A California directive that could open the way for some patients sickened with COVID-19 to be sent from overburdened hospitals to nursing homes is being criticized by industry officials who fear vulnerable, elderly residents would be placed at risk.
The California Association of Health Facilities, which represents most skilled nursing homes in the state, warned that many of the nursing homes lack sufficient gloves, masks and other protective supplies to limit the spread of coronavirus infections. Instead, the group is urging government officials to create separate facilities to care for COVID-19 patients who are well enough to be moved from hospitals.
"Under California law, facilities are not required to admit any patient if they are unable to meet their needs, and right now we can’t meet patient needs," the group said.
Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called the plan a "recipe for disaster."
"You have the most vulnerable population in California in nursing homes," McGinnis said. "Many facilities are understaffed ... . They are not prepared."
Looking to get ready for an expected surge in COVID-19 patients, the Newsom administration notified nursing homes last month to prepare to receive patients with suspected or confirmed cases. The Department of Public Health noted that some infections may be mild and not require hospital care, while in other cases patients might have recovered sufficiently to leave a hospital but still require assistance, which could be provided by a nursing home.
The state has over 1,000 nursing homes that provide long-term medical care, known as skilled nursing facilities.
A March 30 state order to skilled nursing homes said the facilities “shall not refuse to admit or readmit a resident based on their status as a suspected or confirmed COVID-19 case.”
However, there are restrictions: In an April 1 order, the state said patients should not be sent to nursing homes without consultation with local health officials, and the nursing home must have adequate supplies and be following federal guidelines for the care of patients with COVID-19, the respiratory illness caused by coronavirus.
The Department of Public Health said in a statement that COVID-19 patients can only be transferred to nursing homes “that have been prepared” to care for them, such as setting up portions of their facilities with separate staff and supplies.
The coronavirus crisis "requires our whole health care delivery system to work together seamlessly for the health and safety of all Californians," the agency said.
Earlier this year, coronavirus outbreaks at nursing homes in Washington, Illinois, New Jersey and elsewhere highlighted the industry’s long-running struggle to control infections with often limited, poorly paid staff.
At the Life Care Center in the Seattle suburb of Kirkland, federal investigators believe a contributing factor in dozens of deaths was low-pay employees who came to work with the illness and potentially even spread it to other nearby facilities where they took shifts.
In California, Contra Costa Health Services said Friday that at least 27 people who live or work at a skilled nursing facility in Orinda, California, have tested positive for COVID-19. No deaths have been reported in connection with the outbreak.
In Yucaipa, in San Bernardino County east of Los Angeles, eight nursing home residents were hospitalized in a coronavirus outbreak that infected more than 50 people and killed two of them, officials said earlier this week. Six staff members also tested positive for the virus.
Los Angeles County Public Health Director Barbara Ferrer reported four new deaths at skilled nursing or assisted-living facilities.
Gov. Gavin Newsom alluded to the dispute Friday, though he didn't directly address any of the criticisms about potentially bringing the sick into nursing homes.
"We continue to also focus with acuity on what’s happening in our skilled nursing facilities, what’s happening with our senior centers and our adult care facilities throughout the state," he said. "We said at the beginning of this epidemic that homelessness and our seniors, those were our top priorities. They remain so."
Jan Emerson-Shea of the California Hospital Association said there is a need to get patients out of the hospital who no longer need a high level of care. But at the same time hospitals “don’t want to create a worse problem” by moving them into a facility that isn't ready to care for them, Emerson-Shea said.
"It's absolutely going to be on a case-by-case basis," she said.
Associated Press Writers Robert Jablon and John Antczak in Los Angeles and Kathleen Ronayne in Sacramento contributed.