By Cynthia Dizikes and Jason Fagone San Francisco Chronicle April 1 2020
California nursing homes, already struggling to fight the new coronavirus, could soon be forced to accept infected patients from overflowing hospitals, according to a controversial state order that nursing home experts have derided as a “death sentence” for vulnerable residents.
The move is part of the state’s plan to handle an expected surge of patients sickened by COVID-19, the dangerous respiratory disease caused by the virus.
Typically, nursing homes that provide long-term medical care — known as skilled nursing facilities — accept some patients who are discharged from hospitals, as they are equipped with nurses and medical supplies. For these reasons, other states have already moved to enlist their nursing home networks in the fight against the coronavirus, including New York and Massachusetts, where dozens of nursing homes are being emptied and converted into COVID-19 treatment centers.All the stories, all the timeUnlock The Chronicle for 95¢SUBSCRIBE
There are more than 1,000 skilled nursing facilities in California and more than 200 in the Bay Area.
But advocates for nursing home residents and the doctors who treat them say the new policy could make a dangerous situation even worse, bringing the virus into close contact with elderly residents and allowing it to spread.
“Cramming infected patients into crowded, understaffed facilities with extraordinarily vulnerable residents is a recipe for disaster,” Patricia McGinnis, executive director for California Advocates for Nursing Home Reform, said in a statement Wednesday.
Deborah Pacyna, spokeswoman for the California Association of Health Facilities, which represents most skilled nursing facilities in the state, said that the organization strongly opposes the directive and has asked the state only to turn to nursing homes as a last resort for COVID-19 patients.
“In many cases, our facilities don’t have the proper equipment to prevent transmission within their facilities,” said Pacyna. She pointed to widely reported shortages of basic protective gear like masks, gloves and gowns.
The March 30 order from the California Department of Public Health says that skilled nursing facilities “shall not refuse to admit or readmit a resident based on their status as a suspected or confirmed COVID-19 case.” A department spokesperson said in a statement that it’s common practice for patients discharged from hospitals to be placed in nursing homes.
“CDPH is continuing to work with Skilled Nursing Facilities, and all healthcare facilities, to ensure they have the support needed to care for COVID-19 patients,” the statement said.
Jan Emerson-Shea, a spokeswoman with the California Hospital Association, said the unprecedented situation is forcing hospitals to make difficult choices: People who are less sick need to be discharged to free up hospital beds for those who are more sick. But those people, who may still be recovering and need some level of medical assistance, still need somewhere to go.
“There isn’t an easy answer to any of this, and there are concerns on both sides,” Emerson-Shea said. “From the hospital perspective we need to get people who no longer need acute care to find an alternative place to go.”
The state mandate comes as California hospitals are already seeing huge increases in admissions to intensive care units, and nursing homes are scrambling to beat back the virus — and losing.
Once the new virus enters a nursing home, it tends to spread quickly, infecting residents and those who care for them. In Kirkland, Washington, the virus raced through a nursing home in February, killing more than 30 people, and in California, almost 60 patients and staff members at a 90-bed nursing home in San Bernardino County have tested positive for the new coronavirus, according to health officials in that county.
At the state’s largest nursing home, the 780-bed Laguna Honda Hospital in San Francisco, 10 staff members and two residents have already tested positive. City officials have admitted they can’t control the outbreak without significant help from state and federal agencies, including the Centers for Disease Control and Prevention.
Andy Chan, 53, whose mother has been a Laguna Honda resident for three years, said that it would be a “disaster waiting to happen” if hospitals send more patients who may be infectious to nursing homes. Worse, he said, many families aren’t able to take their relatives out because they require significant medical care.
“It’s an option that we can’t take. There’s no way we can provide the services that she has now, at home,” Chan said. “I don’t know what to do.”