As governors take steps to reopen their states in the wake of the COVID-19 pandemic, the long-term care industry is taking a more cautious approach to relaxing the protocols put in place within the past two months.

Long-term care providers have expressed fears that the ongoing coronavirus pandemic could put workers at an increased risk of developing or spreading the disease through facilities.

According to the Kaiser Family Foundation, more than 10,000 COVID-19-related deaths have been reported among residents of assisted living, skilled nursing and intermediate care facilities, and in six states, such residents account for 50% or more of all COVID-19 deaths. 

In Florida, the long-term care industry was represented on Gov. Ron DeSantis’ “Re-Open Florida Task Force,” which last week outlined recommendations on reopening the state beginning Monday. Assisted living communities and nursing homes are not part of the first phase of the reopening.

LeadingAge Florida President and CEO Steve Bahmer was on the task force and praised the phase-in process, but went further in stating how that would look for long-term care facilities.

“Long-term care providers are going to be very cautious about relaxing the protocols they have in place, protocols that are intended to protect the most vulnerable Florida seniors,” he said in a statement. 

Although the task force recommended that older adults continue to stay home and follow social distancing guidelines, Bahmer expanded on those recommendations for long-term care, including prioritizing long-term care for testing and personal protective equipment distribution; standardizing re-open protocols and regulatory guidance; and providing financial and public support for front-line healthcare workers caring for the state’s most vulnerable seniors. 

“We went to battle for critical supplies and the PPE we sent out, and the testing sites that we’ve provided across the state have undoubtedly made a difference,” Florida Division of Emergency Management Director Jared Moskowitz said in a statement. “As we enter the next phase, we will continue to provide around-the-clock support for our first responders, healthcare workers and long-term care facility staff.”

California, New York and Illinois are among states where stay-at-home orders have been extended through May, although some states are opening some businesses. Alaska, Georgia, Oklahoma, Iowa, Texas and Florida are among states beginning a phased plan to reopen their states. Ohio has a state-at-home order through May 29, although some types of businesses will open in a phased plan throughout the month; long-term care facilities will not be among them. CNN compiled a list of where all 50 states stand on reopening.

Mark Parkinson, American Health Care Association / National Center for Assisted Living president and CEO, who formerly was governor of Kansas from 2009 to 2011, said opening states too quickly could result in another coronavirus spike in senior living and care facilities. 

“If states reopen too quickly and another spike in COVID-19 occurs in communities and states, there will be a spike in COVID-19 cases in any congregate care setting,” Parkinson said. “Governors have to be careful about what they allow to happen in states because it will have an impact on buildings.”

Similarly, Argentum President and CEO James Balda recently expressed concern that a shortage of tests and equipment could put senior living residents and employees at risk. 

The Kaiser Family Foundation said significant state variations exist in requirements for assisted living communities and nursing facilities, in terms of prohibiting visitors, screening staff for illness daily and requiring staff PPE use. Although some governors recently announced the relaxing of restrictions that aim to slow the spread of the virus, some state guidance issued for assisted living communities and nursing facilities has expired — or soon will. 

For example, Washington’s order prohibiting long-term care visitation expired on April 15, and executive orders issued by Georgia and Tennessee expired on April 30. Other states, including Arizona and North Carolina, mandated that long-term care guidance will expire upon termination of the state’s emergency declaration related to COVID-19.

“The state-based patchwork regulatory approach shown in our analysis results in increased vulnerability to infection for some nursing facility and assisted-living facility residents, depending on where they live,” according to a recent Kaiser Family Foundation report. “This situation mirrors a larger national trend in COVID-19 response in which some states have taken more aggressive actions than others, while the federal government assumes a ‘backup’ role.

“This state-by-state approach to the COVID-19 pandemic may result in uneven rates of illness, hospitalizations and mortality of long-term care facility residents and staff across the country.”

The consumer-oriented National Consumer Voice for Quality Long-Term Care issued recommendations for protecting residents and staff of long-term care facilities, including establishing a state-level response team; distinct COVID-19-only and transitional facilities / units; requiring transparency of information to residents, families and the public; providing adequate PPE and testing; supporting direct caregivers and other essential workers; and supporting and protecting residents during admission, transfer and discharge. Assisted living communities, the organization said, should be required to consult with an infection control preventionist to develop and implement an infection control plan.