PLATTE — Mark Burket took his work on behalf of the nation’s nursing home and long-term care providers to the White House earlier this month.
Burket, the CEO of Platte Health Center Avera, was one of 25 representatives on the Coronavirus Commission on Safety and Quality in Nursing Homes. He was one of seven members of the commission to meet with Vice President Mike Pence on Sept. 17 in Washington D.C. for about an hour, discussing the commission’s findings and priorities for how nursing homes — which have been hit hard by COVID-19 — can respond in coming weeks and months to the pandemic. It was commissioned for the federal Centers for Medicare and Medicaid Services.
“I can say I was honored to be among that group and to represent that commission and the industry,” he said. “It was an incredible opportunity to experience that and meet the vice president to discuss this important issue.”
The commission, led by the Mitre Corporation, issued a 186-page report with 27 principal recommendations and more than 100 accompanying action steps. Those steps include:
a national testing strategy and rapid turnaround of testing results, while allowing local tailoring of that strategy;
allow local facilities to procure and sustain a three-month supply of personal protective equipment
emphasize that visitation is a vital resident right
provide resources to help staff and residents with mental health and well-being;
identify short-term facility enhancements at a minimal cost to address pandemic-related risks
standardize COVID-19 data collection to assist the federal response.
The commission met for 39 hours in total before turning in their report in late August. At that point, 8% of all U.S. COVID-19 disease cases and 41% of all U.S. COVID-19 disease deaths were linked to nursing homes.
Burket, who oversees a 48-bed long-term care facility, said he had concerns that the diverse commission and its various backgrounds would make it difficult to agree on anything, but he said all members were given opportunities to speak and an equal opportunity to participate. The panel included academics, industry leaders, resident advocates and long-term care facility operators. The commission met via Zoom and had various large group and small group discussions.
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“I really believe in the end that the report is reliable, it’s a source and it will make a true difference in how we respond to the pandemic in nursing facilities,” he said.
The White House meeting included about 40 minutes behind closed doors. It was held in conjunction with a CMS announcement that broadens the federal guidance to allow for more visitation with nursing home residents, including indoor visits if there has been no new COVID-19 cases for 14 days and the facility is not conducting outbreak testing.
Burket said Pence spoke with appreciation to the group about the effort and dedication that nursing home workers bring to their jobs every day, with the vice president calling it a “tough job.” The Platte administrator said workforce issues was his main priority he stressed to Pence when he had the chance to talk.
“I said I work with a vast number of occupations within healthcare and I’ve often told people that (certified nursing assistants) have the toughest job in the building. And I’m not worried about offending anyone else I work with because that’s so well known. … They don’t do it for the money, they do it because it’s in their heart.”
Burket said those employees deserve more money, but recruiting those individuals is difficult because “they can walk across the street and earn more working at McDonald’s.
“In the long term, we need to redefine the long-term care industry and fix many of the systemic problems that have been created here,” he said. “We’ve got a lot of employees that are doing all they can do.”
Burket also said that he spoke to Pence about the difficulties of handling a dangerous pandemic in facilities that are more than 50 years old, and are not “built to respond or deal with the acuity of resident care we’re doing in the facility.”
In June, Burket said he was going to approach the commission and try to blend the demands of science with what is realistic. That prism set up two areas where he dissented on the final report. One was the recommendation that every nursing home in the country should have a full-time certified infection prevention specialist on staff. Burket said he agrees that it would help with maintaining facilities and preparedness, but said it’s not realistic for Platte’s nursing home to have a full-time staff member dedicated to that.
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“We have 20 certified specialists in the entire state of South Dakota. All of them are employed for hospitals,” he said, adding that it would be difficult to recruit, retain and employ those individuals in small communities. “I could not support a mandate that every nursing facility have an infection preventionist because we’re basically creating rules to which upwards to two-thirds of the nursing homes in the country would be non-compliant.”
Another dissent surrounded demands of testing, as CMS has mandated that every nursing home conduct COVID-19 testing. Burket said testing is important for detection and prevention but said the supply chain cannot keep up with the amount of tests they’re doing. The federal government has distributed point of care testing machines to each nursing home but Burket doesn’t have the supplies to run them.
“I have enough to do one testing session,” said Burket, with a Platte session covering more than 100 people and each session costing the facility $14,000. “I have to find other means and fortunately, we’re co-located with the hospital and we do COVID testing there. But we’re allocated a certain amount of tests and it’s not nearly enough compared to what we’re being asked to do.”
