A few states may have found a way to help slow the spread of the coronavirus in nursing homes by converting some of them into "recovery centers" set aside mostly for residents who have left the hospital but still might be contagious or lack immunity.
Critics worry about harming frail, elderly residents by transferring them to make room in repurposed nursing homes. But some public health experts and advocates see potential in combating further infection and freeing up hospital space, and many relatives embrace the concept as a way to protect their loved ones.
Debra Ellis agonizes over whether to bring her 87-year-old wife home if a coronavirus case appears in her nursing home, which currently isn’t reporting any. Ellis lives in Meriden, Connecticut, a state where three of nine planned nursing homes set aside for recuperating COVID-19 patients opened this month.
"It's terrible, the anxiety, you almost feel like they’re sitting ducks," Ellis said.
While nursing homes routinely isolate residents who have an infectious illness, such as the flu, advocates see the more dramatic idea of setting aside an entire facility as necessary, given how easily and fast the coronavirus can spread.
"You can’t stop it. Once it gets in, then it’s going to run its way through the facility," said Charlene Harrington, a professor emeritus of nursing at the University of California, San Francisco, and an expert in the risks of transferring elderly COVID-19 patients.
"So that’s why we want the COVID-only facilities set up and have the hospitals test patients. And if they have the virus, send them to the COVID-only facility," said Harrington, who would like to see California set up such homes.
The idea has been introduced in some other states, including Massachusetts and Utah, but not on as large a scale as in Connecticut.
It's too soon for statistics to show whether keeping hospital-discharged patients in a separate home to recuperate until they test negative will change the infection rate within nursing homes, but Connecticut officials say it has helped open hospital beds. As of Friday, state officials said about 100 patients had been discharged to recovery homes.
The nine homes are expected to free up about 800 beds. The longer plan is to contract with more nursing home operators and have 1,175 beds in COVID-19 recovery homes, state health officials said.
For most people, the coronavirus causes mild or moderate symptoms, and the vast majority recover. For some others, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death.
Over 10,000 deaths have been linked to coronavirus outbreaks in nursing homes and other long-term care centers nationwide. In Connecticut, 43% of the more than 1,700 people who have died of COVID-19 were from nursing homes. Of about 215 nursing homes in the state, 135 have at least one case, the state reported Friday.
Initially, Connecticut officials intended simply to move residents sick with COVID-19, who were already being kept away from others within their nursing homes, to a few homes designated for them. But then it emerged that people can be infected for 48 hours before exhibiting symptoms — so moving people to a different home could actually abet the spread.
The state then tweaked the concept, designating the specialized homes primarily for residents who have the disease but improved enough to leave the hospital — freeing up hospital beds for COVID-19 patients of all stripes by letting nursing home residents complete their recovery elsewhere, but with medical supervision.
Additionally, all residents whose nursing homes are being turned into recovery centers will be temporarily quarantined in their new spaces in case they aren't sick but have the virus anyway.
But that requires uprooting people who might be fragile, even without having the virus, and plopping them into an unfamiliar setting.
"We all know that a lot of seniors, whether they have end-stage dementia or not, they can get confused very often," said Lisa Warzecha, of Middletown, Connecticut, whose 89-year-old grandmother lives in a nursing home in Cromwell that hasn’t had a COVID-19 case. "And if they’re sick, in particular, they’re really going to be confused or frightened, and they’re going to wake up and have all these machines on them possibly, and new nursing staff."
Warzecha said she can see benefits on both sides, but Brent Colley, an elected official in Sharon, Connecticut, where the 88-bed Sharon Health Care Center was converted into the state’s first COVID-19 recovery center, objected outright.
"Moving residents out of their home/care facility is wrong and places these individuals at risk; it disrupts their care; places them in a mindset of confusion, possibly depression; it also affects their care-givers in similar, although different ways," he wrote on social media.
Sharon's owner, Athena Health Care Systems, has agreed to transform another home in Bridgeport, as well as two empty ones, providing about 500 beds.
All patient transfers have been voluntary, said Athena spokesperson Timothy Brown. They have been quarantined in their temporary homes and promised they will return to their original site, he said.
To entice companies, the state is doubling the Medicaid reimbursement for the COVID-19 recovery centers to $600 a day per resident. Typical pay for staff at the Athena homes will nearly double to $35 an hour for a certified nurse's aide, $50 an hour for a licensed practical nurse and $70 an hour for a registered nurse, Brown said.
Elsewhere, a 34-bed home in Salt Lake City is being transformed into a recovery center. The decision came after six residents and two workers tested positive and one resident died.
In Worcester, Massachusetts, the Beaumont Rehabilitation and Skilled Nursing Center this month became a recovery center. Plans to transfer healthy residents were temporarily disrupted as some began testing positive for the fast-spreading virus.
The long-term care ombudsman for Connecticut has heard both compliments and complaints.
“It’s very important to ask that individual rights are protected in people’s homes, and so I think our state is going very slow because of that," said Mairead Painter, the ombudsman. "We don’t want to go so slow that we don’t react appropriately, but we also don’t want to rush and neglect the fact that this is somebody’s home.”