Michigan nursing home workers faced 'heartbreaking' reality as COVID-19 hit, inspection records reveal
As the pandemic slammed Michigan, workers inside some of the state's hardest-hit nursing homes rationed protective gear, went without COVID-19 tests and struggled to care for seniors who carried a deadly virus.
At one Lapeer County facility, an occupational therapist and a nursing assistant said they had been ordered in late March not to wear masks by a supervisor, according to an inspection report.
On March 29 — 19 days after Michigan confirmed its first COVID-19 cases — a nurse at a Macomb County facility told a government inspector that a resident there was "actively dying right now" and there were no tests for the virus available.
Out of the 45 nursing homes in Michigan that have reported the most deaths linked to COVID-19, nearly half — 22 — have been cited by state inspectors in the last four months for failing to follow infection control, isolation or staffing policies, according to a Detroit News review of hundreds of pages of state records.
The News' review of the documents provides the most comprehensive examination yet of conditions inside Michigan's nursing homes as the coronavirus began infecting vulnerable seniors in March and as hospitals were struggling to provide care for COVID-19 patients. They could also play into an ongoing policy debate over Gov. Gretchen Whitmer's decision to have facilities set up isolated areas for caring for residents with the virus.
As of Sunday, the Michigan Department of Health and Human Services had tracked 1,988 COVID-19 deaths linked to the facilities, accounting for 33% of the statewide death toll.
Nursing homes were caught off guard by the virus initially and haven't been able to catch up, said Tamara Blue, who worked for a facility in Detroit as a certified nursing assistant and is a representative for the Service Employees International Union. Blue was making $13 an hour at her job where she cared for residents with COVID-19 before she stepped away because she contracted it, she said.
"It’s overwhelming," Blue said of working in nursing homes during the pandemic. “It’s heartbreaking because you are literally watching someone take their last breath over and over and over again. And there’s nothing you can do about it."
But the situation varies from facility to facility, said Melissa Samuel, president and CEO of the Health Care Association of Michigan, which represents nursing homes. Likewise, she said, the severity of citations from inspectors varies.
"At the beginning of this battle, there were more unknowns than knowns," Samuel added. "New protocols and procedures were being written and implemented on a daily basis. The state and federal government changed our operations overnight.
"Facilities were working to comply and make those changes as quickly as possible. The primary reasons for the COVID-19 outbreaks in nursing facilities is the prevalence in the community and the lack of prioritizing these settings for testing and PPE (personal protective equipment)."
What state reports show
The 45 facilities reviewed by The Detroit News represent about 10% of the nursing homes statewide.
Of the 45, five didn't have COVID-19 inspection or survey reports available online through a website of the state Department of Licensing and Regulatory Affairs. For 18 others, government inspectors listed them in "substantial compliance" with safety policies after COVID-19-related surveys or didn't list any violations in documents available Wednesday.
The Bureau of Community and Health Systems — within the Department of Licensing and Regulatory Affairs — serves as an agent of the federal Centers for Medicare and Medicaid Services and provides regulatory oversight of the state’s nursing homes.
According to the available reports, 22 facilities failed to meet at least one standard directly related to stemming the spread of a virus that has devastated the elderly. Nearly 69% of Michigan's COVID-19 deaths have been individuals who were at least 70 years old, according to state data.
For every citation, a facility must write a plan of correction, and the state must then confirm that those corrections have been implemented, Samuel noted.
AARP Michigan, which advocates on behalf of the elderly, is "greatly concerned about differences in quality from one nursing home to another across the state," said Mark Hornbeck, the organization's spokesman.
"We know some long-term care facilities are doing a great job and others are struggling," Hornbeck added. "We are hearing firsthand accounts every day that reflect these differences."
Some Michigan nursing homes' violations have been relatively minor, such as masks found lying on the ground or a mystery oxygen tank left leaning on a chair in a common area inside the COVID-19 unit.
For others, state inspectors found a laundry list of missteps and specifically said in their reports the facilities' actions increased the potential for spread of COVID-19, hospitalizations and death.
An inspector required The Villages of Lapeer Nursing & Rehabilitation to seek "immediate" action to correct problems in April after workers revealed that the facility's then-director of nursing had ordered them not to wear masks inside the facility.
On March 24 — 14 days after Michigan confirmed its first cases of the virus — the director of nursing, who is not identified by name, entered the facility's therapy room and told an occupational therapist to remove "her own personal protective face mask," according to an inspector's report.
The occupational therapist "was not going to wear the mask in 'her building,'" the director of nursing said, according to the report.
"This was during a worldwide pandemic of the COVID-19 virus," the inspector wrote.
A nursing assistant at the facility told an inspector that the same director of nursing ordered her to take her mask off or "go home."
The director of nursing later resigned, and her successor said all personal protective equipment was welcomed at the facility. According to an inspector's report, the former director of nursing was concerned masks would cause "a panic." By April 7, an inspector found staff to be wearing proper protective equipment.
