Testing turnaround times at nursing homes lag as U.S. COVID-19 cases climb

As COVID-19 cases surge again across the country, nursing homes are trying to fend off spread in their facilities.

Yet, despite the federal government sending rapid point-of-care diagnostic testing devices to nursing homes and requiring surveillance testing based on community spread levels, tests aren’t being turned around fast enough to prevent COVID-19 in these congregate care settings, a new study finds.

The study, completed by researchers at the University of Rochester, Harvard and Brigham and Women’s Hospital, found that only 13.5% of the 15,065 nursing homes included in the study had a testing turnaround time of less than a day for staff and 9.5% for residents, as of Sept. 27. In hot spot counties, 16.4% of facilities were getting staff test results in less than a day, and 13.2% received resident results in less than a day, as of Sept. 27. The antigen tests can provide results within 15 minutes.

“When it comes to testing turnaround, we’d want it as soon as possible: one or two days. In a nursing home environment, one day versus two days is a big deal, especially if you have staff that need to stay home,” said David Grabowski, a professor of healthcare policy at Harvard Medical School and one of the study’s authors.

Yet, by Sept. 27, 39.8% of facilities said staff testing results took three or more days, and 36.6% of sites said resident results took that long, according to the study. The study used information collected weekly by the Medicare COVID-19 Nursing Home Database to determine turnaround time.

“The federal government has now shipped rapid testing to every facility in the country. These results appear to show rapid testing is not dramatically moving the needle,” Grabowski said.

He attributes the delay in turnaround times to nursing homes favoring PCR tests, which are known to be more accurate but also require lab processing instead of providing on-site results. There also are regulations at state and local levels that require PCR tests, leaving nursing homes to figure out what to do with the antigen tests from the government.

“It takes more than just providing the test,” Grabowski said. “I gather some nursing homes just put them on the shelf or in the closet.”

He said there needs to be education provided to nursing homes about how and when to use the tests and an alignment among federal, state and local regulations about testing requirements.

In a recent report from LeadingAge, which represents aging service providers, the organization said, “Providers working in care settings that must meet testing mandates are sometimes forced to navigate multiple mandates on testing—federal, state and local—which can result in confusion and duplicative efforts.” The LeadingAge report also said that the government only sent one to weeks of testing supplies with the testing devices, leaving nursing homes to track down additional supplies.