. Plus, assisted living facilities and personal care homes, which are regulated at the state level, aren’t included in the federal plan.
Music Therapist, John Abel, leading a music therapy session at A.G. Rhodes nursing home in Atlanta during the coronavirus pandemic.
Credit: Photo courtesy of A.G. Rhodes
Credit: Photo courtesy of A.G. Rhodes
Some other states — including Florida and Tennessee — are mandating frequent testing and equipping homes with test kits or paying for testing. But Georgia stopped sending test kits out with the National Guard weeks ago, and the state has announced no plans to help long-term care homes with testing going forward.
That has left Georgia’s senior care operators, whose residents are the most at-risk of death during the pandemic, largely on their own to decide how often their residents and workers should be tested and figure out a way to pay for it.
Some experts say a testing system is so important that the state needs to step forward.
“You can either have a Wild West where every provider is going to sink or swim on their own, in which case those providers with stronger networks and greater resources will do a better job of taking care of their populations, and those with less resources and likely a less affluent population of residents will do less well, " said Dr. Harry J. Heiman, an associate professor in the School of Public Health at Georgia State University. “Or, you can accept that this requires state leadership and coordination and support.”
For nursing homes across Georgia, the opening days of the pandemic proved both deadly and frustrating. Hospitals got the priority for testing, masks and gowns. Finally, in June, things eased up. Senior homes could get better access to supplies and tests, and results were coming back quickly. The outbreaks and deaths slowed.
But that didn’t last long. “Unfortunately the month of July saw [coronavirus] cases grow by over 2,700, which was the highest month that we have had,” said Tony Marshall, president and CEO of the Georgia Health Care Association, which represents senior care providers.
The total number of long-term care residents who have tested positive during the pandemic now exceeds 11,000. The number of workers testing positive increased steeply during July, and that trendline is continuing.
National statistics mirror Georgia’s. “With the recent major spikes of COVID cases in many states across the country, we were very concerned this trend would lead to an increase in cases in nursing homes, and unfortunately it has,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living. “This is especially troubling since many nursing homes and other long term care facilities are still unable to acquire the personal protective equipment and testing they need to fully combat this virus.”
While PPE is easier to get than it used to be, dozens of homes across Georgia do not have a 7-day supply of critical items, according to an AJC review of federal reports.
A statewide mask mandate for everyone and more robust testing are the best ways to protect seniors living in long-term care, said Ginny Helms, president of LeadingAge Georgia, which represents non-profit and mission-driven senior care providers.
“We need the rapid testing,” Helms said. That way, homes can more quickly stop asymptomatic workers from infecting residents.
A.G. Rhodes, a non-profit that operates three nursing homes in Georgia, has ordered on-site testing systems that are supposed to offer the most reliable results, but they are still waiting for them to arrive, said Mary Newton, a spokesperson. The organization is also working on a detailed testing plan, she said.
Pruitt, the CEO of PruittHealth, said he hopes the “point-of-care” systems that a federal agency is sending will be a game-changer even though he’s been told the tests are accurate just 75 percent of the time. His company plans to test part of each nursing home’s staff daily, which could identify outbreaks faster since results come back in an hour, instead of the days it takes now.
“We need the rapid testing.”
- Ginny Helms, president of LeadingAge Georgia
Now, Pruitt said, his company is spending about $430,000 a month for its employee testing plan, which tests every other week in homes without outbreaks and more frequently in homes that have cases. “That’s a significant cost that other states are picking up,” Pruitt said.
He wants Georgia to do more to support the efforts of those running long-term care facilities who find themselves running from one crisis to the next. He’s not sure why nursing homes wouldn’t get the support here that other states are providing.
“We’re at the epicenter of this pandemic.,” he said, “We feel like every day we show up, we’re at war.”
A new state law requires all long-term care residents to undergo baseline testing by late September, and some homes are still working toward that requirement to test everyone for the first time. Assisted living communities and large personal care homes won’t face the federal weekly testing mandate, but they won’t get the point-of-care tests from CMS, either.
