May 27, 2020

The Honorable Andrew M. Cuomo

Governor of New York State
New York State Capitol Building
Albany, NY 12224

Re: Nursing Home Testing Mandate

Dear Governor Cuomo:

Let me start by saying that I, and the physicians and directors who join me in writing this letter, wish to
thank you for your determined leadership during this unexpected crisis. Your confident ability to react
quickly to problems as they arise is both admired and appreciated by me, as an executive, and the medical
community as a whole.
There are, of course, many choices as to the correct manner in which to respond to certain issues, and that is
the reason we write to you today.
On many occasions, Staten Island’s nursing home medical directors, working alongside my Director of
Health and Wellness, Dr. Ginny Mantello, have interacted with members of your staff and of the New York
State Department of Health (NYSDOH), to create and share extensively researched population-level health
protocols. As well, they have been working diligently since late March to locate and purchase tests that
would identify both nursing home residents and staff members who are infected and/or been previously
exposed to the COVID-19 virus.
In late April, after approval through NYSDOH, we finally connected with a medical lab which had created
an antibody test kit that could be purchased at a reasonable price, and who had received an Emergency Use
Authorization to manufacture and market it. We immediately ordered many thousands of these test kits for
our nursing homes here on Staten Island. We have also been trying very hard to get the diagnostic PCR
swab tests, through City and State public health and private labs, and have been since the onset of this
pandemic.
As you can see, we clearly agree that testing the staff and residents is an important piece of the puzzle.
However, given existing circumstances, it has been difficult – nearly impossible, in fact – for the nursing
homes to comply with your recent mandate and Executive Order 202.30. They all lack, to one degree or
another, some of the necessary material to comply with the directive.
Additionally, the amount of testing required is well beyond the capabilities of all local labs, and even if it
weren’t, it is well beyond the financial ability of the nursing homes to afford.
What is even more disturbing are the staffing issues that this mandate has started to create, and which is
certainly going to get worse. In the week since the testing started, throughout the ten Skilled Nursing
Facilities (SNFs) on Staten Island, dozens of staff members have tested positive using PCR swabs. However,
a great majority of those staffers had a previously tested positive on PCR with known diagnosis of COVID-
19, and had already been furloughed for two weeks. In following the directives of the new mandate, the
SNFs are forced to send them home for an additional two weeks, even though CDC advises that patients
may remain PCR positive for many weeks while not being infectious beyond ten days. This results in large
staff shortages, and subsequent gaps in resident services and care.
We all take testing seriously, especially since we have lost personnel and leadership, due to both morbidity
and mortality to this disease. To make matters worse, insurance companies and 1199 SEIU are refusing to
pay for frequency of testing.
These issues, as well as other administrative and financial burdens, are going to result in an unacceptable
lowering of both specialized and routine levels of care, and an equally unacceptable level of suffering is
inevitable. Not only do these SNFs lack the manpower, they lack sufficient PPE and N95 masks to actually
perform the swab testing of their staffs. The supplies and swabs sent by the state are hardly enough to cover
even half of what is necessary, even if the testing was done only once a week. As a result, the SNFs are
having to spend large portions of their time trying to find labs and resources to help comply with this
executive order.
We therefore are requesting, pleading, with you to relax the mandated requirements, perhaps aligning them
with the current CDC guidance, which suggests testing the staff once a week. Additionally, for nursing
homes to comply even with that relaxed regulation, the state would need to provide the necessary resources.
We would also require linkages with laboratories and other facilities capable of conducting the tests without
billing the SNFs, even if that meant mandating managed care organizations to cover the cost of the testing.
On Staten Island we have a unique situation. Our ten skilled nursing facilities all have a close relationship –
almost a partnership. Together we urge you to go back to the original plan: start with antibody testing on all
staff and residents, and exclude from the mandate those that are positive for IgG. Additionally, those that
have previously tested positive on PCR should also be excluded.
Governor Cuomo, we are not exaggerating when we say that this mandate, as it currently stands, will put
such a financial and staffing strain that it may cause the closure of many of our skilled nursing facilities.
Certainly, this is something none of us want, and given the current medical crisis, we simply cannot afford to
lose them.
The medical industry is in an extremely dire situation, with which we cannot cope unless we have a partner
in both the city and state. We share the same goal, that our skilled nursing facilities help stop the rapid
spread of the virus in this extremely high-risk population, thereby saving more lives. SNFs have been heroic
in assisting to decant strained hospitals and assist patients in their road to recovery from COVID-19. We
have seen the fine work done by local institutions where we celebrate the successful discharge of patients’
home after their COVID-19 ordeal. Do not let a few bad apples turn your office from the heroic work often
done in the rehabilitation and long-term care industry.
We urge that you consider relaxing your mandate, and we are certainly more than happy to continue to work
hand-in-hand with your office, the New York State Department of Health, and the New York City
Department of Health.
Thank you for your kind attention, and I hope we can, together, solve this problem.
Sincerely,

James S. Oddo
President, Borough of Staten Island

Lorri A. Senk, LNHA David Rose Max Kenigsberg

Administrator President & CEO Administrator
Clove Lakes Health Care Eger Health Care New Vanderbilt Rehab
& Rehabilitation Center Inc. & Care Center

Philip Buchsbaum, LNHA Michael Kraus Elizabeth Forster, LNHA,RN,BSN

Administrator Administrator Administrator
Richmond Center Silver Lake Specialized Verrazano Nursing Home
Care Center