<figure>
 <img src="https://media.eaglewebservices.com/public/2020/5/1588962826494.png" alt="Protesters outside the Statehouse in Topeka demanded last month that Gov. Laura Kelly let businesses and activities return to normal. Nomin Ujiyediin / Kansas News Service" />
 <figcaption>Protesters outside the Statehouse in Topeka demanded last month that Gov. Laura Kelly let businesses and activities return to normal. Nomin Ujiyediin / Kansas News Service</figcaption>
 </figure>By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2020-05-08/the-kansas-economy-is-reopening-and-experts-say-nursing-homes-arent-ready">Kansas News Service</a>CORRECTION: A previous version of this story incorrectly stated the 
requirements imposed on nursing homes by the Centers for Medicare and 
Medicaid.TOPEKA — Residents and patients in under-resourced
 nursing homes, where outbreaks have fueled more than half of Kansas’ 
coronavirus deaths, will likely pay the steepest price for the state 
reopening its economy.Nursing homes, assisted living centers and 
similar state-licensed facilities don’t have enough protective gear or 
testing to shield the people who are most vulnerable to COVID-19, 
experts say. And even if the facilities stay on lockdown, the state’s 
decision to lift stay-at-home orders could lead to more asymptomatic 
staff unwittingly carrying the virus to work.“The more you open 
up the economy, the more you're going to have these rippling effects 
where staff members may be going home to other family members who are 
interacting with other parts of society,” said Carrie Henning-Smith, a 
professor of health policy and management at the University of 
Minnesota.As of Friday, Kansas’ more than 450 long-term care 
facilities accounted for fewer than 1 in 10 of the state’s confirmed 
cases. Yet the 22 clusters of coronavirus linked to them are the single 
largest source of deaths from the pandemic with 85. <a href="https://www.kcur.org/community/2020-05-07/a-covid-19-hot-spot-in-prairie-village-now-accounts-for-57-known-cases-and-9-death" target="_blank">One cluster in Johnson County</a> has sickened nearly 60 and killed nine and another in <a href="https://www.kansascity.com/news/business/health-care/article241807416.html" target="_blank">Coffey County</a> has had similarly tragic results.Here’s
 what nursing homes, health policy analysts and academics say needs to 
happen in order to save the lives of older people in Kansas and 
nationally.<h2>Where are the tests?</h2>COVID-19
 testing has become more common in Kansas in the past few weeks. Yet 
limited supplies mean testing remains largely reserved for people with 
symptoms or known exposure. Overall, the state has lagged most of the 
rest of the country in ramping up access.Experts say places that 
care for older adults should test all staff regularly — once a week or 
more — regardless of whether they have symptoms. But that remains a 
distant goal for Kansas and the U.S.“We're nowhere near that,” Henning-Smith said. “Any routine testing would be an improvement over what we have.”Nursing
 homes and similar facilities rely on sending samples to external labs, 
but could better protect residents with rapid on-site testing.“We
 could test any and everybody,” says Monte Coffman, executive director 
of Health Management of Kansas, which runs skilled care centers in 
Coffeyville and Iola. “That's how we (could) keep the virus out of 
institutional care.”<h2>Where are the masks and gowns?</h2>Staff
 at many long-term care facilities have spotty access to 
professional-grade protective gear. Instead, nursing home administrators
 say, they wear home-sewn fabric face coverings to help save surgical 
masks for critical times, like bedside care or serving newly admitted, 
temporarily quarantined residents.Prices for professional gear 
spiked after the pandemic hit. Vendors who were slammed with orders sold
 to bigger buyers. LeadingAge Kansas, the state’s association for 
nonprofit aging services, looked into bulk purchasing for its members, 
but struck out.CEO Debra Harmon Zehr said the market appears to 
be improving, and she welcomed the federal government’s decision to send
 two weeks of surgical masks, gowns and eye protection to nursing homes.But, she said, it’s “too little, too late.”“We
 don't have adequate testing, adequate funding, adequate supplies, and 
yet you've got this wolf in the chicken house,” she said, and “(we’re) 
expected to keep it at bay.”<h2>Are the rules consistent at facilities?</h2>Kansas
