States prod nursing homes to take more Covid-19 patients

The fear, advocates say, is that the generous payments designed to help patients will only serve to expose more elderly people to some of the factors that have led to nearly 26,000 Covid-19 deaths in nursing homes, from the rapid spreading of germs to a shortage of protective equipment.

“The places hospitals want to send these Covid-positive patients turn out to be the places least equipped to take them, places that are already the most dangerous facilities in the United States,” said Mike Dark, an attorney at California Advocates for Nursing Home Reform. “These are places that have serious infection control issues, terrible understaffing issues.”

For instance, New Mexico’s first nursing home solely for coronavirus patients, Canyon Transitional Rehabilitation Center, was cited as having issues with infection control during regular inspections in both 2018 and last year, and was fined $13,605 by the federal government last year for a lack of proper procedures that led to a five-minute delay in performing CPR on a resident after he became unconscious.

Nonetheless, Canyon Transitional Rehabilitation Center will receive $600 per bed for housing the patients, more than double the reimbursement rate it received for some residents in the past. In some cases, it will also receive a daily payment for empty beds.

The chief medical officer at Genesis, the for-profit chain that oversees Canyon, said the nursing home “meets or exceeds” the standards needed to help patients, and “staff stays hyper-vigilant and goes above-and-beyond protocols and guidelines from the CDC and others.”

In California, a Los Angeles County nursing home that volunteered to be among the initial batch of facilities exclusively accepting coronavirus patients said it would bill $850 per day, according to a letter to insurers obtained by the Los Angeles Times. The home had been cited twice last year for infection control issues during inspections.

Separately, for small assisted living facilities, which have six residents or fewer, the state is offering $1,000 per day for any facility willing to convert into a Covid-positive home, or $30,000 month, according to a letter sent by the state to facilities earlier this spring. Even with the additional medical costs, that’s a significant increase over the median $4,500 cost of assisted living in the state.

In late March, Massachusetts also unveiled a plan to create nursing homes that were singularly dedicated to coronavirus patients. One nursing home started moving patients without the virus out the same week as the announcement. The plan has since been put on hold, after nursing homes participating in the plan found they could not relocate their patients because some turned out to have the coronavirus.

The state has set aside $50 million to pay to nursing homes that set up isolated wings for Covid-19 patients, in addition to other reimbursement the patients will receive.

But half of the Massachusetts nursing homes that have created dedicated wings for Covid-19 patients are either rated “below average” or “much below average” – two-star or one-star — on the federal scale, according to a review by the advocacy group Massachusetts Advocates for Nursing Home Reform. And two had been designated “special focus facilities” by the Centers for Medicare and Medicaid Services, which put them among the 88 worst nursing homes in the country, the group found.

In Rhode Island, the state is paying two facilities $8,250 per day to serve as coronavirus specialty homes to cover costs related to specialized protective gear, staffing and infection control measures, according to a health department spokesperson. Both of the homes are low-rated: One receiving two stars and one a single star, indicating “much below average.”

Mike Wasserman, a former nursing home company executive and a doctor specializing in the elderly, said allowing facilities with troubled records to handle a large number of coronavirus patients poses huge risks.

“You’re saying facilities that were unable to control the outbreak are now of enough quality to do the hardest job that was ever known to nursing homes, ever,” said Wasserman. And transferring existing residents to different nursing homes or wings could accidentally spread the virus, Wasserman argued.

David Grabowski, an expert in aging and long-term care at Harvard Medical School, said creating Covid-specialty nursing homes is a great idea in theory, but has proven difficult to implement because the best and most qualified nursing homes – the four- and five-star facilities — are already full and don’t have room to take on more patients.

“There’s no way that one-star and two-star facilities for the most part should be doing this unless they can show that there’s been a big change in management” or a partnership with a hospital system, he said.

An illustration of the challenges in implementing such plans is Michigan, which selected 20 nursing homes as “hubs” with dedicated wings to care for coronavirus-positive patients after they’ve been discharged from hospitals. But the hubs chosen by the state are of mixed quality: Eight of them are either one-star or two-star facilities. The state gave them $5,000 per bed initially, and an additional $200 per occupied bed every day.

One Michigan home, which is opening up 27 beds for coronavirus patients, Medilodge of Grand Blanc, has been on a special federal list reserved for nursing homes with a record of poor inspections for 13 months. However, the facility has shown improvement, according to an April list of these facilities, which get extra attention from the Centers for Medicare and Medicaid Services.

In 2017, the home was sued by a state-appointed group investigating abuse and neglect after a resident was found unresponsive, and later died – a case that both parties have since dismissed. A spokesperson for the parent company declined to comment.

Lynn Sutfin, a spokesperson for the Michigan health department, said the facilities were chosen for a variety of reasons, including their track record and ability to quarantine patients. The department, along with other state and local officials, are working together to “ensure appropriate safety and infection control practices were in place” for each facility, she said.

Advocates for the nursing home industry say the vastly increased reimbursements are crucial to maintaining adequate care for Covid-positive patients.

“Long-term care providers are putting significant resources toward responding to this crisis, whether through acquiring high-priced personal protective equipment, offering staff ‘hero pay’ and hiring additional help, or in testing residents and staff,” the American Health Care Association, which represents nursing homes, said in a statement. “More support to nursing homes and assisted living communities will be needed, and it requires a collective effort from the public and private sectors to support long term care.”