Florida transferring nursing home residents with virus to hospitals

Florida has been mass-transferring residents with coronavirus out of nursing homes with outbreaks and into local hospitals since Sunday, regardless of whether they show signs of the virus.

So far, health officials moved 57 residents out of Manor Pines Convalescent Center in Wilton Manors into four Broward County hospitals. In Miami-Dade County, health officials have transferred 104 residents of Fair Havens Center in Miami Springs, along with 35 from Pointe of North Gables assisted living facility. In Palm Beach County, 16 residents have been transferred out of Renaissance Health and Rehabilitation in West Palm Beach.

Health officials also transferred another big group, 20 residents, out of the Alexander Nininger State Veterans Nursing Home in Pembroke Pines. As of Friday, six residents of the facility had died of COVID-19. Also as of Friday, 16 residents of the Manor Pines facility had died, eight at Fair Havens and one at Pointe of North Gables.

The transfers come after two major changes took place: First, the Agency for Health Care Administration issued a directive that

outlines strict protocols for how a facility must respond when it has one or more cases of the virus. Next, the Centers for Medicare and Medicaid Services, which oversees Medicare and Medicaid, issued new federal flexibility in Florida to allow hospitals to bill at an established rate so they can accept residents who are positive but don’t necessarily need hospitallevel care.

Scott Lipman, COO of Marrinson Senior Care Residences, owner of Manor Pines Convalescent Center in Wilton Manors, said his facility was notified only hours before health officials began transferring 56 infected residents out on Sunday morning.

“We have a dedicated COVID unit, but they made the decision to send them out,” Lipman said. “They have not communicated with us when they will be coming back.”

Dr. Joshua Lenchus at Broward Health Medical Center said his hospital has received some of the Manor Pines residents. In Miami, Jackson Memorial has received some of the residents from Fair Haven.

On Monday, Molly McKinstry, deputy secretary for the Agency for Health Care Administration, told nursing home administrators that any resident transferred to a hospital must test negative for the virus twice within 48 hours to be sent back.

Only a month ago, hospitals were eager to send elderly patients back to their long-term care facilities when they were still positive but no longer needed hospitalization. The facilities fought back, resisting re-admission until the residents were healthy and leaving the seniors caught in the middle.

“I have been asked by the Hospital Association again to talk to you about not sending asymptomatic cases to the hospital,” Deborah Franklin with the Florida Health Care Association, an advocacy group for nursing homes, said at the time during a meeting between state health officials and nursing home operators. At the time, the hospitals were not getting paid by the federal government at a higher rate for these patients.

In the last few weeks, multiple nursing homes and assisted living facilities throughout the state have experienced outbreaks, as operators have begged for more testing, supplies and personal protective gear for their workers. As of Wednesday, 776 residents or workers at long-term care facilities have died.

Kristen Knapp, a spokesperson for the Florida Health Care Association, which advocates for nursing homes, said the state put its stricter protocols for handling positive cases in writing on May 5 and some facilities may be less able to meet those requirements to care for positive residents.

“Now there is more clarification,” Knapp said. “We now know that residents will be transferred out of facilities that are not capable of adherence.”

The state has not issued an order saying every resident and worker must be tested. And to date, the state has tested only about 6% of that group.

At a Wednesday news briefing, Gov. Ron DeSantis defended his actions to keep long-term care residents safe during the pandemic. He said “sentinel” surveillance testing teams have traveled to 25 facilities to conduct testing on a sampling of facility employees, adding that the Veterans Administration has added its own 15 teams of testers.

DeSantis added that while he wants universal testing at nursing homes, “it’s going to take a nuanced approach to logistically do it.” He said seniors already can get tested at designated lanes at drive-through testing sites and cautioned that some patients may refuse to get tested.

He also said the state “stepped in” to provide personal protection equipment to nursing homes. And he pointed to his early mandate not to allow hospitals to discharge COVID-positive patients back to nursing homes as a factor in containing outbreaks.

“Taking that extra step to protect our seniors has been worth it in the state of Florida,” he said. “All you have to do is look at places that did not do what we did.”

He also defended his most recent action, transferring patients to hospitals, as one that is necessary and life-saving.

“Getting the COVID-positive residents out of nursing homes will save lives. We appreciate the hospitals that helped with this,” he said.

DeSantis said he also would like to establish state-supported “COVID-dedicated facilities” for long-term care residents as an alternative to hospitals. The state has established one in Jacksonville and is working to open one in MiamiDade County. Jackson Health has an old rehabilitation hospital it hopes to use as a place for people who test positive for the virus and who came from nursing homes but don’t need major medical treatment.

DeSantis emphasized the reason the state needs to act: 62% of deaths from the new coronavirus in Florida are 75 or older.

On Wednesday, Mary Mayhew, secretary of the Agency for Health Care Administration, said Centers for Medicare and Medicaid Services flexibility regarding billing rates has been key to these hospital transfers when nursing homes or assisted living facilities can’t isolate or monitor infected residents at the level required.

For hospitals, she said, “This is their surge. They do need to be a core partner regionally so we can continue this path. We have months ahead of us to continue this level of support to protect the state’s most vulnerable.”