Reply
 
Thread Tools Display Modes
  #1  
Old 05-06-2020, 05:18 PM
Fotheringay-Phipps is offline
Guest
 
Join Date: Mar 2009
Posts: 12,177

Government forcing nursing homes to accept covid patients


I first heard about this from people connected to the nursing home industry, but on looking around I see it's been discussed a bit in the media as well, e.g. here. This seems to me to be one of the stupidest government decisions I can remember. All the nursing home people I know think it's insane, and the experts quoted in these articles are also leery of it. I would think when all is said and done there will have been thousands of extra deaths from this policy.

ISTM to be an example of tunnel vision, where senior officials were so focused on the task of freeing up hospital space that they lost sight of the fact that they were putting what's probably the single most vulnerable group of people in the entire country at tremendous risk.
  #2  
Old 05-06-2020, 05:27 PM
elfkin477 is offline
Member
 
Join Date: Apr 2001
Location: NH
Posts: 23,158
Gee, when I said that a few weeks ago, before the thousands of nursing home deaths, people reassured me that it was no big deal.
  #3  
Old 05-06-2020, 09:14 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
the logical plan would have been to shuffle the deck and put the coronavirus infected people in one nursing home and the non-infected in another. there's just no practical way to keep the airborne virus from spreading within a building without negative pressure rooms and continuous cleaning.

Just looking at the NY numbers it looks like 25% of the deaths were in nursing homes and that's probably a low percentage.
  #4  
Old 05-06-2020, 09:55 PM
nearwildheaven is offline
Guest
 
Join Date: Apr 2013
Posts: 14,231
This thread belongs in the Pit.
  #5  
Old 05-06-2020, 10:01 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Magiver View Post
the logical plan would have been to shuffle the deck and put the coronavirus infected people in one nursing home and the non-infected in another.
True, but that requires a heck of a lot of cooperation from the nursing homes themselves (which have disparate and scattered ownership), and from whoever is paying for the nursing homes (Medicaid, private insurers, family, etc.). Does a governor or state have the power to tell a privately-owned for-profit nursing home that the home must discharge patients A, C, D and F, to make room for B, E, G and H? Can the state compel whoever is paying for A's care to pay the bill at what might be an out-of-network facility, and cut through the red tape of preauthorizations and such?
  #6  
Old 05-06-2020, 10:31 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
Quote:
Originally Posted by slash2k View Post
True, but that requires a heck of a lot of cooperation from the nursing homes themselves (which have disparate and scattered ownership), and from whoever is paying for the nursing homes (Medicaid, private insurers, family, etc.). Does a governor or state have the power to tell a privately-owned for-profit nursing home that the home must discharge patients A, C, D and F, to make room for B, E, G and H? Can the state compel whoever is paying for A's care to pay the bill at what might be an out-of-network facility, and cut through the red tape of preauthorizations and such?
there was no cooperation when the state(s) compelled nursing homes to accept someone with the virus. It was mandated. So I would say it was an extension of the same mandate.

Pick any serious disease that is known to kill people. Can you see a mandate that an institution not equipped to handle it be forced to do so? I don't see the logic this and that is backed up with the knowledge we can go into any building and set up a military hospital. Which is what happened.

Last edited by Magiver; 05-06-2020 at 10:36 PM.
  #7  
Old 05-06-2020, 11:04 PM
thorny locust's Avatar
thorny locust is offline
Guest
 
Join Date: Apr 2019
Location: Upstate New York
Posts: 2,391
Quote:
Originally Posted by slash2k View Post
True, but that requires a heck of a lot of cooperation from the nursing homes themselves (which have disparate and scattered ownership), and from whoever is paying for the nursing homes (Medicaid, private insurers, family, etc.). Does a governor or state have the power to tell a privately-owned for-profit nursing home that the home must discharge patients A, C, D and F, to make room for B, E, G and H? Can the state compel whoever is paying for A's care to pay the bill at what might be an out-of-network facility, and cut through the red tape of preauthorizations and such?
Additionally, many nursing homes have a number of residents in varying stages of dementia. Such people are often seriously upset by a change to unfamiliar quarters.

It may be necessary in some cases to move large numbers of people around anyway; but it sure isn't going to be easy.
  #8  
Old 05-06-2020, 11:15 PM
Beckdawrek's Avatar
Beckdawrek is online now
Member
 
Join Date: Aug 2017
Location: Boonies??
Posts: 23,503
The paper work and red tape would bog it down for months.
The government can't get enough q-tips where they are needed.
It'll never happen.
__________________
Bad, bad, bad!
  #9  
Old 05-07-2020, 12:21 AM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Magiver View Post
there was no cooperation when the state(s) compelled nursing homes to accept someone with the virus. It was mandated. So I would say it was an extension of the same mandate.
From what I've seen, the mandate was "you cannot refuse to accept a patient based solely on their COVID-19 test results." Have you seen anything more specific than that? What you are talking about is more like "you, Nursing Home X, will discharge Annie A., Brad B, and Charlie C. to Nursing Home Y and accept David D., Ethel E., and Fannie F.," which is rather more than a mere extension.

