Without proper controls, infection will spread quickly through a nursing home. It’s one reason states have been grappling with the question of where to put elderly patients who’ve mostly recovered from COVID-19, but are still testing positive.
Connecticut has designated facilities that will care for COVID patients exclusively, while New York, rewinding a previous strategy, is requiring that nursing-home residents test negative before being discharged to a facility.
In Michigan, the state has selected about 20 facilities to take on these patients. As of today, all of them exist as separate units within nursing homes, many of whose residents have not tested positive for COVID.
On Wednesday, Governor Gretchen Whitmer extended her executive order outlining the purpose of these facilities, known in the state’s jargon as regional hubs. Asked by Stateside whether Michigan would consider imposing a rule like New York’s, Dr. Joneigh Khaldun, the state’s chief medical officer, said: “We’re currently looking at that.”
Regional hubs are now caring for 278 COVID patients. For families whose loved ones call these facilities home, a new strategy would come as a major relief.
Bringing COVID-19 to infection-free homes
Kamin Davis’s mother has lived at the Livonia Woods Nursing and Rehabilitation facility for six years. Last month, Davis and his three siblings heard that management at the facility had decided to create a special unit for COVID-19 patients — and that it had volunteered to do so.
This was around the time that Michigan announced its intention to select qualified nursing homes for just that purpose: To serve as step-down facilities for elderly COVID patients whose long-term care facility of residence didn’t have the capacity to isolate them upon their return. As outlined in executive order 2020-50, these regional hubs should be isolated units set up for the exclusive care of COVID patients.
When the Davis family learned their mom’s facility had been chosen to be one, they wondered why.
“Why would they be bringing COVID into the building when there have been no patients with COVID?” said Davis.
There hadn’t been testing at Livonia Woods, but as far as the family knew, nobody there had COVID. They figured it might be safer for everybody if a facility that did have positive cases were selected as a hub instead
But they had their suspicions. And they had to do with money.
“I said, so in essence, you just want the big dollar patients,” said Davis, referring to a conversation he had with an administrator. “That's all this is about.”
From the state general fund, regional hubs receive $5,000 per COVID patient, to help with costs around staffing and infection control. That’s on top of the daily amount these facilities are already receiving per COVID patient, which ranges from $200 to $300, and may be getting a $200 boost. And all of this is in addition to what facilities should already be receiving for a patient’s care.
The Davis family’s objections made it to the board of Wellspring Lutheran Services, the nonprofit organization that owns Livonia Woods. Other families had also raised concerns, and in response, Wellspring decided to delay Livonia Woods’ opening as a hub.
“We have gotten them to pause, because we have advocated so hard, so strong,” said Davis, in an interview at the end of April.
Brian Barrie is the interim director of the Bureau of Medicaid Policy and Health Systems Innovation at MDHHS. He says, to pass muster, a facility must demonstrate that it has three things: bedspace, a history of providing good care, and the ability to isolate patients and provide adequate personal protective equipment to staff.
To make these judgments, MDHHS works with industry groups, which might draft a list of candidates; the state and local long-term care ombudsmen, who can advise based on specific facilities’ history; and the department of regulatory and licensing affairs, which may inspect a facility, if there’s any concern.
“Where there was doubt we were able to have people on site to check out the appropriateness of these facilities to serve as regional hubs,” said Barrie.
This focus on quality may explain why the state selected Livonia Woods instead of another facility in the area. Its five-star rating from the Centers for Medicare and Medicaid Services is well above average among Michigan’s 458 skilled nursing facilities, and its quality of resident care is especially strong.
Davis doesn’t dispute that. After all, he’s been visiting Livonia Woods for years. “It’s been a pretty good relationship overall,” he said. But still, to him, sending COVID-positive patients into any vulnerable community is “asinine.”
Can these patients go somewhere else?
Davis had heard on the news about Michigan’s field hospitals — the TCF Center in Detroit and the Suburban Collection Showplace in Novi — and knew that together they had room for more than 1,000 patients.
“Let those places be the step down,” he thought. “Then when the patient is past COVID, bring him back to the nursing home.”
It turns out state health officials did seriously consider this idea. But converting either field hospital into a giant nursing home was a moonshot. For one, staffing was a problem: Federal staff weren’t recruited to care for elderly patients who needed regular assistance with daily activity. And aspects of the layout, such as the distance between beds and the bathroom, wouldn’t have been easy to manage for the typical nursing-home resident.
“I don't know that we've totally given up,” Barrie said. “But the obstacles for making them a successful and effective option in this space were just astronomical.”
Pinning down details on the isolation unit
So, if Livonia Woods really was destined to become a hub, the Davis family needed to know: How would administrators keep the COVID unit truly isolated?
They had heard early on that the main precaution would be a thin plastic sheet to separate the unit, but they shot back, saying that wasn’t enough. On May 8, Livonia Woods announced in a letter to families some pending changes to the actual facility structure. They would build a new wall, with a one-way door, at the unit’s interior entrance. They would also build a new side entrance into the unit, for exclusive use by its staff.
Still, Davis worried. One option Livonia Woods gave him was to take his mother home while the facility served as a regional hub. They would even save her bed. But the Davises felt that if they were able to care for their mother themselves, they would have never sent her to Livonia Woods in the first place.
“To bring someone home that needs 24/7 care is more than a notion to ask a family to do,” said Davis.
As of early this week, Livonia Woods had planned to start accepting COVID patients on Monday, May 18.
But on Wednesday, the Davis family met some welcome news. Wellspring Lutheran, Livonia Woods’ parent company, said it would not become a regional hub after all. Though the facility still appears in the state’s list of hubs, a spokesperson for MDHHS said the department would honor Livonia Woods’ decision.
Among the facility’s reasons for shifting course were the “concerns and fears” of families — like the Davises.
Sarah Hulett contributed to this report.