AARP AZ Letter to Governor Doug Ducey on Nursing Home Wellbeing

May 14, 2020


The Honorable Doug Ducey

Governor

State of Arizona

1700 W Washington St.

Phoenix, AZ, 85007

Dear Governor Ducey:

AARP Arizona, on behalf of our over 900,000 members and all older Arizonans, appreciates the efforts you and your administration have undertaken to address the COVID-19 pandemic and the unprecedented public health and economic crisis that we all face. The gravity of the present challenge will require both new policies, additional resources, and investments to address the growing needs of all Arizonans.

We strongly urge you to take action on to better protect the wellbeing of individuals residing in nursing homes and other long-term services and support (LTSS) settings in line with the recent goals of the Trump Administration. While severe health impacts of COVID-19 can occur across ages, as of April 13, nursing facility residents comprised 15% of all deaths nationally due to the virus.[1] In Arizona, deaths of those 65 and older vastly outnumber all other age groups combined, and we recently hit a grave new milestone of over 100 deaths of patients in long-term care facilities.

We greatly appreciate the important actions your administration has already taken in this area, including virtual visitations for those living in long-term care facilities, requiring insurers to cover telemedicine, a push to add more caregivers to these facilities, and most recently pushing for testing in skilled nursing facilities. To further address the impact of COVID-19 on the LTSS population, we ask that you seriously consider the following policy recommendations:

Transparency of Information on COVID-19 Cases

AARP Arizona sent a letter to your office dated April 13, 2020 urging you to publicly release the names of nursing homes, assisted living communities, and other residential care facilities with confirmed COVID-19 cases among residents or staff. This transparency is critical for public health and the health and well-being of the residents and staff of these facilities. Moreover, residents and family members deserve to have this information for their own health decisions and as they consider possible next steps and interventions for their loved ones.

To be clear, we are not advocating for the disclosure of any private patient information. We also sent another letter to your office last month detailing that the Health Insurance Portability and Accountability Act (HIPAA) rightfully protects the privacy of an individual, however, it does not preclude a state health agency from releasing the names of facilities, because those facilities are not a covered entity as defined by the law. We once again ask that you publically release the names of facilities with confirmed COVID-19 cases.

Access to Personal Protective Equipment and Testing

Personal protective equipment (PPE) is essential to efforts to reduce the spread of the virus. CMS issued guidance on April 2 that nursing home staff should use full PPE when they have direct contact with known or suspected COVID-positive residents and masks when while they are in the facility. At least one Governor, Larry Hogan of Maryland, is now requiring nursing facility staff to wear full PPE at all times while providing care to residents in the facility regardless of COVID status and to follow CDC guidance at other times.

We recognize, however, that certain facilities may still have difficulty acquiring sufficient PPE for their needs and the CMS guidance includes a caveat that its PPE standards apply “to the extent PPE is available and per CDC guidance on conservation of PPE.” In response to this guidance, AARP Arizona believes the state must take immediate steps to ensure that staff caring for individuals in nursing homes, assisted living communities, and home and community-based settings are provided with proper PPE and that staff are properly trained and using them.

Testing

Testing is the only method of being certain whether or not someone is COVID-positive. To the extent possible, we believe it is important for both the staff and residents of Arizona’s LTSS facilities to have ready access to testing. President Trump has recently said that he believes that it is important to have everyone in nursing homes to be tested. In this vein we again commend your efforts in this area by leading the charge for testing in skilled nursing facilities, however we also ask that assisted living facilities be included in these efforts.

This testing will help control the spread of the virus among the resident population and the community at large, as staff, emergency health care providers, on-site maintenance contractors, and others come and go from the facilities. As you know, COVID-19 spreads quickly in these facilities and to other facilities in their general area. In an article from azfamily.com, 3 facilities, not more than 5 minutes from each other have all had confirmed cases of COVID-19.[2] This also makes another case for more transparency. As I shared with you on March 9^th, this is a workforce that often works at more than one facility.

AARP believes Arizona must take immediate steps to ensure full access to testing for staff and residents of all LTSS facilities, including assisted living facilities. If supply shortages prevent wide-spread testing, the state should prioritize testing for individuals with known contact with COVID-positive individuals, and for staff that have direct contact with residents, regardless of whether or not they are experiencing symptoms as many of those who work in LTSS facilities may work in multiple facilities and settings.

AARP Arizona greatly appreciates the state’s efforts to ensure the health and safety of Arizonans during this challenging time. Thank you for your prompt attention to this issue.

We stand ready to help in any way that we can. If you have questions, please contact me via email at dkennedy@aarp.org or Brendon Blake at bblake@aarp.org.

Sincerely,

Dana Marie Kennedy, MSW
State Director AARP Arizona


[1] See “Nursing Homes Are In the Pandemic’s Crosshairs. They Can’t Be Neglected,” Washington Post Editorial, Apr. 13, 2020, https://www.washingtonpost.com/opinions/nursing-homes-are-in-the-pandemics-crosshairs-they-cant-be-neglected/2020/04/13/7341919a-7db0-11ea-a3ee-13e1ae0a3571_story.html

[2] https://www.azfamily.com/news/continuing_coverage/coronavirus_coverage/chandlers-desert-cove-senior-living-now-has-5-deaths-73-cases-related-to-covid-19/article_f858ae74-9177-11ea-a17e-2f867e1d8e39.html