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Cuomo’s Nursing Home Order Could Trap Recovered Patients In Hospitals For Weeks
By
Gwynne Hogan
Published May 14, 2020
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John Minchillo/AP/Shutterstock
By
Gwynne Hogan
Published May 14, 2020
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Nursing home operators and hospitals are concerned about the unintended consequences of an executive order signed by Governor Andrew Cuomo on Sunday.
The order prohibits the discharge of COVID-19-positive patients to nursing homes and requires nursing home staff to be tested for the virus twice a week.
But doctors are finding that some older patients continue to test positive for as many as six weeks after they recover, according to Dr. Maria Carney, the chief of geriatrics and palliative medicine at Northwell Health.
Similar reports have emerged from China and South Korea. Carney said her medical directors mainly report the phenomenon among older patients, and they don’t have any data about how prevalent it might be among the rest of the population.
The biggest fear, she said, is that elderly patients will languish in hospitals longer than they need to, keeping them from their homes and increasing the burden on hospitals.
“These chronically positive patients can’t stay in a hospital this long. That has its own dangers,” Carney said. “The risk is delirium, the risk is falls-in-the-hospital because they’re alone [in an] isolation [room] with no assistance. Hospitals are not set up to care for this population long-term.”
The long stays also create logistical hurdles and hospitals may run out of beds to care for patients, Carney said.
“I don’t want to cause more harm for a vulnerable patient population who really clinically doesn't need an acute hospitalization and really should go back to the facilities [that are] their home,” she said.
Nursing home operators also have concerns about the governor’s order.
In a letter to Cuomo and NY State Health Commissioner Dr. Howard Zucker on Tuesday, the directors of five nursing home industry trade organizations questioned the feasibility of a provision that requires them to test 140,000 employees twice a week.That’s about twice the number of tests currently being conducted statewide each day.
A man in protective gear stands at the front of the Sapphire Center for Rehabilitation and Nursing of Central Queens on 17 April 2020
JUSTIN LANE/EPA-EFE/Shutterstock
“There are not sufficient testing supplies to accommodate this new demand,” the letter reads. “Simply put, the State must take ‘ownership’ of ensuring that sufficient testing materials will be made available to all facilities to enable them to meet any deadline.”
All long-term care facilities were required to submit plans to the state health department by Wednesday afternoon describing how they plan to test staff. At his daily press briefing on Wednesday, Cuomo was asked whether nursing homes would get help from the state to meet the new testing requirements.
“We will help them with the number of tests. The tests will be [at] no cost to the employees,” Cuomo said, without providing further details. “Yes, it’s an inconvenience, it’s a pain in the neck, but we’ll help them get the tests. But I think we have to be able to say we did everything we can.”
Coronavirus has ravaged downstate nursing homes, with 5,516 deaths of residents in congregate care facilities as of Monday afternoon. This number does not include residents who were transferred to hospitals and passed away there. Those cases are counted as hospital deaths.
Nursing home operators, employees, and watchdogs raised red flags for weeks about a lack of access to testing for staff and residents and a lack of adequate supply of personal protective gear for staff. Some facilities said they were unable to separate sick and healthy residents, and had begged for the state to send some residents to facilities like the USNS Comfort or the Javits Center, to no avail.
While some facilities have reported improvements in recent weeks, with support from the state in accessing testing and personal protective gear, Susan Dooha, the Executive Director of Center for Independence of the Disabled, which acts as a watchdog for the state’s long-term care facilities, said some facilities are still struggling.
“There isn’t adequate protective gear, PPE. We know that there isn’t any program of universal testing for residents and we know that there isn’t any universal testing program for personnel,” she said. “We believe that these indications will continue to be giving us very bad news for some time to come.”
Facing pressure over the mounting death toll inside long-term care facilities, Cuomo said the State Attorney General would investigate what went wrong, and then issued the new order on Sunday. It reverses an earlier requirement for nursing homes to accept covid-positive patients if they could properly isolate them, which was designed to ease the strain on hospitals.
“We want to advocate for the best [care], but we have to be very cautious so we don’t create any unintended harmful consequences,” Dr. Carey said. “I don’t want people to stay in the hospital any longer than they have to be, if they can be cared for properly at the next level of care and I do believe they can be.”
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COVID-19
coronavirus
nursing home
Gwynne Hogan
Gwynne Hogan is a former Gothamist reporter.
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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