Quote:
Originally Posted by Magiver View Post
Pick any serious disease that is known to kill people. Can you see a mandate that an institution not equipped to handle it be forced to do so? I don't see the logic this and that is backed up with the knowledge we can go into any building and set up a military hospital. Which is what happened.
A governor can set up a military hospital only if s/he has a National Guard unit in his or her control capable of establishing, equipping, and running one. I don't think every state does, but perhaps you know differently?

Beyond that, any nursing home or skilled nursing facility should have a basic understanding of and supplies for infection control. It's not at all unusual to have individual patients with infections, and influenza is an annual event for which any long-term-care facility needs to be prepared. This particular disease is more deadly, so the stakes are higher, but these really should not be nursing homes "not equipped to handle" an infectious respiratory disease. Remember, 90% of flu-related deaths and 50-70% of flu-related hospitalizations occur in adults over 65 (cite), so managing and containing an outbreak is not some never-before-encountered situation for these facilities.
  #10  
Old 05-07-2020, 06:12 AM
doreen is offline
Charter Member
 
Join Date: Dec 1999
Location: Woodhaven,Queens, NY
Posts: 7,090
Quote:
Originally Posted by slash2k View Post
From what I've seen, the mandate was "you cannot refuse to accept a patient based solely on their COVID-19 test results." Have you seen anything more specific than that? What you are talking about is more like "you, Nursing Home X, will discharge Annie A., Brad B, and Charlie C. to Nursing Home Y and accept David D., Ethel E., and Fannie F.," which is rather more than a mere extension.
Here, the governor has explicitly said many times, that if a nursing home can't properly care for a particular patient, the nursing home can contact the Board of Health which will find an appropriate placement. But they can't turn the patient down just because they test positive - and BTW, I have dealt enough with nursing homes to know there are some patients they just don't want and certain homes will use any excuse they can to reject them or discharge them.

In my state, (and I assume the others) the issue is not so much admitting patients who test positive from the community , but admitting or re-admitting patients coming from the hospital who no longer need hospitalization but can't be cared for at home (including prior nursing home residents).

Last edited by doreen; 05-07-2020 at 06:16 AM.
  #11  
Old 05-07-2020, 06:53 AM
Ludovic is offline
Charter Member
 
Join Date: Jul 2000
Location: America's Wing
Posts: 31,204
I think the question is moot now, since the virus went away at the end of last month like we were promised it would.
  #12  
Old 05-07-2020, 07:02 AM
Francis Vaughan is online now
Guest
 
Join Date: Sep 2009
Location: Adelaide, Australia
Posts: 5,319
I very much doubt that there are orders to discharge patients. As beds open up (basically as residents die) new patents will be admitted. As doreen says, there are patients that nursing homes will do anything to avoid taking. The two that come to mind as those that have been residents of mental institutions, and those that have a golden staph infection. The former can be very difficult to manage. The latter leads to infecting the entire hospital, which is a long term disaster. Homes may simply be worried about perceptions. Most are commercial institutions and reputation counts.

But I have also seen at first hand what seems to be a serious hole in the health care system. Elderly patients who have recovered from an acute problem, but who are not well enough, or otherwise able, to be looked after at home. They fall between the cracks. A hospital is not the right place for them. They don't get the care they need to recover. The usual answer is to ship them off to a far flung ward of the hospital and try to find them a place in a nursing home. Some go to a nursing home to recuperate with a view to eventually going home. The majority sadly find it is a one way journey, and the home they enter they will only ever leave in a box. But until a place is found they languish in a hospital bed in what amounts to the waiting room. They can wait months. It is a truly dismal and awful experience.
So, I interpret these orders to be - if you have an open bed, you can't refuse a recovering covid-19 patient. As we know, many patients, although they have survived, are seriously beaten up, and in need of a lot of care.

There shouldn't be any suggestion that these patient are infectious. Such a patient must be cared for in a setting rated for care of any infectious patient, and that is not a nursing home.

Last edited by Francis Vaughan; 05-07-2020 at 07:03 AM.
  #13  
Old 05-07-2020, 07:07 AM
FlikTheBlue is offline
Guest
 
Join Date: Dec 2010
Posts: 2,166
Quote:
Originally Posted by Magiver View Post
the logical plan would have been to shuffle the deck and put the coronavirus infected people in one nursing home and the non-infected in another. there's just no practical way to keep the airborne virus from spreading within a building without negative pressure rooms and continuous cleaning.

Just looking at the NY numbers it looks like 25% of the deaths were in nursing homes and that's probably a low percentage.
Having one specialized nursing home taking care of patients with Covid-19 is the logical thing to do. None of the nursing homes in my area want to accept any patients that have Covid-19. There isn’t going to be a scenario where patients need to be exchanged or shuffled around, since so far at least none of them are in the nursing homes yet. At least not in my area. This thing spreads like wildfire, and if there are any nursing homes out there with one or two patients with Covid-19, they won’t stay that way very long due to the nature of the beast. Such an order from government officials is tantamount to a death sentence for multiple patients. Whoever came up with the idea(s) to force nursing homes to take these individuals has no idea what they are doing.

