Whitmer task force urges big changes to Michigan's COVID-19 nursing home policies

Craig Mauger
The Detroit News

Lansing — A task force appointed by Michigan Gov. Gretchen Whitmer is recommending significant changes to the state's policies for nursing homes during the COVID-19 pandemic, according to a draft document obtained by The Detroit News.

The group wants to identify excess hospital capacity and use a new program creating "Care and Recovery Centers" across the state to help serve elderly individuals with the virus if there's a second wave, according to the draft copy. The task force's recommendations were due Monday to Whitmer. 

The recommendations seek to limit the sending of COVID-19 positive individuals to nursing homes that don't have a history of caring for residents with the virus. And they aim to change the "regional hub" system that's been a cornerstone of Whitmer administration's policies, which have focused on using isolated areas of existing nursing homes.

"The state should select a geographically diverse array of facilities that appear best suited to meet the state requirements, provide high quality care and engage in rigorous and consistent infection control protocols," the draft recommendations say.

Advantage Living Center Roseville located at 25375 Kelly Road, Roseville, MI
Max Ortiz/The Detroit News

About 32% of Michigan's COVID-19 deaths have been nursing home residents, prompting Whitmer's handling of the virus in the facilities to become a topic of much debate this summer. In June, she created the 20-member Nursing Home Preparedness Task Force to make recommendations.

Whitmer is likely to release Tuesday the formal version of the report by the task force — which includes members of the Whitmer administration, state lawmakers, industry leaders and one nursing home worker, said Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services. The Democratic governor's office didn't immediately respond to a request for comment.

The document will include 28 wide-ranging recommendations, according to a draft copy. One recommendation calls for outdoor visits to be allowed and strongly encouraged for residents of long-term care facilities. Another says nursing home staff should be provided with "a bank of paid leave time totaling 80 hours" for the duration of the public health emergency to "offset the toll on their emotional and physical health."

The only recommendation that faced objections within the task force was on limiting the facilities where individuals with COVID-19 can be placed — a topic that's spurred heated disagreement among lawmakers and Whitmer.

"COVID-positive residents who are discharged from hospitals should not be sent to 'COVID-19 naive facilities' (facilities that have not had COVID-positive residents) except in exceptional circumstances, as identified by the state in policy or guidance," the recommendation says.

A footnote explained that a "a lack of consensus on the specific criteria" prompted a vote and the majority position was represented in the task force's final recommendations.

The task force also urged that hospitals not discharge COVID-positive residents back to their nursing homes if they have less than 72 hours remaining in their isolation periods and the creation of "Care and Recovery Centers." The draft report describes the centers as an "adaptation of the regional hub program."

Protestors, including, Jonathan Nunoo, left, of Westland,  practice social distancing as they participate in a protest in front of the Ambassador Nursing and Rehabilitation Center on E. Jefferson in Detroit, Thursday afternoon, April 9, 2020.

Michigan established 21 regional hubs in April to help care for nursing homes residents 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.

Meanwhile, Republican lawmakers have called for the creation of entirely separate facilities to stem the spread of the virus among a vulnerable population.

A month ago, Whitmer vetoed a bill from the GOP-controlled Legislature that would have shifted elderly people with COVID-19 away from nursing homes and into separate facilities.

The Democratic governor said the bill, sponsored by Sen. Peter Lucido, R-Shelby Township, was based on "the false premise that isolation units created within existing facilities are somehow insufficient to protect seniors."

The task force recommends  the state continue "to explore the option of creating dedicated COVID-19 facilities," according to its draft report. 

"This option presented substantial procedural challenges that may not allow for timely implementation if we are faced with a second wave this fall," the report says.

For the "Care and Recovery Centers" program, consideration would be given to "facility quality and survey history," according to recommendations.

Nearly half of the nursing homes that Michigan selected to serve as regional hubs to care for elderly individuals with COVID-19 had below-average quality ratings from the federal government, The Detroit News reported in June.

Under the state's current regional hub program, the selected hubs receive $5,000 per approved bed and a $200-per-day payment for any occupied hub bed. That's on top of any additional funding the hubs would receive for patient care.

The new recommendations say the state should "determine whether modifications to the previous funding model would increase the potential number of facilities interested in being designated as Care and Recovery Centers."

The task force is also recommending that officials improve coordination and distribution of personal protective equipment (PPE) to ensure nursing homes are prioritized, according to the draft report.

The task forces labels shortages of PPE "a glaring issue from the very beginning of the public health emergency."

The Detroit 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.

As of Monday, the state had reported 2,087 COVID-19 deaths among nursing home residents and 21 among nursing home staff.