At nursing homes, long waits for results render COVID tests ‘useless'

More nursing homes are waiting longer for COVID-19 test results for residents and staffers, according to federal data, making the fight against record numbers of omicron cases even harder.

The double whammy of slower turnaround times for lab-based PCR tests and a shortage of rapid antigen tests has strained facilities where quickly identifying infections is crucial for keeping a highly vulnerable population safe.

A KHN analysis of data from the Centers for Medicare & Medicaid Services finds that 25% of nursing homes that sent tests to a lab waited an average of three or more days for results as of Jan. 16. In early December, that number was 12%.

At Lutheran Life Villages in Fort Wayne, Indiana, the long wait for results renders PCR tests "useless," President Alex Kiefer said. "If we send somebody off to get a PCR test, sometimes it takes two days for them to get an appointment. And then it takes two, three, four days to get a read."

So Kiefer's organization mainly relies on rapid antigen tests. But on Jan. 12, long-term care sites in the state were alerted to shortages of Abbott Laboratories' rapid BinaxNOW antigen tests, according to the Indiana Department of Health. Lutheran Life Villages was using 125 rapid tests a day, including on vaccinated people. Now as transmission rates remain high, "we are scrounging to try to find enough," Kiefer said. He called the state shipments sporadic. "The scariest thing is, if we get to a point where we can't get those, we will have to rely on PCRs, and the timing of that is just really challenging," Kiefer said.

Federal officials require the country's 15,000 nursing homes to submit data on COVID in their facilities; KHN's analysis of testing speeds is based on reports of turnaround times in early December and mid-January from about 10,900 homes. Nursing home residents have high vaccination rates — more than 87% are fully inoculated, and 67% have received boosters. Still, experts warn, delays can pose significant safety risks. For one, in the time it takes to receive results, outbreaks can emerge undetected. And with omicron, breakthrough infections appear to cause more severe symptoms for older people.

This many nursing homes haven't waited three or more days for test results since March 2021, CMS data show.

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Broadly, PCR tests are considered the gold standard for accuracy and are more likely to be used for regular surveillance testing because rapid tests can miss asymptomatic cases. The drawback is that labs can take days to return PCR results under normal circumstances, let alone when testing demand and staffing shortages delay processing.

Dr. Naveen Patil, deputy state health officer of the Arkansas Department of Health, said the state recommended that long-term care facilities shift to PCR tests during COVID outbreaks because they are more reliable, even when plenty of antigen tests are available.

"But now," he said, "most of them are doing PCR because they don't have adequate supply of antigens."

The Biden administration, which is sending 1 billion rapid COVID tests to U.S. households, has been shipping long-term care facilities 2.5 million tests a week. But that supply has proved measly against omicron's winter surge, which has fueled even greater infections among nursing home residents, according to CDC data.

The American healthcare Association, which lobbies for nursing homes and assisted living facilities, recently said the administration plans to send the sector an additional 5 million rapid tests in the coming weeks, but the industry says that's not nearly enough. A spokesperson for the U.S. Department of Health and Human Services did not respond to questions about the new shipments.

Two years into the pandemic, nursing homes are still managing a crisis. Testing is "a bit of a mess," said David Grabowski, a long-term care expert and health policy professor at Harvard Medical School. "It's déjà vu all over again."

Industry workers say rapid test shortages also complicate their efforts to honor residents' right to receive visitors while ensuring the virus doesn't come in with them.

A survey in early January by LeadingAge, which lobbies for nonprofit nursing homes and other care providers for older adults, found that 76% of nursing homes had adequate testing supplies, but facilities said restocking was getting harder. The American healthcare Association asked the Biden administration to increase the sector's testing supplies and related equipment. The group estimates the sector needs 5 million tests per week.

Dr. Swati Gaur, medical director for New Horizons Nursing Facilities in Georgia, said some facilities "are having to kind of pivot to PCR" tests because of antigen test shortages.

Before omicron arrived, Tina Sandri, CEO of Forest Hills of DC in Washington, would get PCR test results back in about a day. In January, that turnaround time increased to two or three days. Sandri's company, which operates skilled nursing and assisted living facilities, relies on PCR testing to have more confidence that they'll catch asymptomatic cases.

"Those antigen test kits are really hard to get," she added. "We would need hundreds of them every single day, and there just aren't enough of them for us to use as a practical solution." Their most valuable use, Sandri said, would be for employees to test themselves at home after an exposure or infection before returning to work.

COVID infections among nursing home residents and staff members have begun to decline nationally, but the total in the week ending Jan. 23 — 42,584 resident cases — surpasses the numbers from last winter's surge, when initial doses of the COVID vaccine were becoming available. In the past month, the number of resident deaths has increased each week — and was 1,298 for the week ending Jan. 23. That is well below the 4,100 deaths reported in the same week a year ago, CDC data shows.

Long-term care facilities that aren't worried about COVID testing say they can reliably get test results in less than a day or two. And they have ample supplies of rapid antigen tests from federal shipments.

"I maybe get two or three shipments a week" of rapid tests, said Karen Venis, CEO of Sayre Christian Village in Lexington, Kentucky. The lab that processes Sayre's PCR test samples — which they use for routine surveillance — sends staffers to test residents and workers twice a week. Results are typically provided within 24 hours, and Venis estimated they use about 100 antigen tests a week, saving them mostly for people with symptoms.

"We've got the support that we need," she said.

For Kiefer in Indiana, though, using more PCR tests isn't tenable.

"That's how we were making decisions early on in the pandemic," he said. "It was difficult to do everything."

At least with rapid tests, he said, "we can take action right away."

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.