Sources. I am a nursing home doctor. Every single one of my colleagues who I’ve spoken with feel the same way.
  #14  
Old 05-07-2020, 07:41 AM
Fotheringay-Phipps is offline
Guest
 
Join Date: Mar 2009
Posts: 12,177
Quote:
Originally Posted by doreen View Post
Here, the governor has explicitly said many times, that if a nursing home can't properly care for a particular patient, the nursing home can contact the Board of Health which will find an appropriate placement. But they can't turn the patient down just because they test positive
I believe that's true. But the problem is that even if you have a perfect setup, with all the protocols and PPE etc. they are not a complete panacea, and the infection will still spread, even if less than without those protocols and equipment.

[In addition, all the nursing homes are required to have proper protocols in place anyway for dealing with Covid, so making an exception for not being able to care doesn't mean much.]

Quote:
In my state, (and I assume the others) the issue is not so much admitting patients who test positive from the community , but admitting or re-admitting patients coming from the hospital who no longer need hospitalization but can't be cared for at home (including prior nursing home residents).
This is correct. The driver of this was freeing up hospital space.

I think the politicians were looking at the shortage of hospital space - which had attracted a lot of publicity at the time - as "their problem" and people dying in nursing homes as "someone else's problem". And since they had government power and someone else didn't, they got priority.
  #15  
Old 05-07-2020, 07:47 AM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Quote:
Originally Posted by FlikTheBlue View Post
Having one specialized nursing home taking care of patients with Covid-19 is the logical thing to do. None of the nursing homes in my area want to accept any patients that have Covid-19. There isn’t going to be a scenario where patients need to be exchanged or shuffled around, since so far at least none of them are in the nursing homes yet. ...
How long do you think it will take to create and staff a specialized nursing home in each area for those who are being discharged having resolved from COVID-19 (low albeit non-zero transmission risk COVID-19 patients with likely little to no viral shedding at that point, likely having peaked shedding in the day or two before symptoms and the first few days of illness)?

Soon enough to deal with a specific region that does not have adequate hospital beds and staff beds to take care of acutely ill patients, inclusive of those from nursing homes? Are you prepared to take care of those acutely ill nursing home patients in your sites on site because there are no hospital beds to accept them?

You know that the answer is no.

There is no question that we are failing to adequately protect the very vulnerable nursing home population. The source of infections into the facilities appear not to be resolved patients discharged from hospitals, but to be from asymptomatic and presymptomatic (or even mildly symptomatic) healthcare workers. These vectors likely are inclusive even of physicians who round at multiple facilities, but mostly the low paid staff with inadequate supplies of PPE (possibly with inadequate training on proper use) and inadequate testing (inclusive of screening of those asymptomatic with fast turn around tests). It spreads by way of that staff and by asymptomatic, presymptomatic, and mild to atypically symptomatic residents.

I don't know what, in comparison to current standards, best practices should be to reduce that from happening but what is being done is clearly not the right approach. And keeping resolved patients in hospitals beds that they no longer need but that others do, because they are perceived as having a Scarlet C upon them, is not going to reduce that problem.
  #16  
Old 05-07-2020, 08:28 AM
FlikTheBlue is offline
Guest
 
Join Date: Dec 2010
Posts: 2,166
Quote:
Originally Posted by DSeid View Post
How long do you think it will take to create and staff a specialized nursing home in each area for those who are being discharged having resolved from COVID-19 (low albeit non-zero transmission risk COVID-19 patients with likely little to no viral shedding at that point, likely having peaked shedding in the day or two before symptoms and the first few days of illness)?

Soon enough to deal with a specific region that does not have adequate hospital beds and staff beds to take care of acutely ill patients, inclusive of those from nursing homes? Are you prepared to take care of those acutely ill nursing home patients in your sites on site because there are no hospital beds to accept them?

You know that the answer is no.

There is no question that we are failing to adequately protect the very vulnerable nursing home population. The source of infections into the facilities appear not to be resolved patients discharged from hospitals, but to be from asymptomatic and presymptomatic (or even mildly symptomatic) healthcare workers. These vectors likely are inclusive even of physicians who round at multiple facilities, but mostly the low paid staff with inadequate supplies of PPE (possibly with inadequate training on proper use) and inadequate testing (inclusive of screening of those asymptomatic with fast turn around tests). It spreads by way of that staff and by asymptomatic, presymptomatic, and mild to atypically symptomatic residents.

I don't know what, in comparison to current standards, best practices should be to reduce that from happening but what is being done is clearly not the right approach. And keeping resolved patients in hospitals beds that they no longer need but that others do, because they are perceived as having a Scarlet C upon them, is not going to reduce that problem.
The problem I have with this line of thinking is the assumption that we’re talking about patients with resolved cases. Whether it’s Covid-19 or any other condition, the hospitals in this area are not in the business of discharging patients with resolved / asymptotic illnesses. Maybe it’s different in other areas of the country, but here hospitals are in the business of discharging patients who are just barely well enough to no longer need acute inpatient hospital care but are still very much ill and symptomatic.

