Being labeled by some experts as the “ground zero” of the coronavirus pandemic, nursing homes and long-term care facilities are facing another challenge as some are now being required to open their doors and accept recovering COVID-19 patients.
Last week, New York state mandated that nursing homes begin accepting COVID-19 patients who are on the mend and who cannot be sustained in overwhelmed hospitals.
In an advisory sent out on March 25, the New York State Department of Health ordered that “No resident shall be denied re-admission or admission to the [nursing home] solely based on a confirmed or suspected diagnosis of COVID-19.”
“There is an urgent need to expand hospital capacity in New York State to be able to meet the demand for patients with COVID-19 requiring acute care,” the advisory continued. “As a result, this directive is being issued to clarify expectations for nursing homes receiving residents returning from hospitalization and for nursing homes accepting new admissions.”
The state, which is leading the nation in coronavirus cases and deaths, is grappling with getting enough protective equipment, supplies and ICU beds to hospitals both in and outside of New York City.
This leaves many nursing homes in a tough position. While hospital systems need to be relieved of the number of COVID-19 patients needing beds and ventilators, nursing homes are particularly vulnerable to the spread of infections. Many are also understaffed and don’t meet federal standards to operate safely and effectively, allowing violations to fall under the radar.
Dr. Swati Gaur is a geriatrician associated with AMDA, the Society for Post-Acute and Long-Term Care Medicine in Maryland. From a medical perspective, she said she’s concerned that moving COVID-19 patients to nursing homes could be a potentially dangerous idea.
“When we have COVID-19 in a nursing home situation, we’re not seeing only one or two people get it,” Gaur said in an interview with Being Patient. “We’re typically seeing 15, or 20, or 50 people get it. What they’re hearing from the field is despite having the best infection control practices that people can have, there’s a disease-specific high infection rate in long-term care facilities.”
The goal is to transfer patients once they’re in recovery and no longer contagious—meaning they haven’t had any fever, cough or other symptoms for 72 hours. Even still, without proper precautions, some COVID-19 patients may still be infectious.
“Keeping COVID-19 cases out of the building is the best defense [nursing homes] have,” Gaur said.
Forcing nursing homes to take a COVID-19 patient, Gaur continued, could result in the same statistics that the nursing home in Kirkland faced when the virus was introduced into the facility: up to 60 percent of patients getting the disease, with many ending up hospitalized, and up to 30 percent dying.
In Massachusetts, public health officials are asking some nursing homes to clear out residents in order to make room for COVID-19 patients. Some other states, including Indiana, may be eyeing similar paths.
If other states follow New York’s lead, opening the doors of nursing homes to COVID-19 patients may contribute to further infections, according to the American Health Care Association (AHCA).
“Multiple states are considering adopting an order similar to what was issued in New York that requires every nursing home to admit hospital patients who have not been tested for COVID-19 and to admit patients who have tested positive,” Dr. David Gifford, Chief Medical Officer at AHCA, said in a statement.
“This approach will introduce the highly contagious virus into more nursing homes,” Gifford continued. “There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths. Issuing such an order is a mistake and there is a better solution.”
In the meantime, the number of COVID-19 cases in nursing homes and long-term care facilities continues to rise. CDC data shows that there are some 400 long-term care facilities with COVID-19 cases across the country, according to NBC News—an increase from just 140 last week.
In New York, there have already been over 1,000 COVID-19 cases in nursing homes throughout the state.
Gaur says she understands the thinking behind transferring COVID-19 patients to long-term care facilities. Hospitals are overwhelmed, and they need to place patients somewhere—and nursing homes are often the next step in the current system, where people leaving the hospital go for continued long-term care.
But if this process introduces more outbreaks in nursing homes, that could hospitalize more people, and keep the overwhelming cycle going.
Gaur urges medical experts to think outside of the box and pinpoint safe facilities that can be put in place to support recovering patients.
“People need a place where they can be safe” from COVID-19, Gaur said. Hospitals and medical experts should be talking to “facilities that may already have had COVID-19 cases and have identified units that are physically removed from the rest of the facility, or figured out plans to somehow isolate these patients in COVID-specialized facilities.”
“We should be creating off-sites like shuttered nursing homes, hospitals or convention centers to bring in a coalition to provide care to these [recovering] patients,” Gaur continued. “This crisis is forcing us to break the silos that we created for ourselves by having that system of a clear line between hospital and long-term care.”