Recently, state and county officials rolled out plans for mass COVID-19 testing in nursing homes. But there’s no roadmap for widespread testing in another senior care venue: assisted living facilities.
Consequently, in assisted living facilities there’s little asymptomatic testing of residents and staff, potentially missing those who are unwittingly spreading the virus, according to a broad swath of those in the senior care industry. In contrast, most of the region’s nursing homes have completed at least one round of universal testing.
There are nearly 600 assisted living facilities in San Diego, from small homes to upscale facilities with 250 residents. Just as diverse is the care they provide. Some facilities primarily help with bathing, dressing and medication management. Others care for those with dementia or other complex needs, who are especially vulnerable to COVID-19.
But a push for mass testing in senior facilities hasn’t extended far beyond skilled nursing facilities, frequently called nursing homes.
“Ideally there would be the same level of guidance and support for testing in assisted living facilities,” said Dr. Taib Rawi, owner of a San Diego-based mobile geriatric practice. “It’s a high-risk population.”
San Diego County’s public health department, which guides testing in senior facilities, has followed the playbook of two state agencies.
In late May, the California Department of Public Health called for universal testing in nursing homes. Similar prodding hasn’t come from the California Department of Social Services, which regulates assisted living facilities, board and care facilities and other care homes.
Scott Murray, a Department of Social Services spokesman, in an email said that detailed resident and staff testing guidance will soon be issued, but he didn’t respond when asked if the plan would amount to universal testing. In addition, Murray said nursing homes differ from residential care venues like assisted living facilities. The latter are “non-medical facilities that provide assistance with activities of daily living,” he said.
Industry advocate Chris Murphy said that’s an artificial boundary because some assisted living facilities have hospice and bedridden residents, and even facilities with residents who are simpler to care for face a fast-spreading virus in close quarters.
“They need a full court press to get everybody tested in the assisted living facilities, just as they have done with skilled nursing facilities. The demographic isn’t significantly different,” said Murphy, the executive director of Consumer Advocates for RCFE Reform, a San Diego nonprofit focused on residential care facilities for the elderly, or RCFEs.
She added months into the pandemic neither the Department of Social Services nor the county have “stepped up to lead on testing”
The California Department of Public Health’s nursing home testing plan, while criticized for coming far too late , jump-started testing.
From mid-May to mid-June, the county’s public health lab processed about 17,000 nursing home test kits, up from 1,500 test kits the month before, according to county data. Facilities can also send tests to private labs.
As of June 18, 70 of the region’s 86 nursing homes had tested all residents and staff at least once, some with the county’s help. The remaining facilities had started mass testing.
Under California Department of Public Health guidelines, facilities are asked to complete at least one round of universal testing, plus retesting, with more frequent retesting when cases are found.
It’s unclear how many assisted living facilities in San Diego have tested everyone. The county has aided some assisted living facilities with testing, in part because it’s uncommon for these facilities to employ licensed nurses, who are better equipped to perform testing.
The county lab from mid-May to mid-June processed 2,100 test kits from residential care facilities, which includes assisted living facilities, more than four times the prior month.
Because assisted living facilities lean on county testing support, mass testing would be difficult, said Cyndy Minnery, who advises local senior facilities. Compounding the challenge: the sheer number of facilities, some of them small homes with little time and money to spare.
But, she added, it would help if the Department of Social Services got more involved.
“In assisted living there’s testing of the symptomatic, but generally not the asymptomatic,” said Minnery. One exception: Facilities require a negative COVID-19 test to admit a resident, whether showing symptoms or not.
It’s especially important, Minnery said, to test staff, who due to low pay frequently work at multiple facilities, increasing the likelihood of the virus spreading. Typically, staff receive a temperature check before entering facilities, which shouldn’t be relied on as the only tool  for detecting COVID-19.
Rosemary Vasquez, whose husband of 64 years lives in Brookdale Oceanside’s memory care unit, said she was relieved to hear the facility tested all staff and residents on June 16. Even better were the results: Everyone in the assisted living facility came back negative.
“It was comforting that everyone was tested,” Vasquez said. Senior facilities have been on lockdown since March to stem the spread of COVID-19, meaning her connection with her husband is limited to phone calls and photos that the facility sends.
“It’s really, really hard,” she said.
A spokesman for Brookdale Oceanside said the county picked up the tab for testing. Facilities can also turn to health plans and private labs, a county spokeswoman said.
“Who pays has been a difficult nut to crack,” said Dr. Francesca Torriani, the medical director of Infection Prevention and Clinical Epidemiology at UC San Diego Health.
Private, federal and state insurance can cover resident testing, but it’s less common for staff testing to be covered. Further, many workers do not have insurance. Torriani said even when insurance covers staff and resident testing, for facilities it’s complicated to bill various sources.
The National Center for Assisted Living has requested $5 billion in federal aid for supplies, as well as expanded testing and added staffing. Unlike hospitals and nursing homes, assisted living facilities were shut out of the Coronavirus Aid, Relief and Economic Security Act, the organization’s leadership has argued.
Larry Polivka, executive director of the Claude Pepper Center, which studies aging-related issues at Florida State University, said nationally it seems assisted living testing lags far behind that of nursing homes.
“Assisted living hasn’t had the same attention of nursing homes,” he said. “But the fact is in both you have older folks living in close quarters. So I don’t see why you would make a distinction in your testing policy.”
Several assisted living facilities did not return calls requesting comment on testing.
Sally Michael, president of the California Assisted Living Association, said in a statement: “County health officials determine testing priorities, but as testing capacity improves, we are likely to see more testing throughout the system.”
In San Diego County, 14 assisted living facilities  have at least one staff or resident COVID-19 case, according to state data. But the figures omit facilities with six or fewer residents — or about 74 percent of San Diego’s 593 assisted living facilities.
Jared Whitlock reported this story with support from the 2019 Impact Fund, a program of the USC Annenberg Center for Health Journalism .