On the other hand, I do agree with you on what the vector has been so far. 5 of the local nursing homes are in the process of testing everyone, staff and patients, due to having an employee who works at multiple facilities who tested positive. I myself am one of the individuals tested just yesterday due to this incident.* The conclusion I’ve drawn, however, is that this is one more instance demonstrating that nursing homes are not up to the task of taking care of patients with active cases. Someone who is no longer ill, sure, not a problem. But hospitals want to discharge patients way before they’ve reached that point in the recovery process.

*. I’ll be working via telemedicine until my test results are in.

Last edited by FlikTheBlue; 05-07-2020 at 08:29 AM.
  #17  
Old 05-07-2020, 12:49 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
So let’s play some different hypothetical circumstances.

Hospital capacity not near capacity. For sure keep until considered as no significant risk of contagion. Open debate if one asks for negative PCRs or 10 days from onset 3 days no fever and consistent improvement of symptoms. When back still good PPE use etc.

No room at the inn to accept patients getting sick in nursing homes. Patient from nursing home who was admitted sick now afebrile and improving to no longer needing hospital care but not completely resolved. No place to send if nursing home won’t take back. No room for new sicker patients if they don’t leave. Much less likely contagious than the newly sick person in the nursing home. What to do?


BTW, best hopes for your being negative!
  #18  
Old 05-07-2020, 01:52 PM
crowmanyclouds's Avatar
crowmanyclouds is offline
Guest
 
Join Date: Sep 2005
Location: ... hiding in my room ...
Posts: 5,081
Can I shoot the hostage patient?

CMC fnord!
  #19  
Old 05-07-2020, 03:21 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Not having a hospital bed for the person in the nursing home is basically doing that.

Best is to figure out (and provide for) better best practices that keeping them from getting exposed by HCWs and others so fewer get sick. I’m not a big fan of the idea of mass testing everyone every week in general, but these HCWS and residents? Might be a reasonable part of a plan. Residents wearing N95s when in groups or getting visitors or a worker in the room? I don’t know but something better than we do now.
  #20  
Old 05-07-2020, 06:03 PM
VOW is offline
Member
 
Join Date: Apr 2002
Location: NE AZ
Posts: 4,299
I think the nursing homes can get backed into a corner on this. If a COVID-19 patient is no longer infectious, I don't see how he or she could be refused a bed in a nursing home.

Because of the highly infectious nature of this disease, it would be a great public health catastrophe for someone who is still shedding virus particles to be discharged from the hospital. This wouldn't be +an insurance issue or a hospital ruling, it would be a public health matter.

So, if the patient is non-infectious, a nursing home may not be crazy about accepting him or her. Public, private, for-profit or non-profit, if the institution accepts any government funds, then the government has a huge say-so.


~VOW
__________________
Klaatu Barada Nikto
  #21  
Old 05-07-2020, 07:08 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
Quote:
Originally Posted by DSeid View Post
No room at the inn to accept patients getting sick in nursing homes. Patient from nursing home who was admitted sick now afebrile and improving to no longer needing hospital care but not completely resolved. No place to send if nursing home won’t take back. No room for new sicker patients if they don’t leave. Much less likely contagious than the newly sick person in the nursing home. What to do?


BTW, best hopes for your being negative!
the "inn" you speak of is the entire hospital capacity of the United States. What New York City did when their hospitals were overloaded was to evacuate patients to other hospitals within the state and also to surrounding states.

Utilize what you have to work with.

Last edited by Magiver; 05-07-2020 at 07:08 PM.
  #22  
Old 05-07-2020, 07:10 PM
RioRico is offline
Suspended
 
Join Date: Sep 2019
Location: beyond cell service
Posts: 3,193
Quote:
Originally Posted by slash2k View Post
A governor can set up a military hospital only if s/he has a National Guard unit in his or her control capable of establishing, equipping, and running one.
Many decades ago, after Army years, I joined a CAL-ARNG field hospital unit, not quite a MASH. We were prepared for disasters like wildfires, earthquakes, floods, any evacuation or casualty situations, as well as combat, but were quite unsuited for a pandemic. I've not kept track so I don't know if California or any state's NG can handle plagues.

Quote:
Originally Posted by VOW View Post
I think the nursing homes can get backed into a corner on this. If a COVID-19 patient is no longer infectious, I don't see how he or she could be refused a bed in a nursing home.
MrsRico's mom died negligently in a chain nursing home that we learned, too late, regularly settled wrongful-death suits. The nursing homes I've seen - quite a few when I worked a desert ambulance shuttling patients, and more since - are not medical facilities setup to isolate the contagious. Sending COVID sufferers to such care shows desperation.
  #23  
Old 05-08-2020, 03:13 PM
Gestalt is offline
Guest
 
Join Date: Apr 2003
Posts: 1,657
Quote:
Originally Posted by DSeid View Post
The source of infections into the facilities appear not to be resolved patients discharged from hospitals, but to be from asymptomatic and presymptomatic (or even mildly symptomatic) healthcare workers. These vectors likely are inclusive even of physicians who round at multiple facilities, but mostly the low paid staff with inadequate supplies of PPE (possibly with inadequate training on proper use) and inadequate testing (inclusive of screening of those asymptomatic with fast turn around tests). It spreads by way of that staff and by asymptomatic, presymptomatic, and mild to atypically symptomatic residents.
DSeid, do you have a cite for this?

