A new report from the Center for Health and Research Transformation (CHRT), an independent nonprofit health policy center at the University of Michigan, shows that Michigan is reporting fewer COVID-19-related deaths in nursing homes than the national average.
Michigan nursing home resident deaths account for 33.2% of all COVID-related mortalities in the state, compared to 38.6% nationally.
As of Aug. 23, 726 nursing facilities nationwide reported three or more COVID-19 cases, representing 4.7% of facilities in the country. Michigan had eight facilities reporting three or more cases, which is 1.8% of the facilities statewide.
“If you look at the evidence together, it says the opposite of the criticisms,” Michigan Department of Health and Human Services (DHHS) Director Robert Gordon said during a Tuesday press conference with CHRT.
Michigan’s handling of the COVID-19 crisis in nursing homes has been under scrutiny from the GOP-led Legislature. The U.S. Department of Justice (DOJ) requested that Gov. Gretchen Whitmer submit data related to nursing homes and COVID-19 deaths last month along with other Democratic governors.
Whitmer, in a joint statement with New York Gov. Andrew Cuomo, said the DOJ’s request was politically motivated.
In June, six Republican U.S. lawmakers from Michigan — U.S. Reps. Fred Upton (R-St. Joseph), Bill Huizenga (R-Zeeland), Paul Mitchell (R-Dryden), Jack Bergman (R-Watersmeet) and Tim Walberg (R-Tipton) — called on Attorney General Dana Nessel to investigate Whitmer’s handling of COVID-19 in nursing homes. Nessel denied the request, also calling it partisan.
Michigan ranks 18th in the nation and the District of Columbia in the number of nursing homes deaths, according to the U.S. Centers for Disease Control’s National Healthcare Safety Network. Massachusetts; New Jersey; Connecticut; Louisiana; Rhode Island; Mississippi, Washington, D.C.; Pennsylvania; Maryland; Delaware; Arizona; Georgia; Indiana; New York; South Carolina; Illinois; and Alabama rank ahead of Michigan in deaths.
In April, DHHS announced its regional hub strategy, which designated certain facilities to isolate COVID-19 positive admissions and residents from other non-infected residents.
At its peak, Michigan had 21 regional hubs among nine counties in the southeast, southwest and northwest regions of the state. As of Aug. 19, there are eight regional hubs remaining.
According to the analysis, the percentage of deaths among nursing home residents with COVID-19 was considerably lower in Michigan’s nursing home hubs than in the state’s non-hub nursing homes — 17.4% in hubs compared to 26% in non-hubs.
However, Gordon admits that there is room for improvement on the state level and CHRT offered recommendations.
“The state did use criteria when they selected the hubs to begin with, but as we noted in the report, it was done at a time of crisis,” said Marianne Udow-Phillips, founding executive director of CHRT and a former human services director under Gov. Jennifer Granholm. “We’re in a moment where we think there’s an opportunity to review those criteria. And because we know more about how patients now can be maintained safely within nursing homes, we think there’s an opportunity to strengthen that criteria.”
One of the main recommendations CHRT offered is that they do not believe it is in the state’s best interest to implement COVID-19-only facilities and could be “counter-productive.”
Udow-Phillips said a facility that isolated COVID-19 positive patients would be “very expensive, very inflexible and certainly not needed.”
CHRT does recommend that the state maintain the hub strategy with new criteria that incorporate lessons learned, including cohorting, assurance of training and adequate tools and continuing plans with referring hospitals.
Udow-Phillips also recommended that the state broaden its current visitation policies.
Whitmer first issued an emergency order to restrict visitation in nursing homes on March 14 and it has since been extended multiple times until Sept. 30.
However, Gordon said DHHS is expected to issue new guidance on visitation “this week.”
Udow-Phillips also said that the state should centralize state and federal COVID-19 guidance to all nursing homes and local public health departments.
“The guidance of the federal government is changing frequently. It’s very difficult to access for the nursing homes themselves, and frankly it’s very difficult for local public health to access this guidance,” she said. “It’s been very difficult to follow, and many nursing homes are not sure that they’re doing the right things.”
CHRT also recommends the state improve data tracking and standardize reporting.
“We think that for Michigan, giving more clarity to the hubs and the non- hubs about what should be recorded, when it should be reported and having more ongoing quality checks of the data is quite important for us all to understand what’s really happening and how to move forward,” Udow-Phillips said.