If Utah’s new goal of keeping the coronavirus fatality rate below 1% has a single nemesis, it’s nursing homes.

Nursing homes and similar types of long-term care facilities, such as rehabilitation centers, homes for the disabled and licensed assisted-living centers, have accounted for about 43% of Utah’s COVID-19 deaths. The nationwide percentage is about the same.

A federal plan released last month calls for frequent coronavirus testing of long-term care residents and staff in hot spots like those found in Utah. That testing can also help Utah meet one of its objectives in keeping each outbreak at a long-term care facility to under five new cases.

But people working in Utah’s long-term care industry warn they may need some help to meet the testing and mitigation objectives — and prevent deaths.

“There is now a new hurdle in front of us,” said Joe Walker, the CEO of Advanced Health Care, which operates short-term transitional facilities in Utah, “and that is this testing mandate.”

In guidelines issued Aug. 26, the Centers for Medicare & Medicaid Services told long-term care facilities they need to perform regular testing. For facilities in counties where the positive testing rate is 5% to 10% — like Salt Lake County — residents and staff must be tested once a week.

In counties that have a positive rate greater than 10%, like Utah County, the residents and staff must be tested twice a week.

That’s a burden for facilities like the one Advance Health Care operates in Orem. Testing everyone in the 24 beds and all the staff that care for the residents costs between $20,000 and $30,000 every time, Walker said.

Federal relief money has paid for many of the test kits and the machine to process them, but the kits are going to run out if Congress doesn’t pass another relief package, Walker said, and the facilities will have to pick up the costs.

“A nurse that would ordinarily spend eight hours caring for patients is instead spending eight hours running the testing that day,” Walker said.

Walker says the Utah Department of Health has done a great job helping facilities prevent or mitigate outbreaks, but long-term care centers may need further help if they are going to meet the federal testing mandates.

Allie Spangler, spokeswoman for the Utah Healthcare Association, which represents long-term care facilities, said her association and its members have been working with suppliers to acquire testing kits. Those that are available can run as much as $32 a piece.

Some facilities could run out of kits or the money to buy them and will need help from the state, she said.

“At this point just being able to have access to the supplies would be the most helpful,” Spangler said.

Outbreaks in Utah’s 300-plus long-term care facilities declined in August with the rest of the statewide infection totals, and the Utah Department of Health issued guidelines allowing for family visits again — albeit outdoors and only if the facility could meet a set of criteria designed to minimize the risk of infection to residents or staff. Many with loved ones in nursing homes hadn’t been able to have an in-person visit since February, and visits through windows or over a digital screen have been a defining feature of the pandemic.

Recently, the number of long-term care facilities with outbreaks has inched back up. There were 26 facilities with outbreaks on Friday, according to the Utah Department of Health.

The department has deployed rapid-response teams to nursing homes and similar centers when outbreaks have been suspected. The teams provide testing, helps create a plan to isolate the infected and ensures the facility has enough staff.

Lt. Gov. Spencer Cox, who is leading Utah’s response to the pandemic, on Thursday announced the new goal of keeping the fatality rate below 1%. Tom Hudachko, the spokesman for the Utah Department of Health, said there are no new plans for preventing the spread into long-term care facilities, but the pandemic policymakers have set a goal of keeping each outbreak to less than five cases.

Hudachko compared the relationship between the mitigation goal and fatalities to football strategy. The most important issue is the final score — or the number of deaths — but to win the game, you may set a goal for the number of yards gained or how many yards you hold the opponent to — or how many nursing home resident contract COVID-19.

“The idea is if you accomplish all of these other supporting goals, you will accomplish this ultimate goal,” Hudachko said.