Assisted living communities need $5 billion in emergency relief funding to pay for staffing, testing and personal protective equipment to fight COVID-19, the leaders of the American Health Care Association / National Center for Assisted Living told the heads of the Department of Health and Human Services and the Federal Emergency Management Agency on Monday.

“With a vulnerable population much like nursing homes, assisted living communities will not be able to overcome this unprecedented health crisis and protect our residents and caregivers without adequate funding and resources,” AHCA / NCAL President and CEO Mark Parkinson and NCAL Executive Director Scott Tittle wrote in a letter to HHS Secretary Alex Azar and FEMA Administrator Peter Gaynor. “We sincerely appreciate the recent steps taken by your agencies to make nursing homes a top priority. Now we need the same level of support for assisted living communities,” they added.

To date, the more than 42,000 assisted living communities that serve more than 1 million people have not received any direct federal funding, despite “an alarming number” of confirmed COVID-19 cases in assisted living, Parkinson and Tittle noted.

Operators, they said, have incurred expenses due to hiring additional staff members to cover for sick employees and to deliver meals to residents because dining rooms are closed; providing overtime and other incentive pay; securing PPE supplies, which are priced at a premium; paying for COVID-19 testing; quarantining residents who have or are suspected of having COVID-19; offering enhanced, one-on-one activities and telehealth; increasing their cleaning and disinfecting efforts; and accepting COVID-19-positive individuals discharged from hospitals per state requests.

Money from the Provider Relief Fund created through the Coronavirus Aid, Relief, and Economic Security (CARES) Act could help communities with confirmed cases control outbreaks and could help communities without confirmed cases keep outbreaks from occurring, Parkinson and Tittle said.

As states start issuing guidance allowing long-term care facilities to welcome visitors again, assisted living providers need to be able to regularly test caregivers, residents and visitors and get test results quickly, they said, yet “approximately 75 percent of assisted living providers have been unable to find sufficient PPE, like masks, gowns and face shields for caregivers,” and some are using homemade or improvised PPE.

AHCA / NCAL recently estimated that testing every U.S. assisted living community resident and staff member for COVID-19 one time would cost $232 million. “Without adequate support from states or other sources, long-term care providers, especially assisted living communities, will have to shoulder nearly all these one-time and ongoing testing costs,” Parkinson and Tittle told Azar and Gaynor.

The AHCA / NCAL leaders called on HHS to recommend that states make testing of assisted living staff members and residents a top priority and that states direct funding they received from HHS to expand access to testing for assisted living communities. And they called on HHS and the Centers for Disease Control and Prevention to provide “stronger” guidance to states on testing strategies for assisted living communities and other long-term care settings.

“There is inconsistency among the states on the implementation of a baseline test of all residents and staff, as well as questions surrounding surveillance testing,” they said. “We would appreciate [it] if the federal government could provide states clear direction based on the best evidence currently available regarding the behavior of this virus.”

Additionally, Parkinson and Tittle called on FEMA to send 14-day supplies of PPE to each U.S. assisted living community, much like the agency previously promised for nursing homes.

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