Families, lawmakers seek answers on Michigan's COVID-19 nursing home death toll
The last time Beverly Fields was able to talk to her husband, James, he was in the hospital. The call happened over FaceTime with the assistance of a nurse. James couldn't open his eyes.
"I only wish I could see his eyes open," Beverly said five weeks later.
James Fields, who was 81 years old and loved boating and scuba diving, spent weeks in a Livingston County nursing home before testing positive for the coronavirus. He died at an Ann Arbor hospital on April 24.
Beverly, 69, of Brighton said she believes her husband of 48 years contracted the virus in the nursing home after a hospital stay ended with him being sent there for further care during the pandemic.
Stories like that of James Fields are gaining attention in Lansing as Michigan lawmakers question whether policies of Gov. Gretchen Whitmer's administration formed to guide nursing homes' handling of individuals with COVID-19 led to further spread of the virus among one of the state's most vulnerable populations.
Members of Whitmer's administration and nursing home industry officials said the policies attempted to make the best of a bad and dangerous situation.Facilities weren't forced to take individuals with COVID-19 the facilities didn't believe they were prepared to care for, Whitmer told WJR-AM's Frank Beckmann on Thursday.
“If they chose to, they had to have isolation,” the governor added.
The cases in nursing homes also reflected the spread of the virus in the surrounding area, industry officials said.
"Any death of an elderly (person) in a long-term care setting is devastating, and it's incredibly difficult for providers," said Melissa Samuel, president of the Health Care Association of Michigan, which represents nursing homes. "But COVID is in buildings because it was so prevalent in the community."
With a limited number of residential options available, the Michigan Department of Health and Human Services created a policy geared around providing infection control for nursing facility residents, department spokeswoman Lynn Sutfin said.
"We continue to assess the policy’s effectiveness and to consider improvements, working with skilled nursing facilities, our state partners, local health departments and the Legislature," Sutfin said.
Others, including lawmakers on both sides of the aisle, aren't sure about the policy's effectiveness. The Michigan Senate Oversight Committee has launched a weeks-long inquiry. The lawmakers question whether the Whitmer administration's decision to allow individuals with COVID-19 to be housed in the same facilities as other elderly individuals helped spread the virus.
Sen. Peter Lucido, R-Shelby Township, who serves on the Oversight Committee, said he sees nothing in the situation but "a soup of a disaster." He has called for a ban on the practice of placing individuals with COVID-19 in nursing homes.
The anxiety level of people with family members in the facilities is through the roof, he said, as restrictions on visitors are in place to stem the spread of the virus.
"The most vulnerable cannot fight back," Lucido said. "They can't get into the nursing home and that person can't get out. Therefore, they're left with only desperation and despair."
During a May 27 oversight hearing, Lucido pressed Robert Gordon, director of the state Department of Health and Human Services, on keeping individuals with COVID-19 in the same facilities as those without it.
"If the governor's correct that there may be another wave ... why don't we go make a ground zero so we don't have to go ahead and worry about how many are dying by putting the same people in the facility of which they're supposed to be protected?" Lucido asked.
Gordon responded: "I think we're doing everything in our power to protect people who don't have COVID from getting infected by people who do given the facilities that we have and given the need to treat people in facilities that are appropriate for them."
Policies in the spotlight
As of Thursday, Michigan had tracked 5,600 COVID-19 cases in the state's nursing homes and 1,505 deaths linked to the virus with about 93% of facilities reporting. That death toll represented about 27% of the COVID-19 deaths at that point.
Michigan has had 2,297 COVID-19 deaths in Michigan nursing homes, according to "preliminary" data from the federal Centers for Medicare and Medicaid Services. The figure would represent 41% of total confirmed deaths if it goes unchanged. But state health department spokeswoman Sutfin said the federal numbers weren't accurate.
The department is "currently in the process of reaching out to each of Michigan’s nursing facilities individually by telephone to manually verify their cumulative data on cases and deaths. We will share the results of that reporting by the end of this week," she said.
As COVID-19 emerged in Michigan, state officials faced weighty decisions on how to handle nursing home residents and individuals in need of long-term care who had the virus or who were leaving hospitals stretched for capacity.
Whitmer issued an initial executive order on COVID-19 in long-term care facilities on April 15 — 36 days after the state confirmed its first cases of the virus.
Under the order, the Michigan Department of Health and Human Services designated regional hubs — existing nursing home facilities that had the ability to care for individuals with COVID-19 in isolated areas within their buildings.
