Long term and post-acute care providers are tired and drained from their continuing battle against the still-raging COVID-19 pandemic, says Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

The battle against the virus is a marathon, he says, and only around one-half over, with next spring being the most logical time a vaccine can start to bring relief for residents, families, and caregivers who have been on the frontlines since March.

In a wide-ranging talk with Provider, the longtime association leader presented a no-nonsense assessment of where skilled nursing, assisted living, and other settings of care for the nation’s elderly and people with disabilities stand heading into the final months of a year that has marked thousands of residents dying from a virus that keeps challenging facilities even as most take every precaution to keep it out.

“I think that the unfortunate reality of the pandemic has been to expose that older people are not held in the same priority as younger people,” he says. “Older people are not held with the esteem that they should be, and so political decisions were made that led to the deaths of tens of thousands of people.”

“I think that we are about halfway through, maybe a little over halfway. I am optimistic that there will be a vaccine by the end of the year and that we [long term care] will be prioritized. Even with that it will take a couple of months for our staff and residents to be fully vaccinated.”

Providers Make Progress, But Public Limits Success
Parkinson says the way in which providers have learned to keep the infection out of facilities, and if not able, to treat those infected, has improved dramatically since the crisis started in March.

“Providers have gotten really good at taking care of people with COVID. We started with absolutely no knowledge of how to treat this virus, and they quickly demonstrated that given the proper PPE [personal protective equipment], therapeutics, and resources that they can get most people well,” he says.
“There have been hundreds of thousands of recoveries of residents in our buildings, and the success rate is growing all the time.”

The problem, however, is not limited to what happens inside nursing homes and assisted living communities. “Unfortunately, the public has proved to be completely incapable of social distancing and of wearing masks, so the incidence of COVID in the general population has not declined, and in fact in some parts of the country it continues to increase, which puts enormous stress on long term care facilities and makes containing the virus very hard,” Parkinson says.

He adds that he does not think the public is suddenly going to get more disciplined, and, therefore, for the next five or six months providers will continue to fight COVID before there is a vaccine.

“It is going to be just as challenging as it has been for the last six or seven months,” Parkinson says.

Fatigue Has Set in

The association leader says it is important to realize that these next months will be even harder because of the fatigue factor, born from the long days and nights logged by all involved in the battle.

“Providers are tired. Whether you are a frontline CNA or a CEO, all these folks have worked basically nonstop for the last seven months. And, fatigue has set in, and for them to be able to continue this fight for the next six months as I think will be required is going to be very, very tough for them,” Parkinson says.

As head of AHCA/NCAL, he thinks the most important thing the organization has done for the past seven months is being very effective at getting provider members the resources that they need. “The government relations team led by Clif Porter has been really effective in convincing Congress and HHS [Department of Health and Human Services] that our members need support, and the support has been provided.”

Parkinson says when combining the federal support with the state aid that has been provided, “we are probably well over $20 billion in relief that has been provided so far.” But the assistance cannot stop now as he says the continued challenge for the next six months is to keep Congress and HHS focused on “that continual need that providers have.”

Money Issues Hit All

Every provider, he notes, has been negatively affected in that they have had significant COVID in their buildings or if not then because census is down across the board.

Providers that have been hit hard by COVID have been able to stay afloat from the federal and state assistance, but if there is not more help in 2021 some people will be in real financial trouble. “So far the funds have been adequate, but the challenge right now is to keep them going in 2021,” Parkinson says.

“If we had not had federal funding that we have received so far there would have been hundreds of buildings that were already closed. That funding kept those buildings open, and similarly we need that continued funding in 2021 or hundreds of buildings will close.”

Who makes many of the high-level decisions could be impacted by the election results that occur on Nov. 3. Normally, Parkinson says the election outcome affects the profession in a very dramatic way, but in 2020 with the pandemic there has been bipartisan support for taking care of older people and supporting long term care.

“Regardless of the outcome of the election, we are going to get a good response for continuing assistance. The changes may be bigger on the regulatory side, as some may look at what has happened at nursing homes and look to overregulate or penalize more. Others who get elected want to be more collaborative [with the long term care sector]. We are hopeful members who get elected to Congress want to be collaborative,” he says.

When Will Census Recover?

Providers are also hopeful for a return of normal business in order to recover census and fill beds with people who need long term and post-acute care. Parkinson says the “when will we recover” question is the most important one.

“Census in nursing homes dropped about 10 percent very quickly in April and May and seemed to bottom out on June 1. But it has not gotten any better,” he says.

“For the sector to truly recover financially, census has to recover. My view is that once we have a vaccine, people will renew their confidence in our care setting, and there will be a slow recovery of census. It will not snap back immediately; it will be more like half a percent or 1 percent a month for a year or two, and then census will recover.”

Parkinson says he does not believe “we will have a permanently lower census as a result of the pandemic. Our services are necessary for people. The people who live in our buildings are just not capable of living at home, so once we get their confidence back, our census will recover, but it will take a year or two.”