 is among 26 states that recommend but don’t require assisted living 
facilities to keep visitors out during the pandemic, according to <a href="https://www.kff.org/medicare/issue-brief/data-note-requirements-for-nursing-homes-and-assisted-living-facilities-in-response-to-covid-19-vary-across-states/" target="_blank">the Kaiser Family Foundation</a>. Nor has Kansas adopted requirements for staff to undergo daily coronavirus screenings and don protective gear.Those
 steps are important, the health organization said, because the federal 
guidance on these measures is only for homes under their regulatory 
control, such as nursing facilities. Much long-term care falls under 
state control, such as assisted living centers.The lack of 
requirements in states like Kansas is “shocking” given the risks of 
coronavirus spreading in a facility, said Joseph Ouslander, a professor 
of geriatric medicine at Florida Atlantic University and the executive 
editor of the Journal of the American Geriatrics Society.“It can be like a tinderbox,” he said. “It’s a perfect storm.”While
 screening workers daily, donning protective gear and banning visitors 
can’t guarantee a facility will be outbreak-free, Ouslander sees them as
 basic steps that shouldn’t be decided facility-by-facility. States can 
require these measures, he said, without penalizing facilities that 
simply can’t get enough protective gear to fully comply.A 
spokeswoman for the Kansas Department for Aging and Disability Services 
said in an email that adopting the extra state requirements would take 
resources. And right now, she said, the agency’s staff is focused on 
infection-control efforts under guidance from the Centers for Medicare 
and Medicaid.<h2>Why aren’t outbreaks being disclosed publicly?</h2>Many
 states publicly report a raft of details about coronavirus outbreaks in
 long-term care facilities, the Kaiser Family Foundation said, <a href="https://www.kff.org/medicaid/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/" target="_blank">but, again, not Kansas</a>. Kansas doesn’t publicly list which nursing homes have COVID-19 cases and deaths.Some
 local health departments have, like in Johnson County, where COVID-19 
outbreaks at long-term care facilities have killed 25 people. The county
 discloses case counts and deaths by facility <a href="https://public.tableau.com/profile/mapper.of.the.day.mod.#!/vizhome/covid19_joco_public/Dashboard" target="_blank">on its website</a>.Advocacy
 groups want the information made public so communities can stay 
informed on the toll coronavirus is taking and demand better resources 
and care. Researchers want the data to scour for patterns, such as links
 between outbreaks, staffing levels and other measures of care.<a href="https://www.kff.org/medicaid/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/" target="_blank">Recent federal guidance</a> will push nursing homes to report cases and details directly to the Centers for Disease Control and Prevention.“So
 we would expect to see some form of public data available at some 
point,” said Priya Chidambaram, a Medicaid expert at the Kaiser Family 
Foundation. “We don't have a timeline yet.”<h2>Will there be more money?</h2>Kansas
 nursing home advocates say they plan to make their case to Gov. Laura 
Kelly that elder care in the state needs more funding, something they’ve
 pressed in the Legislature year after year.Low Medicaid 
reimbursement payments to nursing homes makes it hard for them to keep 
up quality in the best of times, advocates like LeadingAge argue. During
 a pandemic, it means homes can’t afford inflated prices for protective 
gear and other increased costs.This week, <a href="https://kansaspublicradio.org/npr-news/nursing-home-association-asks-10-billion-federal-coronavirus-relief-funds" target="_blank">a national trade group</a>
 called on the Trump administration to dole out $10 billion in stimulus 
money to nursing homes, but they’ll have to compete with hospitals and 
other health care providers jostling for more of that pot, too.Celia
 Llopis-Jepsen reports on consumer health and education for the Kansas 
News Service. You can follow her on Twitter @celia_LJ or email her at 
celia@kcur.org. The Kansas News Service is a collaboration of
 KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on
 health, the social determinants of health and their connection to 
public policy.

Economy is reopening, but experts say nursing homes aren’t ready