The Centers for Medicare and Medicaid Services will for the first time require the regular testing of nursing home staff for the novel coronavirus, the agency’s administrator said Tuesday.

Until now such testing has only been recommended by federal authorities, in part because the slow turnaround time in getting results has seriously hampered their usefulness. But employees are thought to have played a major role in inadvertently introducing the virus to nursing homes and spreading it among residents, more than 40,000 of whom have died of COVID-19 since the outbreak began in March.

“We want to make sure each and every nursing home is doing this,” the CMS administrator, Seema Verma, told a telephone news conference. Fast tests are becoming available, with more than 5,500 “point-of-care” test kits already shipped out to nursing homes around the country, according to Adm. Brett Giroir, assistant secretary for health.

Verma said nursing homes will also be required to “offer” tests to residents when there has been a positive test result in the facility or someone is experiencing what could be the symptoms of COVID-19. She said the agency will not force residents to take tests.

The tightening up comes after months of criticism of the nursing home business and of state and federal health officials who oversee nursing home operations.

Making staff testing a requirement from the beginning “absolutely would have made a tremendous difference in those states that had high outbreaks,” said Charlene Harrington, a registered nurse who is a professor emerita in the department of social and behavioral sciences at the University of California San Francisco. She has written several papers on the response to COVID-19 in nursing homes.

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“The asymptomatic staff are as high as 50 percent, so there was no way to detect them without testing, so they were passing the virus to all the vulnerable residents,” she said.

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Residents at the Southern Pines nursing home are separated and wear face coverings during their daily bingo game in Warner Robins, Ga., in June. Nursing homes and labs will now be required to report test results to health officials, including demographic information about those tested. John Bazemore/Associated Press

The slow turnaround time of tests up to now could have been addressed if labs had been required to make nursing homes a priority, she said. “They should have been all along. If there’s a big outbreak, they should require a test of every resident. I don’t understand why they don’t say what needs to be done, and then we can figure out how to make it happen.”

Many lives, she said, could have been saved.

Verma said $2.5 billion from the Provider Relief Fund, created by the Cares Act, will be made available to help nursing homes pay for the tests, out of $5 billion in assistance that President Trump announced in July. That’s on top of $7.5 billion that has already gone to nursing homes as emergency federal aid since the disease began to spread.

Guidance on how often staff will need to be tested will be issued later this week, Verma said. It will vary depending on a few factors, including the positivity rate in the surrounding community.

The new antigen test kits are somewhat less sensitive than the lab tests, Giroir said, but they have a 15-minute turnaround time and can conduct 10 to 20 tests per hour.

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Verma said nursing homes and labs will now be required to report test results to health officials, including demographic information about those tested.

CMS has also prepared two new online training courses, one for nursing home management and one for floor staff, on such issues as infection control, dealing with visitors, mental health, proper use of personal protective equipment and “cohorting” of residents into those who have tested positive and those who have not.

It is “a tailored course that features the most recent lessons learned,” Verma said.

Rear Adm. John Polowczyk, who is coordinating the federal government’s distribution of medical supplies, told the news conference that 1.5 million N-95 masks will be distributed to nursing homes in need by the end of next week.

“We continue to be in a much better place,” he said.


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