Lawmakers want answers on nursing homes as 3K COVID-19 cases reported 

Michigan Capitol, March 22, 2019 | Susan J. Demas

State senators on Wednesday voiced concerns about the COVID-19 pandemic’s effect on resident and employee safety in Michigan’s assisted living facilities. In its Monday update, the state reported 3,089 COVID-19 cases in long-term care facilities.

Nursing homes across the country have been hot spots for the disease.

State officials fielded a number of the senators’ questions during a Wednesday meeting of the Senate Oversight Committee. Most of them pertained to an executive order that aims to increase protections for residents and employees of assisted living facilities. The EO in question —  EO 2020-50, issued April 15 by Gov. Gretchen Whitmer — set pandemic protocols for longer-term care facilities. 

It is set to expire Wednesday, unless Whitmer chooses to extend it. 

The measure establishes regional hubs to treat residents who tested positive for COVID-19 and provided that residents who medically stabilized in a hospital could be discharged and rejoin their care facility, said Department of Health and Human Services (DHHS) Director Robert Gordon. 

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It also requires nursing facilities with access to personal protective equipment (PPE) to have separate units for COVID-19 patients, he said. The first of those hubs were approved by DHHS on April 21. 

State Sen. Lana Theis (R-Brighton) voiced her concerns about a part of the order that calls for a nursing home with a census below 80% to create a COVID-19 care unit and provide PPE.

“Earlier in the executive order, it said a long-term care facility must not prohibit admission or readmission,” Theis said. “The way I read ‘admission’ means new COVID-19 patients.”

That doesn’t seem like the safest scenario for senior citizens already in a facility, Theis said. 

“I would challenge that what we should be doing is looking at a safer alternative than putting COVID-positive patients in the same building with the most vulnerable among our population,” Theis said.

Theis asked if any alternative solutions had been considered. Gordon said the major focus of DHHS efforts has been to identify facilities where COVID-positive patients can be “treated with dignity” and get the care they need in a way that is safe for them, their caregivers and other individuals.

He said alternative care sites are meant to be a “last resort.” 

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“The EO explicitly provided that COVID-positive residents could go to alternative care sites only if an appropriate bed was unavailable in the person’s home, a regional hub or in the hospital,” Gordon said. 

Kate Massey, senior deputy director of the state’s Medical Services Administration, said procuring PPE and following U.S. Centers for Disease Control and Prevention (CDC) medical guidelines was the goal of the hubs.

Theis clarified that it is “absolutely [her] goal” to make sure people who test positive for COVID-19 are receiving the best care.

“But you need to balance that with all the rest of the patients also receiving the best care possible,” Theis said before the committee. “When we know the data exists that the vast majority of people dying from this disease are elderly — and that a significant portion are getting it nursing homes — I struggle with the solutions we’ve come up with.”

Gordon clarified and said he doesn’t think there is a sweeping freestanding mandate to admit in the order. 

“I think what’s in the order is a mandate to admit in a manner that’s consistent with guidance from the department,” Gordon said. “… I think it would be a misreading of that section to say that we have been forcing facilities to take residents when they’re not able.”

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State Sen. Ed McBroom (R-Vulcan), the committee chair, asked if DHHS is regularly checking to make sure facilities below the 80% census rate establish a COVID-19 care unit.

Massey said they have not been checking with every individual facility. 

McBroom asked if officials are checking to make sure nursing homes aren’t taking advantage of the situation and if they conduct inspections or have a hotline for nursing home employee concerns. 

Orlene Hawks, director of the Department of Licensing and Regulatory Affairs (LARA), said the Centers for Medicare and Medicaid Services (CMS) has instructed them to prioritize problems in nursing homes due to the pandemic. 

“One of the main things we’re looking at is infection control,” Hawks said. “While we’re there, we are looking at appropriate social distancing, we are looking at appropriate PPE, we are looking at how the providers are applying their PPE so as to minimize and mitigate any spread of the virus from patient to patient.”

Inspectors need to immediately address infection control violations before they leave a facility and report them, she said. 

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Dialysis centers, hospitals and other facilities with high-risk residents are also being inspected, said Larry Horvath, director of LARA’s Community and Health Systems branch.

LARA already has conducted 264 infection control inspections on the long-term care facilities, per Hawks and Horvath. Out of 460 nursing homes, there’s 196 left to inspect, Horvath said. About 80 people are part of their inspection team.

State Sen. Peter Lucido (R-Shelby Twp.) asked when the 196 remaining facilities would be inspected. Horvath said they’re conducting about 20 to 30 inspections per week. If additional concerns are found in a facility, that’ll lengthen the process of making a publicly-available final report, he said. 

Lucido asked how many complaints the department has received from loved ones of patients in the nursing homes. LARA does have that data, but Horvath said he didn’t have it in front of him. 

LARA receives about 6,000 to 8,000 complaints about nursing homes every year, Horvath said. 

Committee members, who met for more than an hour, also heard from state Sen. Jeff Irwin (D-Ann Arbor), who called the discussion “heartening.”

“I’m particularly happy that my colleagues are pointing out the many frayed edges in our human services system,” Irwin said.

But all of it didn’t start with COVID-19, he added. He called out the Legislature for “underfunding and neglecting” the needs of nursing home employees and residents for decades. 

“There are people who work in these facilities at sub-human wages,” Irwin said. “We’re expecting them to be the front-line heroes in this COVID-19 response. It’s ridiculous, so I’m glad we’re finally talking about something serious in this Legislature.”