Covid-19 Testing for Nursing Homes – the Strange Case of Heritage Hall

By Carol J. Bova and James C. Sherlock

The Department of Health and Human Services announced that it would begin to provide 2000 nursing homes with a point of care (POC) rapid-response testing assessment instrument and an initial supply of COVID-19 test assays starting July 20th.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “It gives nursing homes the ability to swiftly identify residents that need to be isolated and mitigate the spread of the virus.”

Eventually, 15,000 analyzer instruments and an initial supply of SARS test assays for those instruments will be distributed nationally directly to nursing homes.

Devices have been allocated to the first 23 of Virginia’s nearly 300 nursing homes.

Heritage Hall. Tommy East is the President and CEO of American Healthcare, LLC, which controls Heritage Hall nursing homes. Mr. East is also listed as a director and officer for each Heritage Hall facility. He is the sole nursing home industry representative on the Virginia Board of Health.

Seven of 18 Heritage Hall nursing homes made it to the head of the line for the first 23 analyzer systems and test assays distributed in Virginia by the CMS program. Heritage Hall is the largest Commonwealth-based operator of nursing homes.

In the last CMS payroll-based journal (PBJ) staffing report by CMS before COVID struck, Heritage Hall facilities were chronically understaffed. The data for the quarter ending December 31, 2019 showed nurse under-staffing in 15 of the 16 Heritage Hall facilities in Virginia that were rated. Rich Creek and South Roanoke are new since that report.

One would think that such facilities would not be rewarded for such dismal performance. One would also think that such understaffed facilities would be challenged administering the tests.

Heritage Hall’s website  advertises, “We use the latest technology, treatments and therapies available” and “cutting edge medical care.”

It is reasonable to question why, given the fact that its patients are by definition profoundly ill and vulnerable, Heritage Hall would not already have either the Quidel Sofia or Sofia 2 or the Becton Dickenson Veritor™ Plus System analyzers being distributed through the CMS program.

Each analyzer is capable of rapid testing for strep, respiratory syncytial virus (RSV), influenza A and B, Lyme and has been for some time. The only recent development is the COVID 19 Antigen test for those machines.

Location, Location and Location. The Commonwealth, with an estimated population of 8.6 million, at the latest count had 14,500 COVID hospitalizations and 2,344 deaths. That breaks out to 168 hospitalizations and 27 deaths per 100,000 persons statewide.

We compiled a chart that shows that none of the localities where the favored Heritage Hall facilities are located has experienced as many hospitalizations per 100,000 population as the average Virginia locality.

See the chart at the link for the hospitalization and death rates in the communities where the seven Heritage facilities allocated machines and test assays are located. Use the state averages above for comparison and see if you can make any sense of the allocation.

Heritage Hall Facilities Allocated Rapid Test Machines

The questions write themselves. A few obvious questions:

  • What influence did the Virginia Department of Health exert in the CMS selection of the first 23 Virginia nursing homes on the CMS list?
  • How did Heritage Hall rate nearly a third of the first 23 machines and tests distributed among nearly 300 nursing homes in Virginia?
  • Were local COVID hospitalizations and deaths part of the decision matrix? If not why not?
  • Does CMS certify rapid testing capabilities in nursing homes? If not why not?
  • Ignoring COVID, how has Heritage Hall tested patients for flu, strep, respiratory syncytial virus (RSV) and Lyme disease (capabilities of the analysis machines) up to now? Is that not a basic requirement for nursing homes?

Perhaps the Virginia Department of Health, which is the inspector of nursing homes for both the Commonwealth and the Centers for Medicare/Medicaid Services, can provide answers.

We will ask them with a FOIA request.

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17 responses to “Covid-19 Testing for Nursing Homes – the Strange Case of Heritage Hall

  1. Pro tip – when writing about special interests, possible graft and politics in the Most Corrupt State in America, always follow the money …

    https://www.vpap.org/search/?q=Heritage%20hall&facet=donors

  2. Here’s another. FYI – W Heywood Fralin is the chairman of a company operating 40 nursing homes. $842,000 out of his pocket to Virginia politicians over the years.

    https://www.vpap.org/money/donors-per-industry/111/?recip_type=all&year=all

  3. Come on everybody. Sing it with me in your best Joel Grey German accent… “Money makes der verld go ’round… der verld go ’round… der verld go ’round. That klinking, klanking sound. It makes der verld go ’round”

    Hope they enjoy the high number of false positives. Worth every penny.

  4. Pocket lint for the Fralins, I assure you, DJ. Then there is this:

    https://www.vpap.org/lobbying/client/111164-american-healthcare-llc/

    East’s lobbyists: One is son of former Delegate C. Richard Cranwell, the other the son of former State Senator Bill Hopkins (and to be clear “young” Hopkins was in high school with me….). The names don’t change in the Roanoke Valley.

    Yeah, I was wondering, NN, if the accuracy of these devices had improved. Last I read, no, but for quickly surveying a large population it is clearly an attractive approach. Say for testing the workforce every day or once a week. It is the false negatives, leading one to relax incorrectly, that would be the big problem. A few false positives I could live with.

    Outbreaks in Virginia congregate care locations continue, per their own reports. About 11 places in a single day recently, followed by seven more the next day. Only 997 deaths in Virginia are NOT traced to a congregate care facility.

    • “Yeah, I was wondering, NN, if the accuracy of these devices had improved.”

      Actually, it turns out that they are currently far worse than they initially indicated in their EUA applications (as used in my BOE write up). In their defense, how could they have known without a lot of testing, and well, it is an “emergency use” authorization.

      Have they improved? Yeah probably. But then, that makes the early uses really scary, no? Kinda like unbuckling the seat belt after a carnival ride and the whole thing comes off in your hand.