The homes that are already doing regular testing are focused on what tests work the best. “We all know the rapid tests aren’t as accurate as other ones, but the question is, what are you going to do?” said Beth Cayce, who operates a senior care company.
Cayce said frequent, accurate testing and careful use of PPE can stop the spread of a virus within a facility. But that doesn’t keep the virus out forever. Workers still have to go home, go to the grocery store and care for children who may soon attend in-person classes at school. Until community spread is slowed with more use of masks and social distancing, she said, even frequent testing can only do so much to protect residents.
Heiman said Georgia’s political and public health leaders should craft a plan for testing in long-term care, help pay for it and hold the facilities accountable for carrying out the plan, given how deadly the virus can be frail, elderly people.
“This is a perfect storm that should remind of us why we need to match resources to needs — to protect those who are most vulnerable,” he said.
The Paces Mill Unit serves as the trailhead for the Bob Callan Trail, which spans three miles and connects to the Chattahoochee River National Recreation Area. It’s also part of a 60-mile network of paths that are either existing, under development or planned around the Cumberland area.
A community improvement district is made up of commercial property owners within district boundaries who tax themselves to pay for public infrastructure projects.
Ann Honious, acting superintendent of the Chattahoochee River National Recreation Area, said the Paces Mill Unit receives more than 250,000 visitors each year.
“We are proud to have 840 acres of national park land within the Cumberland CID boundary,” said Cumberland CID Executive Director Kim Menefee. “This unique partnership with the National Park Service further positions the Cumberland community as a diverse place to live, work and visit.”
Though recessions almost always hit lower-wage workers the hardest, the pandemic is causing especially large gaps between rich and poor, and between White and minority households. It is also widening the gap between big and small businesses. Some of the largest companies, such as Nike and Best Buy, are enjoying their highest stock prices ever while many smaller businesses fight for survival.
Some economists have started to call this a “K-shaped” recovery because of the diverging prospects for the rich and poor, and they say policy failures in Washington are exacerbating the problems.
Congress has not passed another relief bill, and the bulk of the federal stimulus originally passed in March to sustain small businesses and more than 28 million people on unemployment benefits has largely expired.
As talks between Republicans and Democrats in Washington have disintegrated, the burden of supporting the economy has fallen on the Federal Reserve, which has pumped trillions of dollars into the financial system to prop up businesses and markets, fueling a 50 percent gain in the stock market since March and a surge in home and car buying. But the Fed’s main tools in this situation are reducing the benchmark interest rate and buying bonds. The Fed cannot give people checks, which is why its actions have done little to help renters facing eviction or small businesses on the verge of dying.
Fed leaders have urged Congress to act swiftly before the damage to the economy becomes permanent. Boston Fed President Eric Rosengren warned on Wednesday that “the recovery may be losing steam.” Former Fed chair Janet L. Yellen called for “urgent” fiscal action.
“The stock market isn’t the economy. The economy is production and jobs, and there are shortfalls in virtually every sector of the economy,” Yellen said in an interview with The Washington Post.
“This pandemic is causing suffering and losses,” Yellen said. “Individuals and businesses are not going to make it through this unless they get grants, and only the federal government can do that.”
As much of the economy has moved to work-from-home mode, the shift has mainly benefited college-educated employees who do most of their work on computers. A Fed survey found that 63 percent of workers with college degrees could perform their jobs entirely from home, while only 20 percent of workers with high school diplomas or less could work from home.
Richer Americans also have seen their wealth recover — or even surge — as home values have jumped to their highest level ever (even in inflation-adjusted terms), according to the National Association of Realtors.
New analysis by Opportunity Insights of Labor Department data found employment is still 20 percent below pre-pandemic levels for workers earning under $14 an hour, and 16 percent down for those making $14 to $20 an hour. Opportunity Insights also analyzed data from the payroll processors Paychex, Intuit and Earnin and came to a similar conclusion.
