The answer from Charlene Harrington, an expert on medical care in nursing homes, is unequivocal. Asked if federal and state health officials should end the practice of discharging hospitalized COVID-19 patients into nursing homes without separate specialized care facilities, the University of California-San Francisco emeritus nursing professor offers an unhesitating "yes."
Once the virus gets into a long-term care center, it can "spread like wildfire," Harrington told an editorial writer recently. Given residents' vulnerabilities and the facilities' long-standing challenges of staffing and infection control, it's best to err on the side of caution even though it appears the virus has entered these centers through infected staff and contractors.
Harrington is a respected researcher. Recommendations from others who have the same deep expertise are needed as federal and state officials combat an epidemic that has disproportionately claimed the lives of long-term care (LTC) residents. Minnesota recently rolled out a five-point "battle plan" to thwart this, but improvements such as the one Harrington recommended are clearly needed.
Since this new strain of coronavirus arrived in the U.S., it has been unrelenting in taking the lives of those living in congregate care settings. Over 80% of Minnesota's COVID-19 fatalities have been LTC residents. That high percentage has eclipsed what most states have reported, suggesting the virus is exacting a larger toll in LTC facilities here than elsewhere.
But new data from the Trump administration indicates that Minnesota may not be a tragic outlier nationally. Instead, it appears state health officials have cast a broader net to find LTC deaths, a finding that should inform and elevate the debate as legislators look for ways to protect seniors. The new information comes from the federal Centers for Medicare and Medicaid Services (CMS). In April, the agency required nursing homes to report COVID-19 cases and deaths directly to federal health officials. The data gathered is useful for disease surveillance and provides the first real chance to do an "apples to apples" comparison of COVID-19's impact on nursing homes.
Until now, states have had wide latitude in choosing how or even if they report this information. For example, if an LTC resident became infected but died in a hospital while receiving care, that death may not have been included as an LTC death. Or, states may not have reported deaths only from nursing homes instead of all elder care facilities such as assisted living.
In Minnesota, there have been 12.7 deaths from the virus per 1,000 nursing home residents. The national average: 27.5 deaths per 1,000. The real outliers are New Jersey, with 145.5 deaths per 1,000 and Connecticut with 125.
Regionally, the comparison is less favorable for Minnesota, with Wisconsin and Iowa reporting lower death rates (4.7 and 8.8, respectively). At the same time, a far lower percentage of nursing homes in these two border states were surveyed, suggesting that the data may still not be comprehensive. Regardless, Minnesota clearly still has much work to do to reduce the death toll among its seniors. A Tuesday hearing led by state Sen. Karin Housley, R-St. Mary's Point, put a commendable spotlight on this issue.
Housley plans to hold future hearings on this. These would be more productive if she invited medical experts such as Harrington to testify. Changing the hospital discharge policy should be explored, but it's an err-on-the-side-of-caution policy, not a silver bullet. Right now, there's no evidence of outbreaks caused by COVID-19 patients discharged into LTC facilities. What else can be done to close off the main avenue by which the virus enters care centers, via infected staff and contractors?
Another topic that needs scrutiny: What is working in other states? If Wisconsin and Iowa's new metrics are better than Minnesota's, what is it that they're doing to achieve this?
Minnesota Health Commissioner Jan Malcolm has a long record of troubleshooting complex policy issues. Her recent work on elder care regulatory reforms brought together elder care advocates, the long-term care industry and legislators. Consensus was achieved and solutions implemented.
The same process needs to unfold even faster to safeguard Minnesota's LTC residents from COVID-19. Minnesota's leaders are up to the challenge. They need to focus, drill down and above all, collaborate.