Covid-19 Testing Mandates For Assisted Living Raise Questions About Access, Cost

As more states are now mandating that assisted living facilities test either residents, staff or both for Covid-19, providers that have been asking for widespread testing for weeks are now faced with logistical challenges and unanswered questions.

This highlights the need for best practices and guidelines if testing mandates are going to become more commonplace, AMDA — The Society for Post-Acute and Long-Term Care Medicine Executive Director Christopher Laxton told Senior Housing News.

“The whole question of a testing strategy needs to be outlined,” he said.


A look at testing mandates across various states reveals wide disparities in the types of communities that should be tested, and who within them should be tested. Last month, Tennessee Governor Bill Lee announced that all long-term care facilities and nursing homes in the Volunteer State would be tested for the virus — impacting over 70,000 residents.

New York’s testing mandate, meanwhile, focuses on staff. Governor Andrew Cuomo signed an executive order last week announcing that assisted living employees would be tested twice a week or subject to fines of up to $2,000 per violation per day, as well as risk having their licenses revoked.

And in Florida, where long-term care facilities have lobbied for more testing, state health authorities would only test in communities with a confirmed positive case. Last week, the Florida Department of Public Health issued an executive order mandating that communities must allow authorities inside to test staff and residents, or risk fines and license revocations.


Experts believe that testing practices should involve discussions with providers and trade associations, Hedy Rubinger, national health care practice chair at law firm Arnall Golden Gregory, told SHN. She cites New York as an example where obligations fall entirely on an assisted living operator to comply with recent requirements for twice weekly staff testing.

“[Currently], the obligation is on the assisted living operator in New York to facilitate and coordinate staff testing, and then attest to the fact that all testing obligations have been satisfied,” she said.

While trade associations are applauding the mandates, they are pushing for federal and state authorities to assist with funding, and with the testing itself. And, they are highlighting the need for frequent testing.

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Ongoing testing is needed in order to keep residents and staff safe, American Health Care Association and National Center for Assisted Living (AHCA/NCAL) Senior Vice President of Quality and Regulatory Affairs Dr. David Gifford said in an interview on Scripps National News.

Then there is the issue of reimbursement. In states with universal testing mandates, this can place more pressure on facilities already under financial strain, Laxton told SHN. Tests average between $50 to $150, with the facility absorbing the costs.

The impact goes beyond profit and loss statements, as well.

“Our evidence shows that once you do a universal test on both staff and residents, you know, you may lose up to 20% of your staff to quarantine for 14 days, and so how are you going to respond to the care needs of residents when perhaps a fifth of your staff are off on quarantine?” Laxton said.

AMDA recommends that providers in states with testing mandates have solid recruitment strategies in place in case they do lose associates to quarantine, or else relying on agency staffing will increase labor expenses further and place residents at higher risk of contracting the virus.

Some states are looking into financial assistance to ramp up testing, such as grants and other incentives.

“Some of the programs are first come first served, so operators want to keep an eye out for any sort of grant funds or other sort of funding mechanisms in their state that might help offset the costs of testing. We’ve also seen some funding that will help cover hazard pay for staff in assisted living facilities,” Rubinger said.

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