PEORIA — Though nearly three months have passed since Illinois Gov. JB Pritzker announced a plan to test residents and staff at all nursing homes without known cases of COVID-19, administrators at area long-term care facilities are still grappling with the directive.


"Every provider in the state of Illinois would like to know exactly what the guidance is for testing. There continues to be a good bit of confusion," said Karen Messer, president and CEO of LeadingAge Illinois, a group which represents long-term care facilities all over the state.


While testing guidelines are fairly clear for facilities where there is an outbreak, facilities with no known cases have not been given clear directives. And because of concerns about cost, the invasive nature of the test, and questions about the usefulness of administering a point-in-time test only once, some administrators have continued to delay facility-wide testing.


"We recognize that we will have to do facility-wide testing to reopen, but we want to wait to do that until we get clear guidance on what that means," said Matt Feucht, administrator at Apostolic Christian Skylines in Peoria. "We don’t want to begin testing until we have a case, or we get clear guidance because at least at this point in time it appears that it is going to be very expensive."


While tests for residents are currently being covered by their individual health insurance plans, there is some question about who would have to pay for tests administered to staff, said Feucht.


"Every time we test all of our staff here in the organization it will cost $25,000," he said. "We probably test 130-140 staff each time, and it’s like $179 for each test."


Administrators at long-term care facilities all over the state are concerned that they will be asked to shoulder the cost of tests in the future, said Messer.


"That’s probably the biggest concern for our providers, that eventually someone is going to say ‘we’re not paying for this anymore,’ " she said. "We just heard late last week from a member in Urbana that a small insurance provider there is beginning to question the medical necessity of the frequency of the testing."


Initial efforts to do blanket testing at long-term care facilities were designed to stop the silent spread of the virus among vulnerable populations. On April 20 Pritzker announced a plan to have strike teams visit every nursing home in the state to do baseline testing. The program, which has yet to reach the Tri-County Area, was beset with organizational problems, said Messer.


"The team would show up, they would open up the supply package sent from the department and things would be missing," said Messer. "There were many, many, many problems with just the testing supplies. So here you have four or five nurses coming from the Illinois Department of Public Health, traveling to sites, they get there and they can’t use what’s there. So how efficient was that? And we were hearing it a lot."


Perhaps because of these problems, Pritzker put forth a new directive May 28 ordering all long-term care facilities to figure out how to test residents and staff themselves, but no deadlines were issued and frequency of testing was not addressed.


Lacking clear guidance, facilities have been essentially left to their own devices. Assisted living facilities have dealt with added confusion the original directive was for skilled nursing facilities, which are regulated by a different organization.


"We will be testing all residents and staff here, but we haven’t set a date because the priority is skilled nursing first, and then assisted living," said Janelle Clark, executive director for Serenity Assisted Living & Memory Care in East Peoria. "And we have been lucky enough not to have an outbreak. That would jump you up on the list."


Some area long-term care facilities have taken the initiative to test staff and residents. In Peoria County, Sharon Healthcare, Hunter House, Heddington Oaks and Heartis Village have all done facility-wide COVID-19 testing, said Peoria City/County Health Department administrator Monica Hendrickson.


While testing is important for controlling the spread of COVID-19, it is only one part of the plan IDPH has asked long-term care facilities to implement in an effort to stop the spread, said Hendrickson.


"Testing is definitely one component of it, but you can have a million tests and if you don’t have infection control and hygiene and the PPE and everything else that goes around it, the tests are ineffective," she said. "Our long-term care facilities were tasked initially with assessing their facilities and creating a plan that looked at a variety of things, from visitor restriction, to how they did education and screening of their staff and residents, what their PPE was, hygiene and disinfecting, as well as looking at patient surveys."


The understanding of how to manage COVID-19 in congregate living settings continues to grow and evolve, and one thing authorities have learned is that aggressive testing can lead to a different set of problems in long-term care facilities, said Hendrickson.


"Why some of this language from the state has changed over time is there was recognition about creating burden as well as care issues. For example, if you tested, everyone and all of your staff had to go into quarantine, that’s going to create other health issues on that vulnerable population," she said. "And that really happened a lot in some of the northern counties… With that drastic, ‘lets test everyone’ policy some of those facilities lost a lot of staffing."


While the best policy is still to identify and quarantine infected individuals, staffing issues have to be taken into consideration, said Hendrickson.


"I think we’re seeing that in healthcare workers in general," she said. "In guidance from the CDC, if you have asymptomatic, individuals that can wear proper PPE they don’t necessarily have to be excluded from work … If you are in the middle of a high capacity situation with a lot of absenteeism, if you don’t have a lot of staffing available, one of the things they were looking for is if are you able to properly PPE and be able to work still ...The risk of them spreading it if they are asymptomatic and wearing proper PPE decreases considerable."


Leslie Renken can be reached at 270-8503 or lrenken@pjstar.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.