The Villages of Lapeer has reported 47 COVID-19 cases among residents, 16 cases among staff and 19 deaths linked to the virus among residents, according to state data. An official didn't respond to a request for comment for this story.
Patient 'actively dying'
Many of the 22 facilities cited for failing to meet safety standards faced shortages in personal protective equipment, staffing or COVID-19 tests, according to the inspection reports.
At Medilodge of Southfield, a handful of employees told an inspector that they had to use the same isolation gown "all day for residents with COVID-19 and those without it," according to a state report on that facility.
A nursing assistant told an inspector that the assistant was not provided a face shield to use when caring for residents with the coronavirus before April 28, 49 days after Michigan confirmed its first cases of the virus.
"CNA I (the abbreviation used to keep the employee's name secret) indicated that residents would cough all over them and the staff were getting sick," an inspector wrote.
Medilodge of Southfield has reported 51 cases among residents, 16 cases among staff and 20 deaths linked to the virus among residents, according to the state's tracking.
Medilodge didn't respond to a request for comment. But according to the inspection report, staff members were re-educated on the use of personal protective equipment and walking rounds were made by management staff each shift to conduct observations of staff and the use of the equipment.
Multiple facilities faced staffing shortages as employees called off work or contracted the virus and had to take time off, according to inspectors' findings.
At Advantage Living Center Roseville, a nursing assistant told a state inspector on March 29 that the nursing assistant was the only one working on the facility's isolation unit, which had 23 residents. Of those 23 residents, 98% required assistance or were incontinent, the nursing assistant said, according to the inspection report.
Asked how the nursing assistant provided regular care for each of the residents, the nursing assistant responded, "I can't."
On the same day in the same facility, an inspector reported questioning whether a nurse was aware their mask was not positioned properly.
'"No," the nurse replied before adding, ''I have one (resident) who is actively dying right now,'" according to the survey report.
The nurse told the inspector she didn't have time to take a break, the facility wasn't able to obtain COVID-19 tests to determine who had the virus and there were "no tests" available on March 29.
As of Tuesday, Advantage Living Center Roseville reported 66 COVID-19 cases among residents and eight among staff, according to state tracking data. The facility reported 20 COVID-19 deaths among residents and one death among staff.
Advantage Living Centers didn't respond to a request for comment. However, it instituted a plan to resolve issues identified in the state's inspection, according to the report. The plan included re-educating staff on personal protective equipment procedures.
Testing was also an issue at Medilodge of Kalamazoo, according to an inspection report.
There, an unnamed nursing home administrator told an inspector on April 23 that four staff members had tested positive for COVID-19 and the administrator said "they would not test anymore of their staff members for COVID-19," according to a report.
A spokesman for Medilodge didn't respond to a request for comment. On June 15, Gov. Gretchen Whitmer's administration unveiled new testing policies, requiring nursing homes to test all residents and staff initially and to test residents and staff with symptoms of the virus.
Gov policy fight
Michigan's nursing home policies have been in the spotlight for months now as Republican lawmakers and some Democratic legislators have disagreed with the Democratic governor's decision to have elderly individuals with the virus cared for in isolated areas of existing facilities.
Republicans have argued individuals with COVID-19 should be cared for in other facilities like hospitals or separate quarantine centers to prevent the spread of the virus to other vulnerable nursing home residents. But Whitmer's administration has been worried about overwhelming hospital capacity during the pandemic and has voiced concerns about the ability to properly care for nursing home residents in a makeshift field hospital.
The debate has largely focused on buildings and not the safety of nursing home employees, said Sen. Jeff Irwin, D-Ann Arbor, who serves on the Senate Oversight Committee, which has been investigating nursing home policies.
"They can’t afford to miss work if they’re sick," Irwin said of nursing home workers Wednesday. "They can’t afford to contract a cold, much less COVID-19."
Samuel, who leads the Health Care Association of Michigan, said state and federal government need to prioritize nursing facilities for personal protective equipment, testing and support for staff.
"The collective goal of local, state, federal agencies as well as other stakeholders should be to build up nursing facilities to enable them to meet and overcome the challenges inherent with the presence of COVID-19," Samuel said. "Nursing facilities are taking extraordinary measures to meet the new expectations of how care is provided based on regulatory and operational changes required by the state and federal governments."
Whitmer established the Michigan Nursing Homes COVID-19 Preparedness Task Force in June to help the state ready facilities for a potential second wave of the virus. On Tuesday, the governor announced the task force's 20 members.
The panel includes four state lawmakers, two members of Whitmer's administration, the leaders of a handful of health care interest groups and Trece Andrews of Detroit, who is a caregiver at the nursing home Regency at St. Clair Shores.
"I’m excited and proud to be a voice who can speak with first-hand experience on conditions in nursing homes," Andrews said in a press release. “A lot of attention has been paid to resident safety, but not enough to worker safety."
On Monday, Michigan's Bureau of Community and Health Systems said it had completed 100% of federally required infection control surveys of nursing homes. All of the state's 442 federally certified nursing homes went through an infection control survey from March 26 through June 19, according to the press release.