Nursing homes have been hit hard during the coronavirus pandemic, accounting for 41% of the nation's deaths due to the disease. With states reopening, advocates are concerned that without adequate testing and surveillance, senior residents will once again be the hapless victims of this highly contagious virus.

Kaiser Health News reports that the Centers for Medicare and Medicaid Services warns nursing homes should be among the last places to reopen and urges "extreme caution."

"The reality is that too many nursing homes and other aging service providers are still desperately in need of testing and personal protective equipment (PPE), and we don't know when or if it's coming," said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit aging services, according to The Hill.

The Trump administration has recommended that nursing homes should not reopen until they have protective gear and appropriate staffing, but it is leaving the ultimate decision to state governors, according to The Hill. The administration also recommended that all nursing home staff and residents get tested over the next two weeks and said it would be supplying more than 15,000 Medicare and Medicaid-certified facilities with PPE. Visitors should not be allowed until staff and residents have tested negative for the virus for at least 28 days, advised federal authorities, according to Kaiser Health News.

Many state governors, including Gov. Andrew Cuomo of New York, have already mandated testing. Cuomo is sending 320,000 testing kits to nursing homes throughout the state and said staff members must be tested twice weekly.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that along with testing, nursing homes have to institute surveillance plans to keep both residents and staff safe by preventing infections from coming into the building and isolating sick people if they do become infected.

"In the long range, we will have to have infection control capabilities in nursing homes that are really pristine and really unassailable," he said, according to The Hill. "General testing for all is a good place to start but when you look where you are going in the future, there needs to be a significant degree of surveillance capability."