I work in healthcare with some inpatient work, and as others have said, up until now (meaning even pre-COVID), the focus has been on discharge, discharge, discharge. It can be tricky getting people back to their previous nursing homes once they have been admitted--in my state at least if it's been a certain number of days since admission, the nursing homes can refuse to take them. So, I can understand the reflex impetus to discharge ASAP, which we know now was the wrong plan.
  #24  
Old 05-08-2020, 03:48 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Let's start with the very first nursing home case: it was not someone transferred in, it got in from the outside.

The spread is clearly driven to large by the asymptomatic and presymptomatic.

Infectiousness is highest in the day or so before symptoms and falls off rapidly by day seven.

Here's some on what has been found by contact tracing in nursing homes.
Quote:
"The biggest challenge with COVID-19 in facilities is the silent carriers" who don't exhibit symptoms, Jakobovits said.

Employees are encouraged to stay as confined as possible when they go home, but that's not something the company can control, he said.

About two weeks ago the South Mountain facility's infection control nurse overheard an employee cough and ordered that person to go home and get tested for the novel coronavirus, Jakobovits said. The employee, who has asthma, believed the cough was from allergies, but the nurse didn't take any chances, he said. It turns out the employee tested positive for COVID-19 and contact tracing was done, identifying 13 residents to be tested — one of whom tested positive for the virus, he said.
Examples like that are trivially easy to find. Note what is NOT there - cases in which the source tracked to an individual returned from a COVID-19 hospital admission. I can't find any.
  #25  
Old 05-08-2020, 04:32 PM
Gestalt is offline
Guest
 
Join Date: Apr 2003
Posts: 1,657
FYI, the Medpage article you linked to showed asymptomatic transmission among residents, not workers.
I'm not saying it's not possible that the infections are spread by workers, but I'm not seeing any hard data showing that, so saying that the spread appears to be from workers appears premature.

If we are just going to keep speculating, the initial infections may come from workers, but the residents have many more interactions with each other than any individual workers, so it might be that asymptomatic residents are spreading it among themselves.
I'm not saying that's the case at all, just spit-balling like you did.
  #26  
Old 05-08-2020, 04:47 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
Quote:
Originally Posted by DSeid View Post
Let's start with the very first nursing home case: it was not someone transferred in, it got in from the outside.

The spread is clearly driven to large by the asymptomatic and presymptomatic.

Infectiousness is highest in the day or so before symptoms and falls off rapidly by day seven.

Here's some on what has been found by contact tracing in nursing homes.

Examples like that are trivially easy to find. Note what is NOT there - cases in which the source tracked to an individual returned from a COVID-19 hospital admission. I can't find any.
I'm sorry but what does WA have to do with NY?.

You're suggesting an influx of covid patients isn't a factor in the spread of the disease? By default they are spending 24/7 at these facilities so they represent a much higher degree of exposure then anyone else visiting or working there. And every nursing home I've ever been too was filled with the sounds of people who can't take care of themselves and are constantly coughing.

By default, they are going to spread the disease.
  #27  
Old 05-08-2020, 05:29 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Quote:
Originally Posted by Gestalt View Post
FYI, the Medpage article you linked to showed asymptomatic transmission among residents, not workers.
I'm not saying it's not possible that the infections are spread by workers, but I'm not seeing any hard data showing that, so saying that the spread appears to be from workers appears premature.

If we are just going to keep speculating, the initial infections may come from workers, but the residents have many more interactions with each other than any individual workers, so it might be that asymptomatic residents are spreading it among themselves.
I'm not saying that's the case at all, just spit-balling like you did.
It began with the positive worker was how I read it, but sure could have been the other way.

So here.
Quote:
Staff members at the Seattle-area nursing home overrun by COVID-19 spread the coronavirus to other facilities where they worked, an investigation led by the U.S. Centers for Disease Control and Prevention has found.
The report published Wednesday said that as of March 9, the CDC confirmed 129 COVID-19 cases among people linked to Life Care Center of Kirkland. These comprise 81 residents, 34 staff members and 14 visitors.

Separately Wednesday, public health officials reported five more deaths associated with the facility, bringing the total number who have died to 35 — more than half of Washington state‘s known total of 66.
Given that we know a large number of those infected are asymptomatic or presymptomatic and infectious, pretty sure that even if every individual stayed home when even a little sick it would still have spread.

And here.
Quote:
Asymptomatic long-term care staff helped spread COVID-19 ...

... Deputy Health Commissioner Marcela Maziarz said all 3,700 staff and residents at the 16 facilities included in the program were tested for the virus, and significant numbers have turned out to be positive even though they didn’t show symptoms of the disease.

“What we found was astonishing,” she said.

