By Kim Barker and Amy Julia Harris, New York Times, April 24 2020
California, New Jersey and New York have made nursing homes accept Covid-19 patients from hospitals. Residents and workers fear the policy is risking lives.
Neal Nibur has lived in a nursing home for about a year, ever since he had a bad bout of pneumonia. Now, the 80-year-old man has not only his own health to worry about but that of his neighbors at the Poughkeepsie, N.Y., residence. Four new patients recently arrived from the hospital with Covid-19.
They were admitted for one reason, according to staff members: A state guideline says nursing homes cannot refuse to take patients from hospitals solely because they have the coronavirus.
“I don’t like them playing Russian roulette with my life,” said Mr. Nibur, who is on oxygen. “It’s putting us at risk. I am 80 years old with underlying problems. Everybody here has an underlying problem.”
The disease caused by the virus has killed more than 10,500 residents and staff members at nursing homes and long-term care facilities nationwide, according to a New York Times analysis. That is nearly a quarter of deaths in the United States from the pandemic. On Saturday, Gov. Andrew M. Cuomo of New York described nursing homes as a “feeding frenzy for this virus.”
But states are increasingly turning to nursing homes to relieve the burden on hospitals and take in Covid-19 patients considered stable enough to be released. Although there is no evidence so far that the practice has allowed infections to spread in nursing homes, many residents and advocates fear that it is only a matter of time. One lawsuit in New Jersey alleges that a worker was likely to have been sickened by a Covid-19 patient readmitted from a hospital.
At the epicenter of the outbreak, New York issued a strict new rule last month: Nursing homes must readmit residents sent to hospitals with the coronavirus and accept new patients as long as they are deemed “medically stable.” California and New Jersey have also said that nursing homes should take in such patients. Homes are allowed to turn patients away if they claim they can’t care for them safely — but administrators say they worry that refusing patients could provoke regulatory scrutiny, and advocates say it could result in a loss of revenue.
In contrast to these states, Connecticut and Massachusetts designated certain facilities for Covid-19 patients alone — considered the safest way to free up hospital beds. The Washington Health Care Association, which represents long-term care facilities in Washington State, has asked officials to adopt a similar policy; so far, they have not.
“It’s got to happen,” said Robin Dale, the association’s president. “Then we would not have this hodgepodge of every nursing home in the state having one or two positives and crossing your fingers that it works out.”
Beth Martino, spokeswoman for the American Health Care Association, which represents nursing homes and assisted-living facilities, said her association had heard that a number of states were considering measures similar to those in California, New Jersey and New York. But many others haven’t offered any guidance on the matter.
The fears that moving coronavirus patients to nursing homes might spark outbreaks is compounded by the lack of protective equipment at many facilities, as well as shortages in staffing, requiring workers to interact with more patients. And not all hospitals are testing to check whether stable patients are still infectious before releasing them.
In a national survey released on Thursday of almost 9,000 nursing homes, fewer than 10 percent said they were able to take in new Covid-19 patients from hospitals. The survey was done by CarePort Health, a company that works with hospitals to manage the release of patients to long-term care facilities.
Jay Lawrence, spokesman for the Grand Healthcare System, which has 17 homes in New York, including the one in Poughkeepsie, said the company was doing everything possible to meet state needs and keep residents safe. He said the virus had not spread from those initial four patients in Poughkeepsie to anyone else in the building.
Still, “with Covid being everywhere, it’s a very fluid situation,” he said. “People are trying to be as vigilant as they can. No one knows where and how this is going to rear its ugly head.”
The New Jersey lawsuit, filed on Wednesday against Alaris Health at Hamilton Park in Jersey City by a former nurse, alleges that another employee, a certified nursing assistant, was probably exposed to the virus from a patient readmitted from a hospital.
The assistant was not given protective equipment and not properly isolated while treating the patient, according to the lawsuit. It also said that workers and residents were not told about the patient’s Covid-19 diagnosis. The patient died around March 29, the lawsuit said. Cheryl Roberts, the nursing assistant, was put on a ventilator and died on April 5, said her brother, Darryl Roberts.
“I was devastated, because not only did they put my sister in jeopardy, they put the whole facility in jeopardy,” Mr. Roberts said.
Matt Stanton, a spokesman for Alaris Health, said workers had proper protective equipment and called the claim that residents got staff members sick “ludicrous.”
