Minnesota lawmakers and advocates call for end to 'virus pipeline' to elder care

Minnesota state health officials are facing mounting public pressure to change or discontinue a policy that allows hospitals to discharge coronavirus patients to nursing homes already devastated by the virus.

Since the pandemic began, the Minnesota Department of Health has turned to nursing homes and other long-term care facilities to relieve the burden on hospital systems that were at risk of being overwhelmed by patients sickened with COVID-19, the deadly respiratory sickness caused by the virus. Minnesota hospitals have discharged more than 260 people with COVID-19 to long-term facilities, including communities that have struggled with large and deadly COVID-19 outbreaks.

At a Senate committee hearing Tuesday, state Health Commissioner Jan Malcolm defended the practice of allowing COVID-19 patients to be discharged to senior homes, asserting that the alternative — keeping people in hospitals longer — would potentially expose them to more infections.

"Staying in hospitals beyond the point where you need to be there is itself a risky thing," Malcolm said. "We do believe that a skilled nursing facility is the right level of care for a lot of people leaving acute [hospital] care."

Yet public health experts and senior advocacy groups have warned that transfers of COVID-19 patients to nursing homes could endanger vulnerable seniors, particularly in facilities that are chronically short of staff and have poor health and safety records. As it stands, even nursing homes with poor infection-control standards, as well as large and deadly clusters of the virus have been allowed to accept infected patients from hospitals.

One nursing home, North Ridge Health and Rehab in New Hope, has accepted more than 40 patients from hospitals and other long-term care facilities, even though the facility has been ravaged by the virus and cited for dozens of health and safety violations over the past few years.

A number of groups, including AARP Minnesota and a state association of geriatricians, are calling for more transparency and a careful vetting of facilities that receive COVID-19 patients, to ensure they meet minimum staffing and care standards.

"The public has a right to be assured that, if these facilities are taking on this increased risk, then the proper health and safety protocols are in place," said Mary Jo George, associate state director of advocacy at AARP Minnesota.

So far, 11 facilities statewide have been designated as "COVID support sites," with designated units or wings to handle coronavirus patients. Those facilities have gone through a rigorous vetting process to ensure they have adequate staffing, supplies and infection-control standards, state officials said. However, the Health Department has declined to reveal which facilities have been vetted as COVID support sites.

Sen. Karin Housley, R-St. Mary's Point, chairwoman of the Senate Family Care and Aging Committee, has been pushing for the creation of entire facilities for COVID-19 patients as a way to ease crowding in nursing homes and contain the virus' spread.

"Patients with COVID-19 should be kept in separate buildings with separate staff and separate ventilation systems," she said. "It's a really bad idea to bring them into facilities that have been working hard to stay COVID-free.

"We need to end the virus pipeline from hospitals to long-term care facilities," Housley added.

The practice has begun to generate public outrage. In April, the operator of an Apple Valley nursing home, Augustana Care Health and Rehabilitation, pulled the plug on plans to open a special unit for coronavirus patients after dozens of residents' families voiced concerns.

On a rainy evening last week, about a dozen families of nursing home residents, including some who have lost loved ones to the virus, held a vigil in front of the governor's residence protesting the discharge of COVID-19 patients to nursing homes. They lit more than 700 candles to memorialize residents who have died in Minnesota's long-term care settings and clutched signs saying, "No Transfers!"

"It's a terrible, terrible policy and it has to stop," Vicki Sheaffer of Mahtomedi, who helped organize the vigil, said of the transfers. "We as a society need to be more cognizant about protecting our elders, and putting coronavirus patients in these facilities is basically a death sentence."

The practice of allowing nursing homes to accept COVID-19 patients has been controversial in other states, too. In New York, for instance, Gov. Andrew Cuomo in March mandated nursing homes to admit new or returning patients regardless of their COVID-19 status, citing an urgent need to expand capacity in hospitals. But Cuomo reversed course last month and dropped the mandate after providers complained and a large outbreak occurred in a large nursing home required to take patients as a result of the policy.

The virus has hit residents of long-term care facilities particularly hard, both in Minnesota and nationally. At least 26,000 nursing home residents have died of COVID-19, according to preliminary data released Monday by the federal Centers for Medicare and Medicaid Services (CMS). The numbers also show a grim toll among nursing home staff, with nearly 450 dying of the virus. In Minnesota, at least 15 nursing home staff have died, the federal data shows.

However, the true death toll is likely much higher, because only about 80% of nursing homes nationally have reported death numbers so far. The national data also does not include assisted-living facilities, which are not regulated by the federal government. In Minnesota, assisted-living facilities are home to nearly twice as many residents as more tightly regulated nursing homes.

The dense layout of many larger senior communities has contributed to the virus' rapid spread, despite efforts to isolate infected patients on separate wings or floors. So far, nearly 3,000 residents of long-term care facilities across Minnesota have contracted the illness and 866 have died. Taken together, these facilities account for 81% of the state deaths from the virus. About 400 facilities still have active cases, state officials said Tuesday.

"Why on Earth would they now think that long-term care facilities can handle COVID-19 patients when in Minnesota 81% of the deaths are happening in these facilities?" asked Jean Peters, a nurse and president of Elder Voice Family Advocates, a grassroots advocacy group for seniors. "It is time to stop marginalizing the care of elders and vulnerable adults."