“The recession is nearly over for high-wage workers, but low-wage workers are no more than half-recovered,” said Friedman, who led the research, which is sponsored by Harvard and Brown universities and the Bill & Melinda Gates Foundation.
The pandemic and economic crisis have hit Black and Hispanic neighborhoods the hardest. Many of these households had little savings before the pandemic, and their jobs have been slower to return as the coronavirus risk remains highest in crowded indoor spaces such as shopping malls.
Black men and women have recovered about 20 percent of the jobs they lost in the pandemic vs. almost 40 percent for White men and 45 percent for White women, Labor Department data shows.
The slow job rebound is leaving many minority families fearful of eviction. Nearly half of Hispanic renters and 42 percent of Black renters said they had “no confidence” or only “slight confidence” they could pay their August rent, according to a Census Bureau survey conducted July 16-21. On the social media site Reddit, unemployed Americans are posting harrowing accounts of their electricity being shut off, not being able to afford medication and being days from eviction.
“There’s always been huge disconnect between politicians and the working class. I wish they would pay attention and listen to what we actually need: more clear guidance and some more financial support,” said Derek Caskey, co-owner of Sawstone Brewing Co. in Morehead, Ky.
Sawstone Brewing is one of more than 5 million businesses that received Paycheck Protection Program grants this spring. The grant the brewery received enabled Caskey to keep paying his eight workers and shift his business model to takeout orders. But the PPP money has run out and business has not fully recovered.
“What’s saving us right now is outdoor seating. But when that isn’t feasible, what are we going to do?” Caskey said.
The stock market is telling a different story. Thanks to a wave of optimism about a possible vaccine and an economic recovery, as well as continued support from the Fed, many investors are doing quite well. The Standard & Poor’s 500-stock index is within a few points of hitting a record high. If it happens, it would be the fastest turnaround ever from a bear market, said Howard Silverblatt, a senior analyst at S&P Dow Jones Indices. The tech-heavy Nasdaq composite index has been in record-high territory for more than a month.
President Trump has hailed the “tremendous” stock market gains as a sign of a “super” economic rebound.
“We’re in the middle of a pandemic and yet we’re going to be hitting records,” Trump said Thursday on Fox Business channel.
It’s a similar tale in housing. Families with jobs and savings are taking advantage of the lowest mortgage rates in U.S. history — below 3 percent — to buy bigger homes at bargain rates. Home purchases are up more than 20 percent, and refinancing is up nearly 50 percent from a year ago, according to the Mortgage Bankers Association.
White House economic adviser Larry Kudlow suggested Wednesday that the recovery is going so well that the economy may not need much more aid from the federal government.
“We are entering what I think is a self-sustaining economic recovery,” Kudlow said on Fox Business. “A rising tide does lift all boats.”
Trump’s Council of Economic Advisers issued a report Thursday highlighting that poverty probably declined in the spring because of the $1,200 stimulus checks and extra unemployment funding Congress and the White House approved.
But former Trump economic adviser Gary Cohn was one of several business leaders this week stressing that the U.S. economy is far from healthy and that the consequences of Congress’s inaction could sting for years. He said the stock market gains are a red flag signaling that small businesses are being crushed.
“The stock market continues to reflect big businesses increasing their market share during #COVID19. If a small business closes, a larger business fills the void. We need to contemplate what this means for Main Street USA going forward. Is this really the future we want?” Cohn tweeted.
Janice Tabangcura is one of millions of Americans furloughed and waiting to be called back to work. Tabangcura has been a line cook at Roy’s Waikiki Restaurant in Hawaii for six years. The normally vibrant Honolulu neighborhood is empty, and no one knows when that will change.
“It’s creepy. Waikiki is usually so busy. We call it Hawaii’s little New York. But now you see five people on the street,” Tabangcura said. “They keep extending the quarantine here. It’s dampening our spirits. We thought tourism would pick up this month, but it hasn’t.”
