Nursing home admissions explained

State DoH followed CDC guidance on letting patients return

In the early days of the coronavirus pandemic, the state Department of Health issued its controversial order that nursing homes accept people discharged from hospitals with COVID-19 in order to comply with guidance from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention, acting Health Secretary Alison Beam said Tuesday in a virtual news conference.

Beam reiterated that explanation when asked whether in retrospect issuing that order was a good idea -- given ongoing criticism that it contributed to the catastrophic number of deaths in long-term care facilities, which in Pennsylvania account for 51% of the state's 23,600 COVID-19 fatalities, and given that it has led to a furor in New York state, which adopted the same policy.

The mid-March 2020 order was a bad idea from the start, and the Pennsylvania Health Care Association and other stakeholders warned the state to no effect, Pennsylvania Health Care Association CEO Zach Shamberg said in a phone interview Tuesday.

Shamberg noted that Pennsylvania was one of only five states to follow the federal lead on the issue -- along with New York, New Jersey, Michigan and California.

"Abiding by federal guidance in the role that we play is always (a policy) that's most prudent," said Beam, who did not head the department at the time the guidance was issued.

Among justifications for that guidance was concern that keeping patients in hospitals that would otherwise be going to nursing homes would threaten hospitals with being overwhelmed, Gov. Tom Wolf said.

"(The hospitals) needed capacity," Wolf said. "They needed beds."

The department ordered discharged COVID-19 patients back to nursing homes that could care for them "safely," Beam said.

It also worked with those homes to help ensure "best practices," including policies to help prevent the spread of the contagion, she said.

Moreover, long-term care facilities that patients had left to go to the hospital were residences, so those patients were simply going home, Beam said.

The risks were widely known, according to Shamberg.

"Our providers knew it would be problematic," he said. "We fought against it" -- as did the national organization representing long-term care facilities, the American Health Care Association, he said.

The policy was counterproductive not only for the uninfected residents of homes, but for staff and even the COVID-positive patients being discharged, he said.

At the time the order was issued, nursing homes were "not equipped" to handle COVID-19, according to Shamberg.

They couldn't find enough personal protective equipment like masks, gowns, gloves and goggles, they had trouble with staffing and they often didn't have a grasp on cohorting -- the segregation of COVID-19 patients on separate floors, wings or even buildings, Shamberg said.

To protect Pennsylvania hospitals from the threat of being overwhelmed, there were options other than returning them to long-term care facilities, Shamberg said.

There were "multiple sites," including one set up to receive patients, although it was never used, Shamberg said.

Those patients could have been kept at those alternative sites for 14 days, when presumably their infections had passed, he said.

There was actually some justification for the policy in New York, where hospitals were overwhelmed, Shamberg said.

That wasn't the case in Pennsylvania -- although hospitals in Philadelphia were threatened, he said.

Two of the five states that adopted the federal guidance, New Jersey and California, dropped it quickly, Shamberg said.

New York altered its guidance in May, adding a requirement that patients coming into nursing homes needed a negative COVID-19 test first, according to an Associated Press article.

Pennsylvania added a similar requirement that month, Shamberg said.

The Pennsylvania order remains in effect, although the situation is far different now, as long-term care facilities are much more capable of doing what's needed to keep residents safe, even when some have COVID-19, Shamberg said.

Republican members of the Pennsylvania delegation to the U.S. House have suggested that Pennsylvania Attorney General Josh Shapiro investigate the Wolf administration's use of the COVID-19 admission policy in an open letter.

The Pennsylvania policy "undoubtedly cost lives," stated a news release from U.S. Rep. John Joyce, R-13th District, one of the signers.

"I'm very open" to inquiries, Wolf said Tuesday.

Pennsylvania's guidance is actually a little different from the federal guidance, according to the Pennsylvania Health Care Association.

The federal guidance stated: "A nursing home can accept a resident diagnosed with COVID-19 and still under Transmission-Based Precautions for COVID-19 as long as the facility can follow CDC guidance for Transmission-Based Precautions."

The Pennsylvania guidance stated: "Nursing care facilities must continue to accept new admissions and receive readmissions for current residents who have been discharged from the hospital who are stable, (in order) to alleviate the increasing burden in the acute care settings. This may include stable patients who have had the COVID-19 virus."

The length of time that most COVID-19 patients spent in the hospital was enough for them to get past the contagious stage, according to one New York health department argument in defense of its policy, according to a recent article by the Associated Press.

Alternate facilities weren't suitable for nursing home patients, department officials have argued, according to the AP article.

Asymptomatic employees were the main accelerant for nursing home outbreaks -- a claim supported by the similar percentage of COVID-19 deaths in nursing homes between spring and fall, New York officials argued, according to the AP article.

Mirror Staff Writer William Kibler is at 814-949-7038.