Buncombe County to fund testing for long-term care staffers

$75 can buy a lot of things: groceries, a night of babysitting, a few tanks of gas. Or, it can pay for a COVID-19 test — a hefty sum for long-term care facility employees without insurance coverage to shell out, especially when testing might need to be repeated weekly. 

Buncombe County’s nursing homes have borne the brunt of local COVID-19 cases so far. Despite health officials’ attempts to quash the county’s six current outbreaks  — defined by the N.C. Department of Health and Human Services as two or more lab-confirmed cases of COVID-19 in staff or residents at a single facility — viral infections continue to spread. Right now, the primary need in long-term care facilities is testing, Dr. Jennifer Mullendore, the county’s interim health director, told the Buncombe County Board of Commissioners on June 16. 

The commissioners directed county staff to use up to $250,000 of previously allocated COVID-19 relief funds toward testing all employees of Buncombe’s 35 licensed skilled nursing and adult care homes, allowing the county to become the payer of last resort for individuals not covered by health insurance. The funding will also be used to cover repeated testing costs when outbreaks occur. 

Testing long-term care residents, who are all covered by insurance, is fairly simple, Mullendore explained. But health officials are “hitting a wall” when it comes to testing facility staff.

“We have some staff who don’t have insurance, we have some staff where their insurance plan pays for a few rounds of testing but no more, and some [have] health plans where testing has to be ordered by a primary care provider,” she said. 

County health officials currently partner with Raleigh-based MAKO Medical Laboratories and Asheville’s Range Urgent Care to conduct testing at long-term care facilities. The Medicare-allowable fee for a COVID-19 test is $100; MAKO Medical offers testing for $75, or $72.50 if tests are paid for in advance. Individual facilities may have pre-existing contracts with other testing providers, Mullendore noted during a June 18 press conference. 

If a resident or employee at a congregate living facility tests positive for COVID-19, state guidelines require all residents and staff to be tested immediately. The state has asked facilities to then follow recommendations from the federal Centers for Disease Control and Prevention, which call for weekly retests of all previously negative staff and residents until 14 days have passed with no new positive cases.

The primary need for testing is at Aston Park Health Care Center, Mullendore explained, the site of the largest COVID-19 outbreak among North Carolina long-term care facilities. COVID-19 testing for roughly 96 Aston Park employees costs over $7,000 weekly. 

Approximately 1,000 of the nearly 2,400 employees working in the county’s 35 “most fragile” facilities have not yet received COVID-19 tests, said Buncombe County Manager Avril Pinder. Completing a first round of “point-in-time” testing for those workers will cost up to $80,000, she explained, depending on how many have health insurance. 

Repeated testing will keep long-term care facilities protected, Mullendore said. While baseline point-in-time testing reveals existing cases, there’s no guarantee an employee won’t contract COVID-19 after the initial test.

“We have to remember every one of us, if you followed every one of our interactions, could indirectly lead to someone who is on staff at a long-term care facility,” Mullendore explained. “With the level of community spread that we have, assuming that all of the staff act the same when they go home, it’s potentially luck.” 

Of the county’s 35 skilled nursing and adult care homes, 16 are expected to complete initial staff and resident testing by Friday, June 26, Mullendore said. A deadline for the baseline testing to be completed countywide has not been set. 

According to data released June 19 by NCDHHS, the following COVID-19 outbreaks are reported at Buncombe facilities: 52 staff, 82 residents and 30 resident deaths at Aston Park Health Care Center; two staff and one resident at Brian Center Health and Rehabilitation/Weaverville; four staff at Carolina Pines at Asheville; seven staff, three residents and one resident death at Deerfield Episcopal Retirement Community’s Simonds Health Care Center; two residents at Harmony at Reynolds Mountain; and five staff and five residents at Stonecreek Health and Rehabilitation.