  5. Steve says. “Only 997 deaths in Virginia are NOT traced to a congregate care facility.”

    This is a huge important fact. So nobody in Virginia’s government wants to talk about it.

    Why?

    Because the current regime in Virginia is gaining so much control and power over Virginians, their economy and their government, while doing so much harm to the regime’s political opponents and supporters, and making so much money in the process off Covid 19 “crisis”, that the current regime want to keep the “crisis going”, until at least the upcoming November elections.

    Imagine:

    Virginia population’s in 2019 was 8.536 million. None congregate care Covid-19 deaths are 997 people. Compared t0:

    VA Leading Causes of Death, 2017
    1. Cancer 15,064
    2. Heart Disease 14,861
    3. Accidents 3,922
    4. Stroke 3,555
    5. Chronic Lower Respiratory Disease 3,363
    6. Alzheimer’s disease 2,549 27.6
    7. Diabetes 1,967 20.1
    8. Kidney Disease 1,618
    9. Septicemia 1,249
    10. Flu/Pneumonia 1,245

    Virginia Mortality Data
    Firearm Deaths 1,041
    Homicide 455
    Drug Overdose Deaths 1,507

    Virginia highway deaths 2019- 827 deaths

    And only Covid-19 is declared a crisis. Now we know why.

    • Don’t forget, per CDC only 6% of death certificates list COVID as the sole cause. Many had one or more of your top ten going in. New data out now about younger patients who have a history of vaping being way, way more likely to get very sick and even die. No surprise there. NBC seemed shocked by that in its report last night.

    • Thank you for providing facts. Facts are friendly. Not to people for whom the facts do not support their narrative.
      Please keep bringing the facts forward. Thank you.

  6. Jim Sherlock, I have gotten a FOIA from VDH answered but asking for the database from the local head is another story. I wanted her to put up or shut up.
    She knows I’ve been going after her because she can’t answer a flaming thing.

  7. My FOIA requests have always been answered by VDH. The Deputy Commissioner who is responsible for answering FOIA requests is faithful about that duty. Often the answers that he gets from the office responsible are not the best (ahem), but we’ll see on this one. I sent it earlier.

    • For four years I wrote or reviewed every non-case FOIA response in the Attorney General’s Office. Some of mine were clearer than others, too. 🙂 But we followed the timeline and replied.

  8. Jim Sherlock:

    On 8/12/2020 5:16 PM, Hilbert, Joseph wrote:
    > Ms. Nicholls:
    >
    > This is to advise you that the Virginia Department of Health (VDH) will not be responding to
    > any further communication from you regarding issues and questions pertaining to COVID-19.
    > VDH has been communicating with you since the onset of the pandemic. Since that time, VDH
    > employees in the Chesapeake Health District as well as the VDH Central Office have provided
    > you with close to 40 separate responses of varying lengths and degree of detail.
    > In response to your various inquiries during that time, VDH has provided you with information
    > on the issues and questions you have raised related to masks, testing, disabilities, governmental
    > actions (international, national, state and local), restaurants, retail stores, regulations, schools,
    > metrics, environmental cleaning, general health implications, economic impact, compliance,
    > sanitation, legal interventions, educational materials, food insecurity, racial discrimination, and
    > hotline complaint resources, to name a few. You have been advised that the issues raised related
    > to global and national matters are not within the scope of VDH’s purview.
    >
    > There is nothing further that the Virginia Department of Health can do at this time to address
    > your remaining concerns. We are sorry that you feel that the information we have provided
    > was not helpful to you.
    >
    > Sincerely,
    > —
    > Joseph Hilbert
    > Deputy Commissioner for Governmental and Regulatory Affairs
    > Virginia Department of Health
    > 804-864-7006

  9. It would appear that you wore out your welcome by requesting matters not within their purview. But before I draw any conclusions, it would be nice if you posted the requests they say are not within their purview.

    • When you have to ask several times for the same thing, the same request(s) for the research/data underpining the decisions, and asked was something considered and not get a specific answer, you are going to repeat emails. The last request specifically indicated a FOIA, the VDH rep said they didnt understand so I clarified further. They stopped responding and Mr. Hilbert took over w/this email. There were requests about the APA that were repeated and not responded to, was told they were sent up to the state level, and didnt get any answer. The couple of responses I got did not answer my questions, or were partial sentances. Most were actually partial sentances. I got one that partially answered 3 questions of what I had listed.

  10. VN:
    I could be wrong, but based on what to you wrote here, it sounds like you have a misunderstanding about FOIA , and no one explained the rules on why they weren’t answering. A public body is not required to answer questions, like what data did you use to come to that decision, or whether something was considered. Some research can be exempt from disclosure too. And FOIA does not require creation of a new document to respond to a request.
    FOIA does require you to describe with reasonable specificity what document you are requesting, and it must be something in that body’s possession. If you did want a specific document that’s from another agency, you can go to their website and identify the name and contact info for their FOIA officer and then request it.

  11. Hi,
    The conversation was in several parts:FOIA and questions. You don’t have to separate them in a FOIA request. A previous FOIA request was met with the information with no removal of data within a day, if memory serves.
    I have done several FOIA requests in the past with various groups. Chesapeakes’ public school system refused me documents saying they couldn’t find them, didn’t know what they were, and wanted the name of the file(s). I went to the state, described them, and they found them within 24 hours and emailed them.
    The email was copied to the person who answers FOIA. They knew what I was talking about, but didn’t want to give it up. The data/research I’m watching indicates they either have an ulterior political motive or should not be allowed to manage this.

  12. Pingback: Virginia’s state health system will continue to kill its citizens if we let it | Bacon's Rebellion

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