Reversing course on disclosure, Virginia officials reveal which nursing homes face outbreaks

After months of resistance, Gov. Ralph Northam announced Friday that the Virginia Department of Health would begin releasing facility-specific information on COVID-19 outbreaks within long-term care facilities.

The initial data shows that a total 178 long-term care facilities, including nursing homes, assisted living centers, and campuses with multiple levels of care, have experienced outbreaks of COVID-19. Seventy-one of those are “outbreaks in progress,” according to VDH.

The decision to release the numbers represents an abrupt reversal for Northam, whose administration previously insisted that releasing the data would violate the state’s patient privacy laws. VDH officials have repeatedly stated that the state’s long-term care facilities are considered “individuals” with confidentiality rights. Northam’s spokeswoman, Alena Yarmosky, previously said the nondisclosure policy was “based on guidance from the Virginia Commissioner of Health, in consultation with the Office of the Attorney General.”

Yarmosky said Friday that the decision was “based on changing circumstances with the COVID-19 pandemic in Virginia” and again made in consultation with Health Commissioner Dr. Norman Oliver.

“At the start of the pandemic, fewer COVID-19 outbreaks made it difficult to release the names of these facilities while upholding anonymity requirements under Virginia code,” Yarmosky wrote in an email. “Now that there are more cases in Virginia, it is less likely that releasing this information would compromise anonymity or limit cooperation with a public health investigation. It is also important that this information is released now, given inconsistent information reported at the federal level.”

Yarmosky was referring to data recently released by the U.S. Centers for Medicare & Medicaid Services, which began collecting facility-specific information on COVID-19 outbreaks in May. But the agency’s first weekly release was riddled with errors, adding to widespread confusion over how the virus has been impacting long-term care facilities in Virginia.

The policy change was accompanied by an announcement that Virginia would devote $246 million, largely in federal CARES Act funding, to nursing homes and assisted living facilities. That total includes $152 million in federal relief dollars already delivered to nursing homes, according to a news release from the governor’s office. $20 million of the funding will be directed toward assisted living centers (“nearly doubling state funding for these facilities,” according to the release), which have not previously received federal support.

The total allocation will “support nursing homes and assisted living facilities in addressing staffing shortages, increasing infection control measures, and purchasing personal protective equipment (PPE), as well as complying with the new testing requirements,” according to the release.

More than $56 million will go towards ongoing testing for nursing home residents and staff — one of the requirements for reopening the facilities to visitors.

The long-term care industry has spent weeks advocating for the state to dedicate more federal funding to nursing homes and assisted living facilities, which have been disproportionately affected by the COVID-19 pandemic. As of Friday, long-term care facilities accounted for 62 percent of the state’s 1,602 deaths.

Those calls became more urgent in May, when CMS released sweeping recommendations calling for dramatically expanded testing as a condition for reopening nursing homes. VDH estimated that it could cost between $6 million and $10.5 million to test every resident and staff member in the state.

Under new state-specific guidelines, also announced Friday, nursing homes will be required to conduct baseline testing for all residents and staff in order to enter Phase Two reopening, which allows facilities to reestablish communal dining and group activities (though visitation is still “generally prohibited,” according to state and federal guidance). The Virginia Department of Health has been coordinating with the National Guard to perform that testing — also known as point prevalence surveys — for the state’s 287 nursing homes, with a goal of finishing by July 15, according to the release.

Facilities will also be required to conduct regular testing of staff and residents during the first phase of the reopening process with funding assistance from the state. The current guidelines only apply to nursing homes. Reopening guidance for assisted living centers and memory units is “forthcoming,” according to VDH.

The administration’s approach to long-term care facilities — especially the decision to withhold facility-specific outbreak information — has attracted bipartisan criticism. Republican House Leader Todd Gilbert, R-Shenandoah, blasted the reversal in a Friday statement, saying that he “[couldn’t] fathom” the reasoning behind the announcement.

“Families have sought this information — information they could use to protect their loved ones from a lethal threat — for months,” Gilbert added. “… If it is legal to release the information now, it was legal to release it when it was first requested. Perhaps, had the Governor not been distracted by his political rehabilitation, he could have realized this earlier and lives could have been saved.”