Nearly 2,000 nursing home residents in Michigan have died of COVID-19, making up about 34% of the state’s total deaths from the disease. That figure was announced on Monday by the Michigan Department of Health and Human Services.
The update came with a handful of other announcements that will affect the way skilled nursing facilities protect residents and staff from disease outbreaks for months to come. Health department director Robert Gordon issued new testing requirements for nursing homes, strengthened enforcement mechanisms for reporting COVID-related data, and announced ways in which the state would help facilities manage outbreaks.
In a call with reporters, he also confirmed that, consistent with a new executive order from Gov. Gretchen Whitmer, the state’s regional hub policy would remain intact. The policy gives nursing homes that cannot safely care for COVID-positive residents the option to send them to so-called regional hubs, facilities with isolation units dedicated to the care of those patients.
Here’s a look at Gordon’s main announcements.
In an order issued on Monday, Gordon outlined requirements for Michigan’s 458 skilled nursing facilities to test their staff and residents for COVID-19. Instructions vary depending on a facility’s location and the status of the disease within its units.
For example, in facilities with any positive cases, all residents and staff must be tested weekly “until 14 days after the last new positive result.” And, regardless of whether COVID has been detected, facilities in medium or higher risk parts of the state (basically, the entire southern half) must test their staff weekly.
By June 22, facilities must develop a testing plan consistent with these requirements, and implement that plan by June 29. According to Gordon’s order, they may ask the state for help — for example, with acquiring testing materials — in an email.
According to MDHHS spokesperson Lynn Sutfin, facilities are not required to submit their plans to the department unless requested to do so, though MDHHS intends to set up an audit process. Also upon request, facilities must share their plans with LARA and members of the public.
Data reporting and accuracy
In late May, MDHHS enhanced reporting requirements for skilled nursing facilities to align with federal standards. Including categories such as confirmed and suspected COVID cases, COVID deaths, total deaths, staff shortages, availability of personal protective equipment, and dozens more, the new rules were meant to give the state a better picture of how facilities were protecting staff and residents.
Now, under the new order, facilities may face a $1,000 fine for each day they fail to submit the required information to MDHHS. Those cases of noncompliance will be referred to the Department of Licensing and Regulatory Affairs, which will decide whether to impose the penalty.
MDHHS officials have attributed inaccuracies in the data to a technological learning curve: Early on, when facilities were still unfamiliar with the many new reporting requirements, their submissions contained errors.
Meanwhile, through a system separate from the state’s, the Centers for Medicare and Medicaid Services has been collecting information from all U.S. nursing homes. CMS released the first wave of that data early June. It proved that accuracy was still a problem.
In the Monday press call, Gordon called the CMS data “significantly flawed.” Whereas MDHHS’s count of COVID deaths among nursing-home residents was 1,947 as of June 14, the federal count was 2,297 as of June 4. As Michigan Radio’s Brad Gowland found in an analysis, the CMS data shows 32 facilities in Michigan with more COVID-19 deaths than cases, which, of course, is impossible.
MDHHS verified its data by calling each facility individually, reaching all but one of Michigan’s 458 homes. Acknowledging that his department won’t be able to make a habit of those individual check-ins, Gordon said he hopes the new penalties and clearer instructions will maintain accuracy going forward.
“We have moved extremely aggressively and thoroughly to ensure those facilities report, ensure that they understand the questions they’re being asked, and ensure that the numbers make sense on their face,” he said.
Legislators and advocates for long-term care residents have been asking for more information about these facilities for months.
Some of the new data, including cumulative cases and deaths per facility dating back to January 1 (for both residents and staff), is now available on the state’s long-term care website. It will be updated daily, Monday through Friday.
MDHHS also announced on Monday that nursing facilities having an especially hard time protecting residents and staff may receive direct help from the state.
With workers staying home due to illness or fear of getting sick and infecting their family, many facilities have been facing a shortage of nursing staff. As data relased on Monday indicates, 3,133 nursing-home staff have contracted COVID, and 20 have died from it. To help fill those gaps, MDHHS is working with a staffing agency to send registered nurses and certified nursing assistants to those short-handed locations, where they could work for up to two weeks.
Gordon says he recognizes that increased testing across nursing homes may worsen staffing shortages, as asymptomatic workers are sent home.
“That is the risk,” he said on Monday. “But we do want to make this available, because the testing has to happen, and if there’s a staffing gap, we have to close that gap. And the risk of a staffing gap cannot become an excuse not to do testing.”
MDHHS is also working with the organization Doctors without Borders to provide on-the-ground guidance on infection control to facilities that have struggled to contain outbreaks.
In an executive order issued on Monday, governor Whitmer preserved the state’s regional hub policy, under which facilities across the state, but mostly in southeast Michigan, have been selected to serve as recovery units for nursing residents with COVID.
According to an MDHHS spokesperson, all of those recovery units exist within facilities that also serve patients without COVID. The risk that poses to healthy residents and staff, even with proper infection controls, has provoked legislators like Rep. Leslie Love (D-Detroit) and Sen. Peter Lucido (R-Shelby Township) to demand that the governor end the policy. Lucido has gone so far as to write a bill, which goes before the Senate Committee on Health Policy and Human Services this Thursday.
In Monday’s call with reporters, MDHHS director Gordon responded to questions about alternatives for recovering COVID patients, including the possibility of building dedicated recovery sites. He said “we are always happy” to consider those options, and that the department is open to hearing ideas.
But he also cautioned against transferring nursing-home residents without careful thought.
“You would be force-transferring people in all likelihood,” he said. “You may actually cause harm to people. You can cause psychological harm, you can cause physical harm. Transferring nursing-facility residents is not something to be undertaken lightly.”
*Correction: A previous version of this story said nursing facilities are required to submit their testing plans to MDHHS by June 22. Facilities must have their plans by June 22, but are not required to submit them to MDHHS unless asked to do so. The story has been corrected above.