As part of the pilot program, 12 teams of Cooper University Health Care workers were sent to the 16 facilities — selected because each reported a low rate of infection, fewer than 10 COVID-19 cases. But the nasal swab tests showed that, out of 20,69 residents, 16% tested positive, as did 9% of 1,719 health care staffers. ...
WA and NY and NJ nursing homes are not all that different from each other.

I simply am not finding cases reported where someone returned from the hospital was the identified source. Meanwhile there are large numbers of workers and residents going around in likely highly contagious phases (compared to someone in a resolving phase) interacting totally unaware of the risk they are to others.
  #28  
Old 05-08-2020, 05:56 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Magiver View Post
By default they are spending 24/7 at these facilities so they represent a much higher degree of exposure then anyone else visiting or working there.
A nursing home patient newly discharged from hospital is going to have a lot more exposure to the people helping him/her to bathe, toilet, dress, take medications, and eat than to residents in another room or floor or wing, whom they may never see face to face.

The experience of the Diamond Princess and other cruise ships indicates that merely being in the same structure isn't the major concern; once passengers were confined to quarters, the transmission rate plummeted. The major mode of transmission was being face-to-face in hallways and dining rooms and other venues and touching common surfaces. New arrivals from the hospital, however, are very unlikely to be out gallivanting in the halls, or even eating in the main dining room. In most cases, they're going to be bedridden or nearly so even in the absence of infection control protocols. Meanwhile, the nurses and aides ARE roaming from room to room, touching doorknobs and thermometers, handling trays and carts and wheelchairs, getting up close and personal with multiple patients, and otherwise acting as transmission vectors.
  #29  
Old 05-08-2020, 07:02 PM
RioRico is offline
Suspended
 
Join Date: Sep 2019
Location: beyond cell service
Posts: 3,193
Federal Government Has No Idea How Many Nursing Homes Have Coronavirus Outbreaks
Quote:
The federal government doesn’t know how many U.S. nursing homes have suffered outbreaks during the coronavirus pandemic or how many residents have died, NBC News reports. In mid-April, Medicare Administrator Seema Verma promised that the Trump administration would start tracking outbreaks and deaths at care facilities nationwide—but the numbers have reportedly still not been tallied and are weeks away from being ready to show the public. Public-health experts said the delay will impede officials from being able to target hot spots with more resources. Prof. Charlene Harrington of University of California San Francisco [Medical School] told NBC: “I think the problem is CMS [Centers for Medicare and Medicaid Services] and the governors have not put the nursing homes at the top of the list—and I can’t think of any group that is more vulnerable.” CMS defended its efforts, and said it would take “swift action” to provide the information publicly.
So we have no fucking idea because non-transparency. And we have no fucking idea because all people, dead or alive, aren't tested. Because our [expletives deleted] national leadership has [political jabs deleted] and more. And expect whatever numbers are produced to be faked adjusted for improved optics. Sad.
  #30  
Old 05-08-2020, 07:05 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
Quote:
Originally Posted by slash2k View Post
A nursing home patient newly discharged from hospital is going to have a lot more exposure to the people helping him/her to bathe, toilet, dress, take medications, and eat than to residents in another room or floor or wing, whom they may never see face to face.

The experience of the Diamond Princess and other cruise ships indicates that merely being in the same structure isn't the major concern; once passengers were confined to quarters, the transmission rate plummeted. The major mode of transmission was being face-to-face in hallways and dining rooms and other venues and touching common surfaces. New arrivals from the hospital, however, are very unlikely to be out gallivanting in the halls, or even eating in the main dining room. In most cases, they're going to be bedridden or nearly so even in the absence of infection control protocols. Meanwhile, the nurses and aides ARE roaming from room to room, touching doorknobs and thermometers, handling trays and carts and wheelchairs, getting up close and personal with multiple patients, and otherwise acting as transmission vectors.
25% of the deaths in NY are from nursing home patients. What is moving from room to room is an airborne virus every hour of every day.

That you're trying to suggest it's not from an influx of infected patients is bizarre.
  #31  
Old 05-08-2020, 07:07 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
Quote:
Originally Posted by DSeid View Post

WA and NY and NJ nursing homes are not all that different from each other.
You mean besides the giant stack of bodies?
  #32  
Old 05-08-2020, 08:36 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Quote:
Originally Posted by Magiver View Post
25% of the deaths in NY are from nursing home patients. What is moving from room to room is an airborne virus every hour of every day.

That you're trying to suggest it's not from an influx of infected patients is bizarre.
What is moving from room to room are staff first and foremost and to some degree residents intermingling for needed socialization.

I am repeating some links between threads but -

"Seventy percent of employees and up to half of patients found to be COVID-19 infected by nursing home giant HCR ManorCare were asymptomatic at the time, says the chain’s medical director."


"researchers at Colorado State University conducting coronavirus testing for workers at nursing homes and other skilled nursing facilities made a series of startling discoveries.

Not only were there a large number of positive results in their test samples, and not only were many of those positives from people who showed no symptoms at all, but the asymptomatic workers were still producing and shedding significant amounts of virus that could go on to infect someone else."