Facilities received $5,000 per approved bed to establish a hub, according to the department. In support of ongoing operations, facilities will receive a $200-per-day payment for any occupied hub beds.
The early order also said a nursing home with a census below 80% had to create a unit dedicated to the care of COVID-19-affected residents. Facilities "must accept the return" of a resident who had been hospitalized if it can meet the medical needs of the resident, the order said.
The idea was to take pressure off hospitals while caring for individuals in an appropriate setting.
Samuel of the Health Care Association of Michigan said her organization had "significant concerns" with the initial executive order and expressed them immediately to Whitmer's administration, which later made changes and issued additional guidance.
"In essence, it was really never implemented as originally issued," Samuel said.
Later guidance and orders gave facilities "flexibility" to decide whether to take an individual with COVID-19 based on whether they had the staff, equipment and isolated space necessary to care for the individual, she said.
The Michigan Department of Licensing and Regulatory Affairs has been conducting infection control surveys since March 26, examining 345 of the 422 federally certified nursing homes in the state, said David Harns, spokesman for the department.
The Senate Oversight Committee has focused on the nursing home policies in recent weeks, taking nearly five hours of testimony on the subject. Sen. Ed McBroom, R-Vulcan, who chairs the committee, said he plans to hold more hearings and eventually release a report summarizing the panel's findings.
"So far, my present analysis is that this was an unwise decision," McBroom said of Whitmer's policies that allowed individuals with COVID-19 to be placed in isolated spaces within nursing homes. "In hindsight, it looks very obvious that it was unwise.”
But he acknowledged what other officials have said. "We have not seen any evidence or testimony that says that a nursing home was forced to take someone against their will," McBroom said.
Other Republican lawmakers have suggested that the state should have set up separate facilities to care for individuals with COVID-19 who lived in nursing homes.
But during committee testimony, health department director Gordon said a facility like the TCF Center in Detroit, which served as a field hospital, didn't have the staff or equipment to care for nursing home residents.
'Fight for this cause'
In hindsight, getting nursing homes more personal protective equipment as supplies were dwindling should have been a higher priority at all levels of government, said Henry Boutros, vice president Illuminate HC, which operates 14 nursing home facilities in Michigan, including four regional hubs.
But, he also noted, the hubs in his company have had 515 patients who recovered from COVID-19.
"It was made clear to all of us to only take patients we were capable of taking," Boutros said. "I never felt as an organization that we were forced to take patients."
State Rep. Leslie Love, D-Detroit, has been studying the nursing home policies. Her mother, Frances, contracted COVID-19 while in a Michigan nursing home that served as a regional hub for individuals with the virus.
Although she's asymptomatic, Frances has been in isolation and has only been able to see visitors through a window, Love said.
Love questioned why the state allowed nursing homes with low-quality rankings to serve as some of the 21 regional hubs for caring for elderly individuals with COVID-19. She's also called for more funding for inspections within the facilities.
"(I'm) just trying to stay encouraged and fight for this cause at the same time,” Love said.
In a statement, Orlene Hawks, director of the Department of Licensing and Regulatory Affairs, acknowledged a financial "shortfall" within the bureau that handles nursing home inspections.
"While these funds are greatly appreciated, costs related to these activities continue to rise and this has caused a recent shortfall that has impacted staffing levels for our Bureau of Community and Health Systems," Hawks said.
During a May 13 oversight hearing, state Sen. Jeff Irwin, D-Ann Arbor, said problems with infection control at nursing homes weren't new.
"This Legislature has been under funding and neglecting these needs for many, many years, for decades," Irwin said. "There are people who work in these facilities at subhuman wages, and we're expecting them to be the front-line heroes in the COVID-19 response. It's ridiculous.
"Nursing homes, this is a huge concern."
Like Love, Beverly Fields is also looking for more information about the state's handling of COVID-19 in nursing homes.
Her husband, James, was hospitalized with health problems before being discharged to a nursing home in Livingston County for further care.
On April 13, she received a letter from the facility that said an individual there had tested positive for COVID-19.
"We are doing everything we can to ensure we stop the spread of COVID-19 within our facility," the letter said.
Eventually, Beverly believed her husband's health was deteriorating by the way he looked through his room window. He wound up at the hospital, where he tested positive for COVID-19 on April 18. He died six days later.
"I think the law needs to be changed," Beverly said. "They should never have been able to endanger the residents in the homes when they were not prepared to care for them safely, and without adequate personal protection for the staff and the doctors.”