Will new rules make a difference in Michigan's long-term care facilities?
More than 2,800 of Michigan’s nursing-home residents have tested positive for COVID-19, according to data released Wednesday by the Michigan Department of Health and Human Services.
Two weeks ago the state issued new rules for nursing homes and other long-term care facilities intended to curb the spread of the virus through these vulnerable communities. As of Wednesday, the median age of those who had died from the disease was 76.
86-year-old Nicki Ornsten, from Clinton Township, has shown a lot of resilience these past few months.
Toward the end of February, Nicki went to the hospital for heart surgery. After recovering, she was sent back to the hospital with flu symptoms. Finally, in mid-March, she returned to her nursing home, Heartland Sterling Heights.
That was just days after Michigan had reported its first COVID-19 cases. Heartland, like other long-term care facilities, had stopped allowing visitors. That meant Terry Ornsten and her sister couldn't walk their mom to her room.
“It was horrifying, shocking. She was crying," said Ornsten. "We—we had never seen that before. It was very frightening.”
The sisters did what they could. Each day, they would stop by their mom’s window. They frequently called her room phone. For a while, says Ornsten, she was “fully lucid” and “self-aware.”
But then the flu symptoms started creeping back: a cough, a fever. As their mom got weaker, communication became thin. The sisters grew to rely exclusively on Heartland’s staff for updates.
“If we finally got a nurse on the phone … they would be very, very helpful,” Ornsten said. “You know, telling us all of the vitals and temperature and what's going on. But God forbid, call a second time.”
Their best idea of what was happening inside the facility came from glimpses through the window.
“When we were at the windows, we would see people, you know, they would come in, sometimes they'd have a mask, sometimes they didn't. We'd see nurses walking back in the hall, or aides or whatever, with no masks or anything,” said Ornsten.
Ornsten and her sister repeatedly asked Heartland Sterling Heights to get their mother a COVID-19 test. By the time Heartland agreed, their daily visits to the window had come to an end.
“The blinds were drawn,” she said. “We couldn't even see in the room.”
Still symptomatic, Nicki was moved into an isolation unit. She got her test. Seven days later, it came back positive.
We don’t know how many COVID-19 cases Heartland Sterling Heights had then—Ornsten says the administration claimed zero—but right now, the facility is reporting seven.
The sisters pulled their mother from the facility and brought her home.
New rules, but not much oversight
A week after Nicki left Heartland, Gov. Gretchen Whitmer signed an executive order outlining how senior living facilities should report and manage COVID-19 cases.
In addition to requiring reports of new cases to local health departments within 24 hours, the order tells facilities to use their “best efforts” to provide staff with personal protective equipment. For facilities with at least 20% of beds open, it asks them to create dedicated COVID-19 units, where staff will have to use PPE “as available.”
At places like Heartland, it’s unclear if those rules will translate into staff taking better precautions, especially since state and local health departments are not inspecting every home.
Asked for comment, spokesperson Julie Beckert said Heartland Sterling Heights has been “monitoring all patients, employees and visitors” and instituted “universal masking for all employees” on March 14th. She said right now they have adequate PPE supplies.
Neither MDHHS nor Macomb County (where Heartland Sterling Heights is located) responded to questions about inspections and general oversight of long-term care facilities before this article was published.
“Just wildfires waiting”
This order applies to all long-term care. In addition to nursing homes, that includes licensed assisted living facilities (homes for the aged and adult foster homes) and unlicensed facilities.
Traci Kornak is a personal injury lawyer in Grand Rapids. At the moment she has clients in a handful of assisted living facilities, both licensed and unlicensed.
Visits there are limited due to COVID-19. But Kornak has power of attorney, which means, as she puts it, “they can’t keep you out.”
In the week after Gov. Whitmer’s order, Kornak saw staff entering rooms without PPE, and others sitting at the lunch table—in other words, acting like everything were normal.
“I'm coming in from the outside and I have to have a mask on. But none of the staff is wearing masks. None,” she said. “Including where I go when I sign in, fill out the paperwork and have him take my temperature. We're all using the same pen.”
Kornak has observed staff without adequate PPE at all the facilities where she has clients, licensed or not. It makes it hard for Kornak to believe the state's new rules will be effective.
“I honestly don't see this changing," she said. "Do you see where these are just wildfires waiting? I know COVID is in these facilities. I just don't know who has it and when it's going to break above the surface.”
The worker’s perspective
Staff at some of these facilities say their employers were slow to implement strict precautions, which has had dangerous consequences for them.
An SEIU Healthcare Michigan representative in metro Detroit said the nursing home where he works as a floor technician responded to the crisis too late. When two of his coworkers got sick in early March, the administration “acted like it wasn’t an issue,” he said. To protect his job, we are withholding his name and the name of his employer.
On April 20, after the facility started testing employees, his results came back positive, despite his not having symptoms. But he said even with better precautions, exposure in the home may have been hard to avoid.
“They’re coughing, they’re touching the rails, they’re touching the doors,” he said of the residents. “So, you know, you’re exposed to it.”
A second positive test, a new home
It’s been three weeks since Nicki Ornsten’s daughters pulled her out of her nursing home. They originally planned to care for her themselves, but she was in worse shape than they thought.
“We're basically on a wing and a prayer right now," said Terry Ornsten. "But we are completely incapable of doing what we thought we could do.”
So they did their research, and found an assisted living facility they felt comfortable with, walking distance from their houses.
Right now, Nicki is back in the hospital, with some residual pneumonia. One of the first things her soon-to-be new facility did was demand a COVID-19 test. Somehow, she tested positive a second time, 24 days after first getting tested.
According to her daughter, the doctor doesn’t know what to make of it.
When Nicki does arrive at the new home, she’ll start two weeks of quarantine, from her first-floor room with a window.