Coronavirus: Pay for stay? State offers cash incentive if board and care homes take in COVID-19-positive seniors from hospitals

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By Annie Sciacca and Thomas Peele | Bay Area News Group| Updated May 5, 2020

Even as senior care centers have been particularly hard hit by the coronavirus — with patient and staff deaths accounting for nearly 40 percent of all COVID-19 deaths across California — the state is calling on assisted living facilities to house infected patients in exchange for money.

A letter from the state Department of Social Services sent to licensees of senior and adult care residential facilities on Friday urged them to temporarily take in patients who have tested positive for the virus — for up to $1,000 a day — to make room in hospitals for people who become critically ill and require acute care.

But health experts and advocates say the plan risks introducing the virus into facilities that have been spared or those already dealing with their own outbreaks.

That need continues to grow. As of May 3, nearly 10,000 patients and staff in long-term care facilities in the state of California have tested positive for the virus, and 926 of them have died, according to figures released by DSS, which oversees assisted living, and the California Department of Public Health, which oversees nursing homes. So far, the state has not ordered mandatory testing in long-term care facilities.

“There is an urgent need to provide housing and care for adult and senior care residents that, while positive for COVID-19, do not require hospitalization,” the letter said. “In order to meet this need, the CDSS, Community Care Licensing Division (CCLD), announces an opportunity for Adult and Senior Care licensees to assist in providing additional beds by entering into contracts with the State to temporarily house COVID19-positive individuals in their facility.”

Gov. Gavin Newsom’s office declined to comment on the plan, instead deferring questions to DSS. But medical experts and advocates have sharply criticized the move, saying the contracts could potentially introduce the virus into facilities that have been spared or that are already dealing with their own outbreaks.

But Dr. Michael Wasserman, a geriatrician and the president of the California Association of Long Term Medicine, said, “Any guidance from the government that opens the door to send more COVID-19 into a nursing home or assisted living facility, to me, is medically unsound.”

He pointed out that assisted and independent living facilities — while they might help residents with personal care — are not required to have medical staff on site and are not equipped to deal with infection control.

“The assisted living industry is a real estate industry — it is not a health care business,” he said.

For facilities with six or fewer beds, often referred to as board-and-care homes, the state will pay them an “all-inclusive rate” of $1,000 per day from the date the first resident is placed under the contract, “in recognition of the need to fully staff the facility.” There is no listed reimbursement rate for larger facilities, but the letter encourages them to indicate their interest via an online survey, and a representative from the state will be in touch.

Mike Dark, a staff attorney for watchdog group California Advocates for Nursing Home Reform, called the idea of moving COVID-19-positive patients to assisted living facilities “awful and stupid.”

These facilities are lacking in protective equipment for staff, are often less prepared and “just as vulnerable” as residents in skilled nursing facilities, he said.

The letter sent by DSS said that it prefers to send patients to places that are currently empty, have only COVID-19 positive residents or have a separate structure to separate COVID-19-positive patients from noninfected patients. But the state didn’t rule out placing infected and noninfected patients in the same facility if it is “unable to locate contracted beds in facilities that would house solely COVID-19 positive residents.”

It would be up to the licensed facility to coordinate the housing, staffing and other required services to care for the residents under the contract with the state, and staff caring for the residents under contract would not be allowed to work at other facilities.

Skilled nursing facilities have been asked to take COVID-19 positive cases, too. After doctors and advocates objected to a March letter from the state public health department instructing nursing homes to accept the patients to make room in acute care hospitals, the department slightly modified the order. An April 24 letter advised that nursing facilities would be expected to accept a resident who is positive for COVID-19 “as long as the facility can follow Centers for Disease Control and Prevention (CDC) infection prevention and control recommendations for the care of COVID-19 patients, including adequate supplies of personal protective equipment.” The facility would also have to be able to segregate the positive patients.

Wasserman said the state and county health departments are not listening to experts in geriatric medicine and that this latest letter from DSS is an example of that lack of guidance. He said hospitals are trying to discharge patients to make room for more lucrative elective surgeries.

A spokesperson for the California Hospital Association said she didn’t know anything about the DSS letter but that it had nothing to do with hospitals pushing for returns to elective surgeries.

“Hospitals would never transfer a patient who needs to be hospitalized,” said the spokesperson, Jan Emerson-Shea, in a telephone interview Monday. “Most people who have coronavirus don’t need to be hospitalized. They’re not showing acute symptoms.”

The president of the California Assisted Living Association, Sally Michael, didn’t return a message Monday. A spokesperson for the association wrote in an email, “To our knowledge, there is very limited participation in this effort to date.”

But as the virus has swept through homes such as Gordon Manor in Redwood City, where more than two dozen residents and staff members were struck with the virus and at least 10 died, Wasserman and other critics of the state’s contract offer say any further introduction of the virus into a facility is misguided.

“It’s becoming clearer that the worst outbreaks — the worst situations — have occurred where the virus is allowed to grow unfettered,” he said. “If you have a facility that has a couple of cases and you contain them … even in some cases where we’ve seen fairly large outbreaks and lots of good infection control is applied, we’re seeing better outcomes. So, the least amount of virus you have in your facility, the better.”

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