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Gov. Whitmer shifts nursing home policy with 'care and recovery centers'

Craig Mauger
The Detroit News

Lansing — Michigan Gov. Gretchen Whitmer's administration moved Wednesday to select centers under stricter guidelines to help care for elderly individuals with COVID-19, altering a policy that's drawn criticism during the pandemic. 

Whitmer's office announced an executive order Wednesday evening establishing what it called "care and recovery centers." Whitmer's administration made the changes five months after initially signing an executive order establishing "regional hubs." 

Michigan Gov. Gretchen Whitmer

The regional centers — wings, units or buildings located in existing nursing homes across the state — will have to meet additional safety and preparedness standards compared to the state's past regional hubs, which were put in place at the height of the pandemic to care for individuals discharged from hospitals or residing in facilities that couldn't properly isolate them.

Existing regional hubs could potentially qualify as new "care and recovery centers," also known as CRCs.

"With more time to prepare and more research on best practices and key elements needed for safety available, the state will now employ new criteria and procedures to approve facilities as CRCs," said Bob Wheaton, spokesman for the Michigan Department of Health and Human Services.

Wheaton described the centers as a "second generation" of the regional hubs. The Michigan Department of Health and Human Services issued a "notice of proposed policy" about the centers on Wednesday but said it would accept public comment "concurrently" with putting the changes into effect.

The governor's approach to the virus in nursing homes has been the subject of heated debate in the Capitol for months. About 32% of Michigan's 6,762 COVID-19 deaths have been nursing home residents, according to state data.

Whitmer's administration has focused on caring for elderly individuals with the virus in isolated areas of existing nursing homes. But GOP lawmakers have pushed for wholly separate facilities that the Democratic governor's team has resisted, questioning the feasibility of the idea.

The governor's executive order doesn't appear to adopt the idea of separate facilities promoted by lawmakers. The new "care and recovery centers" must "designate a distinct area for COVID-19 isolation," "dedicate staff" to the area and meet other standards, according to a bulletin issued Wednesday by the state health department. They must have a "designated wing, separate unit or separate building," the bulletin adds.

"From day one, I have taken action to protect both seniors and staff in long-term care facilities from COVID-19," Whitmer said. "We know this virus is a killer that preys on our most vulnerable citizens."

On Aug. 31, Whitmer's Nursing Homes COVID-19 Preparedness Task Force — a panel of industry stakeholders and lawmakers — proposed the creation of "care and recovery centers." Its recommendations described the centers as an "adaptation" of the current regional hub program.

Michigan established 21 regional hubs in April to help care for elderly individuals with COVID-19. The hubs are existing nursing homes that are supposed to have the isolated space, equipment and personnel to care for those with COVID-19 who are being discharged from hospitals or have resided in other facilities that can't properly handle them.

According to the governor's executive order, regional hubs will be "care and recovery centers" until "such time as the facility’s regional hub designation is rescinded."

The task force recommended consideration be given to "facility quality and survey history" in choosing "care and recovery facilities." Michigan's health department will accept applications from nursing homes seeking to become centers, according to the bulletin.

Nearly half of the nursing homes that Michigan selected to serve as regional hubs had below-average overall quality ratings from the federal government, The Detroit News reported in June.

Whitmer's administration has argued the ratings don't tell the whole story. According to the bulletin, "care and recovery centers" will have to have a star rating of "three or higher" in the staffing category of the federal government's rating, which is one portion of the rating.

While research has shown a nursing home's overall star rating doesn't correlate directly to its COVID-19 caseload or related deaths, facilities that were high-performing in the staffing star rating had fewer COVID-19 cases, Wheaton said.

This is a portion of the state's new plan for "care and recovery centers," which was announced on Wednesday, Sept. 30, 2020.

The centers will also need "a three-month history of testing for residents and staff," and the state will consider "death-to-case ratio during the COVID-19 pandemic" in choosing them, according to the bulletin. 

Robert Gordon, director of the Michigan Department of Health and Human Services, told state lawmakers in September that there are "many complexities" to establishing entirely separate facilities to care for nursing home residents with COVID-19, including staffing and equipping the buildings and moving people from one place to another.

“Michigan was very hard hit with COVID, at one point having the third most deaths per capita in the U.S.," Gordon told Joint Select Committee on the COVID-19 Pandemic. "Because the state was hard hit, our nursing homes were hit hard as well."

The News reported in July that nearly half of the 45 nursing homes in Michigan with the most COVID-19 deaths had been cited by state inspectors in recent months for failing to follow infection control, isolation or staffing policies.

cmauger@detroitnews.com