In Alabama and across the nation, nursing homes have faced unprecedented challenges due to the COVID-19 pandemic danger. To counter the spread of COVID-19 within its facilities, nursing homes and long-term care facilities have responded with rigorous new protocols and procedures.
However, safety practices are being compromised because the American Ambulance Association and its affiliates in Alabama are refusing to let their personnel be tested for COVID-19 before entering a nursing home, according to facilities.
“I cannot overstate the importance of infection control in nursing homes to prevent the spread of COVID-19,” said Brandon Farmer, president and CEO of the Alabama Nursing Home Association, in response to an APR request for comment. “Employees of skilled nursing facilities are the only health care providers required by the federal government to undergo regular COVID-19 testing because of the vulnerable population we serve.”
Ambulance companies are routinely contracted by nursing homes and long-term care facilities to provided non-emergency medical transportation for its residents. This includes carrying individuals to regular doctor appointments, dialysis, post-surgery follow-ups and other medical appointments.
But ambulance transport companies claim they do not have to follow guidelines established for entering nursing homes by broadly, and some believe erroneously, interpreting federal regulations.
“It’s critically important that other health care providers entering nursing homes, such as EMS providers, be regularly tested,” Farmer said. “At this time, EMS and medical transport drivers are not required to be regularly tested for COVID-19 even though they are potentially exposed to countless people who may be COVID-19 positive during their daily shift.”
In fact, EMS personnel are only required to be screened for symptoms at the beginning of each shift, far below the federal procedures for nursing homes.
Guidelines issued by the Centers for Medicare and Medicaid Services require COVID-19 testing for all nursing home residents and staff “based on parameters and a frequency set forth by the HHS Secretary.” According to CMS, “Facilities can meet the testing requirements through the use of rapid point-of-care (POC) diagnostic testing devices or through an arrangement with an offsite laboratory.”
According to CMS, “‘Facility staff’ includes employees, consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions.”
Nursing home operators believe these guidelines apply to EMS workers entering their facilities in non-emergency situations, so does the Alabama Department of Public Health. According to ADPH, “EMS personnel do fall under the umbrella of ‘facility staff’ since they provide a service under arrangement to nursing home facilities.”
Other guidelines from a CMS memo states, “We note that EMS personnel do not need to be screened so they can attend to an emergency without delay.”
No one denies that EMS should be exempt from testing in an emergency crisis but extending the exception to include routine non-emergency transport is an unacceptable health risk according to skilled nursing facility providers.
Angie Smith, a partner with Burr & Forman in Birmingham who advises nursing homes on regulation and guidance issues, says the plain reading of CMS guidance is clear that a COVID-19 test is required for vendors, contractors and volunteers, which includes EMS personnel when they are providing non-emergency transports. “We understand that in an emergency, you don’t want to stop and screen them for 15 minutes,” said Smith. But to declare that EMS workers are never subject to testing is a misinterpretation of CMS guidelines, Smith said.
“While we would never delay EMS personnel responding to an emergency, it is critical that we know their COVID-19 status before they enter a nursing home to transport a patient,” said Farmer. “Our staff is tested based on the county positivity rate as outlined by CMS, and the employees of EMS providers should be tested with the same frequency to protect the people they transport.”
But EMS personal and co-workers are not tested like nursing home staff; only the most basic screening is compulsory for EMS employees. In Alabama, nursing homes offer EMS personnel free testing before entering a facility to alleviate costs to the ambulance companies, but still, the transport providers are resistant.
Smith said she didn’t know why EMS providers were taking a hard line on testing. “I don’t know why, I mean, it’s not overly burdensome,” she said, adding that nursing homes in the state are administering the tests free of charge.
However, one nursing home owner did offer a blunt assessment: “It’s about money.”
To speak candidly, the owner asked not to be identified as not to influence any ongoing discussions.
“What they don’t want to happen is for us to test one of their workers and then come back positive,” said the owner. “If an employee tests positive for COVID-19, they would need to quarantine for ten days. Which would cost money.”
“When you go into healthcare, it’s your duty to take care of a resident or a patient,” the owner said. “And to me, if you’re not going to follow the guidelines and the mandates through CDC and CMS and ADHP, then you’re not doing what you’re supposed to be doing.”