"As coronavirus infections increase in nursing homes throughout the state, Santa Clara County made the chilling discovery this month that dozens of staff members with no symptoms of the coronavirus had unknowingly infected the very people they cared for at three facilities experiencing big outbreaks."


"Infections are probably due to workers being asymptomatic and bringing the virus into long-term care facilities without knowing it, Malcolm said. Some work at multiple facilities and may carry the virus from one to another."


"FORK UNION (WINA) – The Thomas Jefferson Health District says the majority who tested positive for COVID-19 at a Fluvanna County long-term care facility over the weekend were asymptomatic. TJHD deputy incident commander Ryan McKay says they tested everyone at the Village at Fork Union — staff and patients. He would not say how many positive were patients and how many were staff."


"For weeks, COVID-19-related deaths and positive cases have been on the rise at nursing homes and elder-care facilities across the state even though those same facilities have been off-limits to visitors since March 15 because of the governor’s executive order. The latest death toll: 577, one in three of all deaths in Florida.

There is little mystery behind what is considered the main culprit in this grim statistic: asymptomatic carriers — many of them long-term care staff members, who are getting tested infrequently or too late. But despite state efforts to ramp up testing, administrators at nursing homes and assisted living facilities told the Miami Herald and Tampa Bay Times it is a piecemeal program that is failing to identify risk and completely contain the virus among the state’s most vulnerable."


Still can't find any actual documented cases of a source being a patient returning from the hospital. Still could be one or two that I can't find. Possible.

There is very little about COVID-19 that I am not willing to hedge on ... my main drum beat is that we know too little to making the confident statements so may opine. On this though, the evidence is overwhelmingly clear: the main risk to elders in long term care facilities is from HCWs who don't know they are infected and contagious, and from residents who are to all appearances with free of SARS-CoV-2 at the time. And this is magnified by the fact that a good number of these workers travel between facilities. The risk posed by a resolving patient, of much less infectivity than someone just about to become symptomatic, handled with the knowledge that they have had COVID-19, is in comparison very very very very very tiny.
  #33  
Old 05-08-2020, 09:29 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,294
again, 25% of NY deaths are from nursing homes and you don't see a correlation between that number and a process that sends infected people to the homes.

You might as well say distancing has no purpose.
  #34  
Old 05-08-2020, 10:23 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Oh I see a correlation between the number of infected people coming in the homes and new infections. The infected people coming in overwhelmingly are asymptomatic, highly contagious just presymptomatic, and mildly symptomatic workers. I’ve shown the correlation.

Please show the correlation you see between resolving cases coming from hospitals and outbreaks. I can find none.
  #35  
Old 05-08-2020, 10:50 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Magiver View Post
again, 25% of NY deaths are from nursing homes and you don't see a correlation between that number and a process that sends infected people to the homes.
In Sweden, about half of their deaths have been in nursing homes, and I am unaware of anything remotely similar to New York's policy/process. To what do you attribute that, if not workers shedding viruses? (Sweden's nursing homes have forbidden visitors since early March, when the number of cases was under 300 and no deaths had been reported.)

The people most likely to live in a nursing home are the elderly and people with serious comorbidities. The people most likely to die of COVID-19 are the elderly and people with serious comorbidities, regardless of their living arrangements.

Quote:
Originally Posted by Magiver View Post
You might as well say distancing has no purpose.
Nursing home residents CANNOT distance themselves from the people who come in and out of the facility every day: to wit, the doctors and nurses and aides and therapists and cooks and cleaners and all the rest of the staff. The homes can cancel bingo and close the communal dining hall, but they can't stop bathing the residents.

Quote:
Originally Posted by Magiver View Post
What is moving from room to room is an airborne virus every hour of every day.
You are apparently under the impression that the disease is easily spread through the air to distant rooms, but the evidence that it is airborne is not at all well-established. The best evidence is that the virus spreads most readily to people who are within 3 to 6 feet or who are touching common surfaces.

I refer you once again to the case of the Diamond Princess. Once passengers were confined to their rooms, there are cases of the disease spreading to roommates and to crew members servicing their room, but NOT evidence of widespread transmission through the ventilation systems. There is likely a non-zero risk of that kind of transmission, but the primary mechanism is face-to-face contact within a few feet. Now, exactly how is a patient supposed to maintain social distance from the person wiping their butt?

Quote:
Originally Posted by Magiver View Post
You mean besides the giant stack of bodies?
Washington State got hit early, but had a far lower level of infection in the community; diagnosed cases per million residents is currently barely half the national average (2258 cases and 120 deaths per million in Washington, versus 3993 cases and 238 deaths per million for the US as a whole). Nonetheless, sixty percent of Washington's deaths have been in nursing homes. What Washington policy do you think caused this death toll?
  #36  
Old 05-11-2020, 08:43 AM
Fotheringay-Phipps is offline
Guest
 
Join Date: Mar 2009
Posts: 12,177
After 5,000 deaths, state changes nursing home policy

Cuomo is backing off this in a weird, face-saving way. The original regulation remains in place, and nursing homes are still barred from refusing Covid patients. But he's adding a new regulation on the hospitals, which bars them from releasing Covid patients to nursing homes.

