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.