Michigan declined nursing home leader's idea to put COVID-19 patients in vacant centers

Craig Mauger
The Detroit News

Lansing — Three days after the confirmation of Michigan's first COVID-19 cases, the state's nursing home association leader recommended in a letter to Gov. Gretchen Whitmer's administration that empty facilities should be used as quarantine centers to "avoid widespread infection."

But state officials declined the suggestion of Melissa Samuel, president and CEO of the Health Care Association of Michigan, and instead set up a system in which infected residents are cared for in isolated areas of nursing homes, separate from residents without the virus.

That policy has been widely criticized by Republicans and at least one Democratic lawmaker who have called for separate facilities for caring for older Michiganians with COVID-19 in a bid to limit the spread of the virus to other elderly, vulnerable individuals.

As of Monday, the state reported 1,947 deaths among individuals who lived in nursing facilities and 20 deaths among staff. The tallies represented about more than a third of the statewide death toll at that point. Overall, two-thirds of Michigan's COVID-19 deaths have been individuals 70 years old or older, according to state data.

Samuel, whose association represents 353 member facilities, said Friday she didn't know why the state didn't follow the association's recommendation.

“I think it’s something that should have been explored," she said. "Maybe they did do that, and it wasn’t shared with us."

Samuel made the suggestion about caring for nursing home residents with the coronavirus at "vacant and new and unlicensed facilities" on March 13. The letter, which was emailed to state health officials, was recently released through a public records request.

"HCAM members have a number of facilities, including in Detroit and Southeast Michigan, that could be used for this purpose," Samuel wrote in the letter.

At this point, no direct evidence has been reported to show Michigan's current nursing home policies made the virus' impact worse.

The state explored several options to address the spread of COVID-19 within long-term care facilities, including the idea of using empty facilities, like Samuel suggested, said Bob Wheaton, spokesman for the Michigan Department of Health and Human Services.

Whitmer set forth the state's policy on caring for COVID-19 nursing home patients in an April 15 executive order.

The order put in place a system where some nursing homes established "separate units for residents who test positive for COVID-19" and others sent residents with the virus to one of 21 regional hubs — currently operating facilities the state selected to help care for the individuals.

"The length of time necessary to establish appropriate licensing, staffing contracts, ensure proper equipment availability within such facilities and the urgent need to identify placement for individuals that were not in need of hospital level of care ultimately led MDHHS to continue exploring other options, including the current regional hub strategy," Wheaton said.

In a March 14 emailed response to Samuel's letter, which included a variety of policy ideas, Michigan Department of Health and Human Services Director Robert Gordon thanked Samuel and said officials had shared the letter "widely."

Michigan officials have previously rejected the idea they should have directed nursing home residents with COVID-19 to temporary field hospital facilities, such as the now-closed TCF Center in Detroit. The facilities didn't have the proper layout, equipment and staff to care for elderly nursing home residents, state officials said.

The federal Centers for Disease Control and Prevention's guidance allows for COVID-19 nursing home patients to remain at a facility, instructing workers to "identify space in the facility that could be dedicated to caring for residents with confirmed COVID-19. This could be a dedicated floor, unit or wing in the facility or a group of rooms at the end of the unit that will be used to cohort residents with COVID-19."

Robert Gordon, director of the Michigan Department of Health and Human Services, sent this email on March 14, 2020, in response to suggestions from the Health Care Association of Michigan on handling COVID-19 in nursing homes.

Families still pained by losses

The policy debate comes amid pain for families who lost elderly loved ones who were living in senior living facilities.

Monique Claybone's 82-year-old mother, Wanda Woodward, lived in a Southfield senior community. Woodward tested positive for COVID-19 after two of her neighbors in the facility got the virus, Claybone said.

Weeks after being sent to the hospital, Woodward died May 8 from complications tied to COVID-19, doctors told Claybone.

The daughter now questions health care workers' handling of her mother and whether enough was done to lock down the senior living facility where her mom resided.

"This is a bad situation that we were not ready for," said Claybone, calling the senior living facility "an incubator" for the disease.

"... My mother was a very fun-loving, outgoing person. She had a beautiful smile. She was very warm. It's just so hard because she didn't deserve to die like this."

Gordon, the state's health and human services director, told a Michigan Senate committee in May that the state hoped to safely serve and isolate COVID-19 patients in the facilities.

He opposed the idea of sending nursing home residents to field hospitals where there would be staffing, equipment and accessibility problems.

"Alternative care sites were, by their nature, meant to be last resorts," Gordon said. "They were not meant to meet the standard of care that could be expected at a nursing home or hospital."

Other states isolate nursing home residents

Other states have used isolated COVID-19 facilities for infected nursing home residents.

In Florida, there are five "isolation centers," long-term care facilities that were built but not operating before the pandemic. The centers are now caring for individuals with COVID-19, said Kristen Knapp, spokeswoman for the Florida Health Care Association.

Asked how the facilities were being staffed, Knapp said in one case, a larger chain sent residents with COVID-19 to its "isolation center" and used its employees to staff the center.

“I think it’s a good strategy because you have people who have the appropriate PPE (personal protective equipment)," Knapp said about specific facilities for caring for infected individuals.

Florida — which has the seventh-highest number of COVID-19 cases in the nation, according to Johns Hopkins University — and Michigan, which has the ninth most cases, have used diverging approaches for handling the virus in nursing homes.

A larger percentage of Florida's COVID-19 deaths have been in long-term care facilities, 52%, than the 34% of Michigan's COVID-19 deaths in nursing homes. But Florida has fewer COVID-19 deaths overall with 3,104 compared with 5,823 confirmed deaths in Michigan through Friday.

As a result, the 1,637 deaths in Florida's long-term care facilities are fewer than the 1,947 deaths reported Monday in Michigan's nursing homes. Many more individuals live in long-term care facilities in Florida — 140,000 to 150,000 people — than are in Michigan nursing homes, usually about 38,000.

In addition, not all "long-term care facilities" are necessarily included in Michigan's nursing home death toll. The Great Lakes state's total doesn't include assisted living facilities, for example.

Sen. Ed McBroom, R-Vulcan, chairs the Senate Oversight Committee, a panel that's been examining nursing home policies during the pandemic.

"This continues to show that we had other options, and the option that we chose was not the best one," McBroom said about Samuel's letter.

But Salli Pung, the Michigan state long-term care ombudsman, said Friday she believes the creation of the regional hubs in existing facilities was the "appropriate choice" for "meeting the unique care needs of people requiring nursing facility level of care."

"Had vacant facilities been available and able to become operational with appropriate staff and supplies, that may have been the ideal situation for selecting hubs, but it was not an option," Pung said.