Assisted-Living Centers Get Much-Needed Virus Aid for First Time

(Bloomberg) -- Assisted-living facilities received a much-needed hand from the federal government Tuesday when for the first time some were given access to aid that was previously restricted largely to nursing homes.

The Department of Health and Human Services program set aside $15 billion for providers that participate in certain state programs like Medicaid and haven’t received any aid yet. That opens a window to some assisted-living facilities, which had been shut out of previous rounds since their residents don’t rely on the federal Medicare program, as many nursing homes do.

Also unlike nursing homes, assisted-living residents have individual living spaces. That’s been an asset in coping with the virus, according to a study from the University of Washington, which attributes the facilities’ design and limited contact with possibly controlling the virus. They tested residents at an community in Seattle after two were hospitalized. Three of 80 residents and two of 62 staff workers tested positive for the coronavirus. One week later, just one more tested positive.

“The door is closed most of the time. People are living independently,” said Alison Roxby, assistant professor of infectious disease at the University of Washington School of Medicine and lead author of the study, published last month.

It’s borne out in the U.S. epicenter of New York as well. In March, a 96-year-old man who fell in his room at the Maple Pointe Rockville Centre on Long Island was sent to the hospital as staff feared that he might have a head injury. 

After he returned, the man developed flu-like symptoms and was re-hospitalized. He died on March 16, Nassau County’s first Covid-19 death.

The hospital notified Maple Pointe, which closed its dining room and isolated its roughly 130 residents to their rooms that night. While nine more residents have since died, the lockdown — which is still in place — kept the number of cases among residents and staff to 17 total. They haven’t had a new case since April 15, according to Executive Director Tammy Marshall.

Nursing homes, which offer round-the-clock medical care and therefore tend not to send residents to the hospital, account for much of the nation’s more than 112,000 Covid-19 deaths. Horror stories such as bodies piled up in a makeshift morgue in New Jersey have spawned criminal investigations. According to federal data, nursing homes recorded 95,515 confirmed cases, 58,288 presumed positive and 31,782 deaths as of May 31. That’s likely an under-count, as the May 6 reporting rule didn’t require facilities to go back before it was introduced.

The U.S. had about 1.78 million total cases and 104,000 deaths as of that date.

Nearly 40% of New Jersey’s Covid-19 Deaths Were at Nursing Homes

Assisted-living operators are struggling after being left out of the $4.9 billion federal aid package focused on nursing homes. Just under half of assisted-living and residential-care communities will likely qualify for this new round based on the state Medicaid criteria, according to the National Center for Assisted Living, a trade group. Most residents pay out of pocket or use long-term insurance to cover what NCAL estimates as a median monthly rate of $4,000.

HHS “will provide relief funds to assisted living providers that provide services to Medicaid enrollees,” an agency spokesperson said in a statement. Eligible facilities will receive at least 2% of total patient-care revenue.

Maple Pointe's parent company Chelsea Senior Living LLC has spent $300,000 equipping its 17 communities with personal protective equipment and is paying staff a 10% “hero pay” bonus, according to Roger Bernier, president and chief operating officer. What he called “the real killer” is the 12% decline in occupancy. He estimates the company will receive less than $1.2 million from the new HHS aid package.

The aid package “is a step in the right direction,” Argentum, another trade group whose members include assisted-living facilities, said in a statement. “However, the vast majority of senior living communities across the country are still being excluded.”

Argentum has lobbied for $20 billion for its members, arguing they serve similarly vulnerable people with far fewer resources than nursing homes. On Monday, NCAL wrote to HHS Secretary Alex Azar and Federal Emergency Management Agency Administrator Peter Gaynor seeking $5 billion in aid. 

How well the industry has done in containing the virus is difficult to assess since it’s regulated at the state-level and the information states disclose varies widely. While limited, the data do support the idea that assisted-living facilities are faring better than nursing homes.

In California, 2,003 of the state’s approximately 85,000 nursing-home residents have died, compared with 351 deaths among both residents and staff of residential-care facilities. In New York, 6,128 of its approximate 100,000 nursing-home residents have died, compared with 170 deaths in adult-care facilities, which house about 33,000 in the state.

Nursing Homes’ Unclear Death Toll Has States Testing Corpses

Nevertheless, some facilities have seen notably dangerous outbreaks. At Prestige Senior Living Orchard Heights in Oregon, 33 out of 58 residents tested positive. Ten have died and three are still sick, according to Prestige Care.

Publicly listed Brookdale Senior Living Inc., the largest senior housing operator in the U.S. with 741 communities, spent $10 million on coronavirus-related expenses in March alone. The rush for supplies saw the company paying fifteen times the normal cost for hot items like masks, Chief Executive Officer Cindy Baier said in a May interview, calling it “devastatingly expensive.”

Brookdale managed to get federal support, as its peripheral businesses like home health, hospice outpatient therapy and skilled nursing entitled it to $29 million, Baier said last week at the Jefferies Virtual Healthcare Conference. The company estimates it will receive less than $5 million from HHS for its skilled nursing beds. She estimated that by the end of June, Brookdale will have spent $60 million on personal protective equipment, staffing and other virus-related expenses.

As for the latest round, Brookdale said the Medicaid restrictions mean it won’t “be of much benefit.”

“Restaurants, hotels have received support,” Argentum Chief Executive James Balda said. “Airlines have received support. And quite honestly we’re on the frontlines of caring for the most vulnerable population for Covid-19.”

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