Since its original guidance, New Jersey has opted to prohibit admissions to facilities that say they cannot safely care for patients. So far, more than 130 facilities have been exempted.Sign up to receive an email when we publish a new story about the coronavirus outbreak.Sign Up
In New York,the new rule has increased strain on nursing homes, many of which are now staffed at less than 50 percent, said Stephen Hanse, the president and chief executive officer of the New York State Health Facilities Association and the New York State Center for Assisted Living.
“This puts nursing home providers in a really precarious position,” he said. “If you want to do everything to protect your residents and staff, your hands are tied.”
Mina Ebrahem, 31, a physical therapist in New York City, works for agencies that have sent him to several nursing homes over the past month. All were admitting Covid-19 patients from hospitals while providing only limited protective equipment, he said. At one home, he helped check in new patients, about five a day. He said 90 percent of them had been treated for coronavirus symptoms at hospitals.
“Whoever made this decision, whoever did this, I consider this a sentence of death for all the older patients, whoever is in a nursing home,” he said.
Asked about admissions of Covid-19 patients in light of nursing-home deaths at a briefing on Monday, Mr. Cuomo seemed unaware of the state rule. “It’s a good question,” he said. “I don’t know.”
Howard Zucker, the state health commissioner, said that nursing homes needed to readmit positive patients and that “necessary precautions will be taken.”
On Thursday, Mr. Cuomo reiterated that nursing homes had to accept the patients — but only, he clarified, if they could do so safely. Homes unable to comply should transfer them to other facilities or notify the state Health Department, he said.
The department, responding to questions from The Times, said that nursing homes were not permitted to discriminate against Covid-19 patients, but that they should avoid taking patients if not “medically prepared.” Mr. Zucker said on Thursday that he did not know of any homes in that position.
Richard Mollot, executive director of the Long Term Care Community Coalition in New York, an advocacy group for residents, said he had heard of several nursing homes that had declined. But the vast majority, he said, have a “tremendous financial incentive” to take in new patients.
Jonathan G. Jacobson, a Democratic assemblyman whose district includes Poughkeepsie, has urged New York health officials to reverse the directive, calling it “misguided.”
“Nursing homes are simply not equipped to act as hospitals and should not be used as depositories for infected individuals,” he wrote in a letter to health officials last week, adding that patients should instead be sent to facilities designated for Covid-19 patients, separate from large populations of elderly residents.
While the rule is still in effect, Mr. Jacobson said he was heartened by the governor’s remarks on Thursday and hoped nursing homes ill equipped to handle Covid-19 patients would reject them.
Connecticut and Massachusetts both set aside facilities to care for Covid-19 patients. One in Connecticut started accepting patients from hospitals last week. Massachusetts emptied one site of other residents and reopened seven closed facilities to treat positive patients.
Nursing homes in Massachusetts are also being asked to take coronavirus patients, but only if they verify that they have adequate staff and protective gear and can isolate the infected. In return, those homes will collect 15 percent more in reimbursements for every Medicaid patient.
Without clear guidelines, patients in hospitals faced the question of where they should go if nobody wants them.
John Stubits, 96, a former civil engineer, was sent by a Michigan memory care center to a nearby hospital on March 30, where he tested positive for the virus. He briefly improved, and the hospital searched for somewhere to discharge him, according to his daughter, Eva Stubits. His previous residence would not accept him unless he tested negative for the infection; no other home in the state would take him.
Ms. Stubits said she was told that her father would be sent to a home in Ohio, more than an hour away. But those plans unraveled when Mr. Stubits became much sicker. Last week, his daughter learned that the hospital planned to send her father to a nursing home in Detroit with poor ratings. After many phone calls, Ms. Stubits found another home about 30 minutes away from his previousresidence.
“The hospitals are desperate to get them out, and they don’t care where they go,” she said. “If you don’t know any better, your relative could end up in a really bad place.”
Despite everything, on Friday, Mr. Stubits died at the nursing home.
Reporting was contributed by Sarah Almukhtar, Jake Holland, Danielle Ivory, Jesse McKinley, Alison Saldanha, Mitch Smith, Timothy Williams and Karen Yourish. Susan C. Beachy contributed research.
Kim Barker is an enterprise reporter, focusing on long-term projects and narrative writing. Before joining The Times in 2014, she was a reporter at ProPublica and the South Asia bureau chief for the Chicago Tribune. @Kim_Barker
Amy Julia Harris is an investigative reporter on the Metro desk. She previously worked at Reveal from The Center for Investigative Reporting, where her team project on drug rehab programs that require patients to work for free was a finalist for the Pulitzer Prize in 2018. @amyjharris