Nursing homes balk at mandate
California nursing homes, already struggling to fight the new coronavirus, could soon become landing spots for infected patients from overflowing hospitals, according to a controversial state order that nursing home experts have derided as a “death sentence” for vulnerable residents.
The move is part of the state’s plan to handle an expected surge of patients sickened by COVID19, the dangerous respiratory disease caused by the virus.
Typically, nursing homes that provide longterm medical care — known as skilled
nursing facilities — accept some patients who are discharged from hospitals, because they are equipped with nurses and medical supplies. Other states have already moved to enlist their nursing home networks, including New York and Massachusetts, where dozens of nursing homes are being emptied and converted into COVID19 treatment centers.
There are more than 1,000 skilled nursing facilities in California and more than 200 in the Bay Area.
The March 30 order from the California Department of Public Health says that skilled nursing facilities “shall not refuse to admit or readmit a resident based on their status as a suspected or confirmed COVID19 case.”
Under pressure from nursing home groups, however, the state health department sought to clarify that order Thursday. It specified that nursing homes could still refuse patients if they weren’t able to follow federal guidelines for coronavirus infection control, including having adequate supplies of personal protective equipment like masks, gloves and gowns.
“Positive COVID19 patients can only be transferred to designated skilled nursing facilities (SNFs) or other facilities that have been prepared,” a department spokesperson said in a statement, noting that transfers must happen in coordination with local health departments. “Some facilities have — or are currently preparing — COVID19 positive only portions of their facilities with separate staff and supplies to care for patients safely.”
But advocates for nursing home residents and the doctors who treat them say the new policy could still make a dangerous situation even worse.
“Cramming infected patients into crowded, understaffed facilities with extraordinarily vulnerable residents is a recipe for disaster,” Patricia McGinnis, executive director for California Advocates for Nursing Home Reform, said in a statement Wednesday.
Deborah Pacyna, spokeswoman for the California Association of Health Facilities, which represents most skilled nursing facilities in the state, said that the organization strongly opposes the directive and has asked the state only to turn to nursing homes as a last resort for COVID19 patients.
Of particular concern, Pacyna said, is that patients who don’t have COVID19 symptoms can still be transferred from hospitals without a confirmation test and following usual procedures, despite growing recognition that presymptomatic and asymptomatic people have likely helped spread the coronavirus in nursing homes.
“We do not want to introduce this virus, which preys on the very people we serve, into our facilities,” Pacyna said.
Jan EmersonShea, a spokeswoman with the California Hospital Association, said the unprecedented situation is forcing hospitals to make difficult choices: People who are less sick need to be discharged to free up hospital beds for those who are more sick. But those people, who may still be recovering and need some level of medical assistance, still need somewhere to go.
“There isn’t an easy answer to any of this, and there are concerns on both sides,” EmersonShea said. “From the hospital perspective, we need to get people who no longer need acute care to find an alternative place to go.”
The state mandate comes as California hospitals are already seeing huge increases in admissions to intensive care units, and nursing homes are scrambling to beat back the virus — and losing.
In Kirkland, Wash., the virus raced through a nursing home in February, killing more than 30 people, and in California, almost 60 patients and staff members at a 90bed nursing home in San Bernardino County have tested positive for the new coronavirus, according to health officials in that county.
At the state’s largest nursing home, the 780bed Laguna Honda Hospital in San Francisco, 10 staff members and two residents have already tested positive. City officials have admitted they can’t control the outbreak without significant help from state and federal agencies, including the Centers for Disease Control and Prevention.
Andy Chan, 53, whose mother has been a Laguna Honda resident for three years, said that it would be a “disaster waiting to happen” if hospitals send more patients who may be infectious to nursing homes. Worse, he said, many families aren’t able to take their relatives out because they require significant medical care.
“It’s an option that we can’t take. There’s no way we can provide the services that she has now, at home,” Chan said. “I don’t know what to do.”