Virus pipeline to elder care: Nursing homes accepting infected patients, even as death toll mounts

Despite the devastating death toll, Minnesota nursing homes are still being allowed by state regulators to admit coronavirus patients who have been discharged from hospitals.

Early in the pandemic, the Minnesota Department of Health turned to nursing homes and other long-term care facilities to relieve the burden on hospitals that were at risk of being overwhelmed by COVID-19 patients. Minnesota hospitals have since discharged dozens of infected patients to nursing homes, including facilities that have undergone large and deadly outbreaks of the disease, state records show.

Now that practice is drawing strong opposition from some lawmakers, residents' families and health watchdogs, who warn that such transfers endanger residents of senior homes that are understaffed and ill-equipped to contain the spread of the coronavirus. They are calling for more state scrutiny over transfers, including stricter standards over which nursing homes should be allowed to accept COVID-19 patients from hospitals.

Currently, even poorly rated nursing homes with large and deadly clusters of coronavirus cases have been allowed to admit COVID-19 patients from hospitals. One such facility, North Ridge Health and Rehab in New Hope, has accepted 42 patients from hospitals and other long-term care facilities since mid-April even as the coronavirus has raged through its 320-bed nursing home, killing 48 of its patients and infecting scores more.

"It makes no sense to bring more COVID-19 patients into facilities that have already failed to protect them," said Sen. Karin Housley, the Republican chairwoman of the Senate Family Care and Aging Committee. "If it were my mom or dad in one of these facilities, I would be really worried."

State health officials and long-term care industry representatives have defended the practice of discharging some COVID-19 patients to nursing homes, saying it is part of a broader strategy to conserve critical hospital beds during the pandemic. Long-term care facilities can provide treatment for coronavirus patients who still need care, but have stabilized enough that they no longer require hospitalization, officials said.

So far, 11 facilities statewide have been designated as "COVID support sites," with separate units or wings to handle coronavirus patients. These specialty sites have gone through a vetting process by the state to ensure they have adequate staffing, supplies and infection-control standards.

However, other nursing homes have been allowed to admit COVID-19 patients under private arrangements with hospitals. The practice is widespread. The state Department of Health has reviewed the cases of about half the patients hospitalized for COVID-19 statewide. The agency found that 27%, or about 268 patients, were discharged to long-term care facilities since the pandemic began.

"Hospital beds are a key resource during this pandemic, and they must be preserved for those who are in need of acute care," the Minnesota Department of Health said in a statement. "For COVID-19-positive patients whose care requirements are below that level, the goal is to get them out of the hospital and into an appropriate setting for their next stage of care — one that can provide the services they do need while minimizing the risk of transmission."

But the fear that moving coronavirus patients to nursing homes might trigger more infections has been compounded by the alarming death toll in such facilities.

Statewide, the respiratory disease caused by the coronavirus has killed more than 600 Minnesotans at nursing homes and assisted-living facilities. That is a staggering 81% of the deaths from the pandemic statewide. No other state in the nation that reports such data has such a high percentage of deaths in long-term care, according to an analysis by a Texas-based nonprofit. Nationwide, outbreaks in long-term care facilities have claimed 33,000 lives — more than a third of all deaths nationwide, according to the Associated Press.

"To be sending more contagious people into these settings is a serious cause for concern," said Rep. Jeremy Munson, R-Lake Crystal, a member of the House Long-Term Care committee.

Jeff Johnson of Maple Grove said his 71-year-old father has been a patient at North Ridge since he suffered severe injuries in a car crash in March. He was surprised when a staff member at the facility informed him that COVID-19 patients were being admitted to the facility from area hospitals. While his father remains symptom-free, Johnson said he is concerned that staff might carry the virus from the newly admitted patients.

"I was absolutely shocked that [North Ridge] would risk exposing workers and everyone else in a facility without asking for our input," said Johnson, a gymnastics instructor. "It seemed that we should have had some say in the matter."

Government health records show that North Ridge has struggled in recent years to adhere to basic standards of patient care. The facility has been fined $117,000 by federal regulators and cited for dozens of health and safety violations over the last three years. The nursing home earned just two stars ("below average") on the federal government's five-star rating system for overall care. The facility was also listed among the most-troubled nursing homes in the nation.

A spokesman for North Ridge acknowledged that admitting patients with COVID-19 has posed challenges, but said the facility has space and enough trained caregivers to handle new admissions of COVID-19 patients. Early in the pandemic, North Ridge set up separate units to isolate COVID-19 patients from the rest of the clients and was able to provide them with a full supply of protective equipment, he added.

"We don't regret caring for people in need for a second," said Austin Blilie, vice president of operations at North Ridge. "These are people who are being turned away from other places that do not have the capability to care for them."

Although there is no evidence that moving coronavirus patients to nursing homes has caused infections to spread, the practice has come under increased scrutiny nationwide. Officials in California and New York both ordered nursing homes to accept coronavirus patients to help reduce potential overcrowding in hospitals during the pandemic; but then both states reversed those directives after an outcry from senior groups and the medical community, according to news reports.

Already, one large Minnesota nursing home has suspended plans to take in coronavirus patients amid public opposition.

The operator of Augustana Care Health and Rehabilitation in Apple Valley had planned to create a separate, 28-bed unit for people recovering from the virus, but pulled the plug in April after dozens of residents' families and local officials voiced concerns in public Zoom calls. Despite assurances that any new patients would be separated and cared for by dedicated staff, many families expressed trepidation about bringing COVID-19 into a facility that has not been infected, said Bob Dahl, chief executive of Cassia, which operates the facility.

"We thought it was a good idea from a public service perspective, but there was significant pushback," Dahl said. "What [families] couldn't accept was this idea of admitting someone with COVID when it was not in the building, and why would we do that now? It was perfectly understandable."

Advocates for nursing home residents and public health experts have argued that facilities should not be allowed to decide on their own whether to admit COVID-19 patients. And they want the homes to meet certain standards. Facilities with low staffing levels and poor infection-control records should be barred from accepting such patients, according to the Center for Medicare Advocacy, a nonprofit legal assistance group for seniors in Washington, D.C.

Across the nation, there are examples of poor-performing nursing homes accepting coronavirus patients with little or no oversight from state regulators, said Toby Edelman, a senior attorney for the Center for Medicare Advocacy. Some of these facilities have a one-star rating of "much below average" from the government for staffing levels and quality of care, Edelman said. "Without some minimum standards, this is a recipe for disaster," she said.

Joseph Gaugler, a professor of long-term care and aging in the University of Minnesota's School of Public Health, said nursing homes should be required to establish certain safeguards before accepting COVID-19 patients. These include demonstrating that they can isolate infected residents, maintaining regular testing, and have a staffing plan to handle an influx of new patients with the virus.

"If a nursing facility isn't following best practices, then [coronavirus] patients should go elsewhere," Gaugler said.

Chris Serres • 612-673-4308

Twitter: @chrisserres