Tabangcura, 30, has waited weeks for an unemployment check, which still hasn’t come. To make some money and stay hopeful, she’s started a baking business, delivering “Bento boxes” of cookies and pastries.
For many of the unemployed, the downturn is lasting far longer than they had anticipated. Nearly 80 percent of furloughed or laid-off workers thought they would be rehired, a Washington Post-Ipsos poll conducted April 27-May 4 found. Yet so far, only 42 percent of jobs have returned, Labor Department data shows.
“This has been a very clear K-shaped recovery,” says Peter Atwater, an adjunct lecturer in economics at the College of William & Mary. “The biggest and wealthiest have been on a clear path toward recovery. Meanwhile, for most small businesses and those worst off, things have only become worse. The contrast is piercing: One group feels better than ever while the other borders on hopelessness.”
One of the key debates between Republicans and Democrats is about how long the U.S. economic recovery will take. Republicans point to the fact that the economy added more jobs than expected in May, June and July as a sign that a comeback is taking hold. They also highlight the swift bounce-back in home, car and truck sales. Some auto dealerships have had their best July ever, and gasoline sales have mostly rebounded.
Democrats point out that the unemployment rate is 10.2 percent — higher than at any point during the Great Recession, and that millions are unable to pay rent. Census data shows that more than half of Americans said they felt depressed or hopeless in July, and 20 percent of Hispanic households with children and nearly a quarter of Black households with children say they don’t have enough to eat.
One of the most telling indicators about the economy is consumer spending. It’s still down about 8 percent from pre-pandemic levels overall, but it was down only 2 percent among low-income households in July. This is largely because of the stimulus checks that went to working- and middle-class families this spring and the extra $600 a week in unemployment aid Congress sent out in April, May, June and July.
Now that those funds for struggling families have stopped, many economists predict a rapid rise in evictions, bankruptcies and vehicle repossessions — as well as a hit to the overall economy as spending slows.
“The consensus is that a deal is necessary if the U.S. is to avoid economic calamity,” JPMorgan wrote in a morning note.
Some districts in Massachusetts are hoping to provide in-person instruction for their most vulnerable students, while in Marin County, Calif., the school system will do so with small groups of special education students. A district near Denver that is starting the year fully remotely is allowing small groups of eligible elementary and middle school students to receive instruction in classrooms staffed by district employees and equipped with good internet access.
San Francisco, aiming for a broader reach, is planning to transform recreation facilities, libraries and community centers into “learning hubs,” where as many as 6,000 students out of a total 54,000 can go daily to complete their online schoolwork. Indianapolis will provide similar “hubs” for its homeless students, with school workers who can help them with assignments. New York last month announced a plan to offer free child care, saying it was looking for space for up to 50,000 students a day — about 5 percent of its total public school population.
“What we need is a kind of quilt of different sources of care in support of learning, between other parents, community-based based organizations, churches and child care centers themselves,” said Elliot Haspel, the author of “Crawling Behind: America’s Childcare Crisis and How to Fix It.” “But it’s not sustainable without Congress passing another significant funding bill.”
He added: “What terrifies me is the idea of the 10-year-olds who are going to be home all day watching the 6-year-olds.”
Ms. Rodriguez has so far recruited two other families for the babysitting co-op she is creating, called Child Poolers of Northeast Pennsylvania. She made a Facebook page for it and posted a video explaining her vision: “tag teams” of two to four host parents who would each take on at least six hours a week of child care during school days.
Instead of going back to her job in a nursing home, which she quit in the spring out of fear for her health and that of her children, Ms. Rodriguez is thinking of delivering food for DoorDash. She also has hopes of incorporating her “child pooling” group as a nonprofit and opening a community center one day.
“I need to leave them with someone I trust,” she said of 8-year-old and 11-year-old sons, whom she enrolled in an online charter school after the pandemic began because the public school’s online program seemed so unstructured. “Someone who can just make sure my kids sign in and get their work done.”