In a move meant to preserve hospital beds for sicker patients, the New Jersey Department of Health this week told nursing homes they cannot turn down a new medically stable admission just because the patient has a confirmed case of COVID-19, the disease caused by coronavirus.
Nursing home leaders have been concerned about accepting new patients who might bring coronavirus into facilities populated by those most vulnerable to the new disease: older people with multiple chronic health problems.
Jon Dolan, president and CEO of the Health Care Association of New Jersey, which represents nursing homes, said he has been hearing nonstop from members about the new state directive.
“On its face, it’s being perceived as a demand,” he said. “The level of staff and [protective equipment] is at such a crisis condition that most will not be able to safely accept such admissions.” Sending infectious patients to an unprepared facility could be a disaster, he said.
The state also told nursing homes to create separate wings or units for patients thought or known to have COVID-19, a step not all are physically able to take, Dolan said. The state also said that all staff and visitors should wear masks while in facilities and symptomatic patients should wear them during care.
New York’s decree last week that nursing homes had to accept COVID-19 patients, whether or not they still tested positive for the disease, was met with criticism from the American Health Care Association, which represents nursing homes, and the Society for Post-Acute and Long-Term Care Medicine, which represents medical professionals who work in nursing homes.
Many patients go to nursing homes or their rehabilitation wings after a stay in a hospital. That makes nursing homes an important safety valve when demand for hospital beds is high.
Ninety-three of New Jersey’s 375 nursing homes have had at least one COVID-19 case. Fifty-two of its 355 deaths — 21% — are associated with long-term care facilities, the state Department of Health said. Pennsylvania has had 200 confirmed coronavirus cases related to nursing homes out of a total of 5,805 cases. Ninety-two of Pennsylvania’s 695 nursing homes have had at least one positive case. Most of those are in Southeastern Pennsylvania, said Nate Wardle, a spokesman for the state Department of Health. He would not say how many of the state’s COVID-19 deaths involved nursing home residents.
Dolan said New Jersey’s rules are more flexible than New York’s. When combined with other guidance, he said, he believes nursing homes will be able to say no under some circumstances, including when they cannot accept admissions safely, when they don’t have enough protective equipment or workers, when they cannot physically isolate potentially infectious patients, and when the hospital has not provided proper discharge information.
So far, Pennsylvania has not precisely told nursing homes they must take COVID-19 patients who still test positive for the disease, but it has said they must keep accepting new admissions from hospitals to “alleviate the increasing burden in acute care settings,” and that might include stable patients who have had the virus.
Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, said that introducing patients known to have the virus or those with symptoms or awaiting test results into a nursing home would risk the lives of anyone entering the facility.
He also said some facilities do not have adequate supplies.
“We hope to work with the Wolf administration and the Pennsylvania Department of Health to identify those nursing homes across the state that have the capability to handle these transitions and the necessary supply of equipment and staff so that patients have the best chance to recover,” he said.
Dolan said he knows of a small group of nursing homes that are comfortable accepting patients with active COVID-19. He wants New Jersey to consider alternatives, such as dorms or hotels.
His members, he said, want to help provide care for the growing number of patients with coronavirus. “We all want to help the hospitals and prepare for surge capacity and the need for critical care beds,” he said.