A task force charged with recommending how nursing homes should manage COVID-19 in the event of a second wave submitted its report to Governor Gretchen Whitmer this week.
The report is expansive, with 28 recommendations that address four key areas: resource availability, quality of life for residents, staffing, and resident placement.
Members of the task force – physicians, nurses, administrators, advocates, industry representatives, and lawmakers – had been meeting twice a week since early July.
“I will carefully review these recommendations and continue to work closely with the task force and our partners to strengthen policies to protect nursing home residents, staff, and their families,” Whitmer said in a statement.
In the resource availability section, the task force recommends that nursing homes get priority in the distribution of personal protective equipment, and proposes “a coordinated laboratory system across the state that prioritizes nursing homes" that need COVID-19 testing.
The quality-of-life section “strongly encourage[s]” outdoor visits and says residents should be able to gather for socially distant, small group activities.
Renee Beniak, executive director of the Michigan County Medical Care Facilities Council, chaired the task force’s staffing work group. She called nursing assistants’ jobs, which involve the most interaction with residents, “one of the most difficult.”
“To take good care of the residents and do the best job possible, I think the staff have to be happy and fulfilled and not overwhelmed and burn out,” she said.
The report says staff should receive better training and adequate paid-leave time for the sake of their “emotional and physical health.”
The report also suggests an alternative to Whitmer’s regional hub policy, which selected nursing homes that could house recovering COVID-19 patients in separate isolation wings.
The first recommendation is to improve coordination between nursing homes and hospitals so that the facilities can make better use of available bed space for recovering COVID-19 patients. If no extra space is available, the task force recommends sending the patient to a “Care and Recovery Center,” which the report calls “an adaptation of the regional hub program.”
Recovery centers would replace the regional hubs. According to the report, they should be “geographically diverse,” “provide high quality care,” and “engage in rigorous and consistent infection control protocols.”
"We're trying to, obviously, have a little more time to prepare," said Beniak. "If there's a second wave, I think (MDHHS will) be able to be a little bit more prescriptive and detailed."
The regional hub policy has attracted a lot of criticism, especially from state Republicans, some of whom claim that it was largely responsible for the more than 2,000 COVID-19 deaths among Michigan’s nursing home residents.
But the initial findings of a separate report, released in combination with the task force's report, present no evidence for that claim.
According to the Center for Health and Research Transformation at the University of Michigan, which is assessing regional hubs’ performance, the policy was a “logical and appropriate” response to the first wave of cases.
“No significant evidence of transmission of COVID-19 between patients admitted from hospitals to nursing home residents in hub facilities” was found, according to the preliminary report.
CHRT’s executive director Marianne Udow-Phillips said the hub strategy should be continued, but improved, much like the task force recommends with its recovery-center model.
“We are recommending — as did the task force — that this essential strategy be continued,” said Udow-Phillips. “We’re recommending strengthening it, but certainly not abandoning it.”
The study also compared Michigan’s nursing home response to that of other states, and found a persistent need to improve coordination among various state agencies and health providers.
In interviews, the researchers learned that some nursing homes received conflicting guidance from MDHHS and their local health departments. Nationally, they found that nursing homes whose administrators kept strong relationships with individuals at local hospitals (like discharge planners) were more effective in controlling infection.
Though the study’s objective is to “develop recommendations for preparedness in the event of another COVID-19 surge,” Udow-Phillips says the findings should herald broader changes to long-term care.
“I hope that we learn from this more generally, not just for COVID-19, about how we can improve care for seniors, but also about how we can do this to support the staff and all of those who really care for our seniors,” she said.
Udow-Phillips says the final report might be available at the end of September.
Additional information was added to the original web post at 10:48 a.m. on September 2, 2020.