A major battle continues to boil in New York State, one of the hardest-hit states in the union by the coronavirus. At the heart of this problem is a March 25th order issued by the state health department and supported by Governor Andrew Cuomo which said: “nursing homes cannot deny readmission or admission solely based on a confirmed or suspected diagnosis of COVID-19”.
The purpose of the rule, according to state officials, was to expand capacity for the predicted crush of those patients who were seriously ill with COVID-19 and needed acute care beds. As a result, recovering patients would be moved out of hospital beds and sent back to nursing homes.
When questioned about this, Cuomo stated, “They [the nursing homes] get paid to provide a service. They get regulated by the state government. There are certain rules and regulations that they must follow and we put in additional rules and regulations on nursing homes in the midst of this crisis.”
Nursing homes from coast to coast have struggled to maintain the spread of the virus, plagued by shortages in test kits, protective gear for front line staff, and employees who assist residents with bathing and feeding. Because of their age or underlying health conditions, the residents in these homes are unable to comply with the infection control guidelines like hand cleaning and wearing masks and make them more vulnerable to contracting COVID-19. But the New York directive was in place despite this.
And when it comes to deaths of nursing home residents, at least 3500 are reported to have succumbed to the virus, including over 2000 in New York City alone.
As a result, there has been pushback from state legislators and nursing home CEOs who question how they can expect to prevent coronavirus from spreading throughout the nursing home system and infecting not only the patients but staff as well. Further, they cite Cuomo’s own words when he described nursing homes as a “feeding frenzy” for the deadly virus early on in this crisis.
Cuomo, when informed about the pushback by nursing homes, countered by launching an investigation into the state's 600 plus facilities. He also stated at a news conference this past Sunday that despite what nursing home operators alleged, his statements were not contradictory.
Donny Tuchman, CEO of the Cobble Hill Health Center in Brooklyn, where 55 patients have died from COVID-19, stated that he has been telling the State Health Department for weeks that he had staffing and equipment problems and following such a directive would not only be unsafe but that there would be “no way for us to prevent the spread under these conditions.”
Tuchman requested that some of the sick patients he had at his home be moved to the makeshift hospitals set up at Manhattan’s Javits Center and the USNS Comfort, docked at the city port, only to be told that these two locations were only for patients from hospitals.
However, just 134 of the 1,000 beds at the Javits Center were full and the Comfort — which had just been reconfigured to accept up to 500 COVID-19 victims, had only 62 patients on board.
When questioned further as to why sick nursing home patients were not transferred to the nearly empty facilities, Cuomo stated, “The Comfort is a federal facility. It doesn’t take transfers from nursing homes. The specific protocol on that specific ship said the people have to come from a hospital because when they come from a hospital, the hospital has to do a full workup, so when they are referred, they are referred with a full workup.”
“This has been a very sad experience,” Tuchman told the New York Post. “Once the virus gets into the building, it is very, very hard to control.” Tuchman’s facility topped the state’s list of coronavirus deaths since the data was first released in mid-April.
But Tuchman was not the only CEO with concerns. Executive Vice-President of Catholic Health Systems, which operates both Nursing Homes and Hospitals, knew it would only be a matter of time before it was forced to send a patient with COVID-19 into one of their nursing facilities filled with seniors, the most vulnerable to this virus.
To prevent this, Markiewicz called another health system, The McGuire Group, asking if they "could find a location and we could stand-up a separate facility, would you be willing to do that with us?” Both companies did just that and avoided a crisis. However, not every nursing home has the ability to carry something like this off.
Markiewicz acknowledged this, saying, “Think about a Mom and Pop or small nursing home that doesn’t have a line of credit, that has difficulty in making payroll at times. Then, you add this additional expense on to it of all of the equipment and these other needs. It’s not an easy thing for them to do.”
When asked again by reporters about this concern for nursing homes. Cuomo appeared to double down, openly criticizing nursing homes for opposing him.
“They don’t have a right to object. That is the rule and that is the regulation, and they have to comply with that. If they can’t do it, we’ll put them in a facility that can do it.” Some nursing home administrators saw this statement as a veiled threat to take retaliatory action against them in the future.
Other New York State health officials agree and support Cuomo, citing the need to clear out hospital beds for the most critically ill. But leading industry groups that represent nursing homes have registered their own objections with the State of New York, stating that by following this directive, it would accelerate the transmission of the virus and kill even more elderly.
The Society for Post-Acute and Long-Term Care Medicine, which represents employees in nursing homes, issued a statement which read in part, “We find the New York state advisory to be over-reaching, not consistent with science, unenforceable, and beyond all, not in the least consistent with patient safety principles.”
The American Health Care Association also issued a statement saying, "The bottom line is that nursing homes are not a priority in the public health system and this policy reflects that. Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment, and staff to accept COVID-19 patients is a recipe for disaster. Governors and public health officials should be working with nursing homes to create as many segregated units as possible right now.”
“Nursing homes are working hard to keep the virus out, now we’re going to be introducing new COVID positive patients?” said professor of health policy at Harvard Medical School, David Grabowski, to NBC News. Grabowski believes that states should create COVID-only facilities for those who are recovering and discharged from hospitals.
Being lost in this battle are the residents and their families, many of whom are scrambling to remove their loved ones from these facilities as a result of the state's edict.
According to NBC News, Christina Peredo was told by the nursing home about the state mandate in late March and she and her family decided to remove her 96-year grandfather from the facility, for fear of contracting COVID, even though he was still on IV antibiotics and recovering from pneumonia unrelated to the virus.
“To make this a mandate without exploring other options, what you’re saying is, ‘Sorry, you’ve lived a good life,’” Peredo, 35, a nurse, said. “It’s reckless and careless.”