Quote:
Originally Posted by slash2k View Post
Nursing home residents CANNOT distance themselves from the people who come in and out of the facility every day: to wit, the doctors and nurses and aides and therapists and cooks and cleaners and all the rest of the staff. The homes can cancel bingo and close the communal dining hall, but they can't stop bathing the residents.



You are apparently under the impression that the disease is easily spread through the air to distant rooms, but the evidence that it is airborne is not at all well-established. The best evidence is that the virus spreads most readily to people who are within 3 to 6 feet or who are touching common surfaces.

I refer you once again to the case of the Diamond Princess. Once passengers were confined to their rooms, there are cases of the disease spreading to roommates and to crew members servicing their room, but NOT evidence of widespread transmission through the ventilation systems. There is likely a non-zero risk of that kind of transmission, but the primary mechanism is face-to-face contact within a few feet. Now, exactly how is a patient supposed to maintain social distance from the person wiping their butt?
I don't see your logic here. ISTM that the a primary vector of transmission would be from patient to caregiver to patient. The more infected patients there are in a facility, the more likely that caregivers will pick up these infections and then infect other patients in that facility.
  #37  
Old 05-11-2020, 09:45 AM
RTFirefly is offline
Charter Member
 
Join Date: Apr 1999
Location: Maryland
Posts: 41,303
Quote:
Government forcing nursing homes to accept covid patients
I've only skimmed the thread, so I might have missed it. But has the OP ever said which government he's talking about?
  #38  
Old 05-11-2020, 10:06 AM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Fotheringay-Phipps View Post
I don't see your logic here. ISTM that the a primary vector of transmission would be from patient to caregiver to patient. The more infected patients there are in a facility, the more likely that caregivers will pick up these infections and then infect other patients in that facility.
Why would that be a more significant vector than low-paid people in the community, who probably have limited sick leave and strong incentive to show up to work regardless of illness, coming in and bringing the virus with them? CNAs and other aides, e.g., are paid $10-15/hour (the median in my state is $12), and it's fairly common that part-time employees, of whom there are many, don't have paid sick leave.

Here in Kansas, several of the first COVID cases identified were in long-term residents of a nursing home in the Kansas City area. Somebody brought the disease to them, and it wasn't another COVID-positive patient being discharged from hospital because there weren't any; it about had to be a worker or a visitor, probably no more than mildly symptomatic if anything.

As noted, places that did NOT have a policy of discharging infected patients to nursing homes ended up with rampant infections therein, so it seems logical that the same factors are in play in New York: people with few or no symptoms go to work and shed the virus anyway.
  #39  
Old 05-11-2020, 10:39 AM
Fotheringay-Phipps is offline
Guest
 
Join Date: Mar 2009
Posts: 12,177
Quote:
Originally Posted by slash2k View Post
Why would that be a more significant vector than low-paid people in the community, who probably have limited sick leave and strong incentive to show up to work regardless of illness, coming in and bringing the virus with them? CNAs and other aides, e.g., are paid $10-15/hour (the median in my state is $12), and it's fairly common that part-time employees, of whom there are many, don't have paid sick leave.
I would think that people who are definitely known to be infected are higher risk than people who might be infected.

Even if CNAs etc. are also at risk of contracting it from the community at large, they are even more at risk if they can contract it both from the community at large and from known infected patients who are given to their care.

At any rate, my specific point in response to your post was that the transmission risk via introducing infected patients to a facility is not (only?) via ventilation systems and the like as you seemed to imply but rather via the very person-to-person caregiver contact that you pointed to as the primary source of transmission.
  #40  
Old 05-11-2020, 10:57 AM
PoppaSan's Avatar
PoppaSan is offline
Guest
 
Join Date: Mar 2011
Location: West shore Lake Michigan
Posts: 2,492
Quote:
Originally Posted by RTFirefly View Post
I've only skimmed the thread, so I might have missed it. But has the OP ever said which government he's talking about?
I've seen references to Cuomo so I'm assuming New York state.

My wife's facility has been temp checking staff since early April when the positive numbers started to get into double digits in our county. They had banned everyone except staff since mid-March. Residents that left the facility for medical treatment (only allowed excursions) were locked into their rooms for 2 weeks upon their return. No common meals or Bingo with the staff. Don't know the call on the staff member that had an appendectomy this past weekend. Her medical and lifting restrictions may make a quarantine a moot point.
__________________
The cheek of every American must tingle with shame as he reads the silly flat dishwatery utterances of a man who has to be pointed out to intelligent foreigners as the President of the United States. --Chicago Times review of the Gettysburg address
  #41  
Old 05-11-2020, 11:30 AM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by Fotheringay-Phipps View Post
I would think that people who are definitely known to be infected are higher risk than people who might be infected.
With people definitely known to be infected, everybody involved knows the stakes are higher, and staff are more likely to be cautious and wear PPE. Staff who don't know they are infected are more likely to ignore masks, etc. This is just human nature.

Quote:
Originally Posted by Fotheringay-Phipps View Post
At any rate, my specific point in response to your post was that the transmission risk via introducing infected patients to a facility is not (only?) via ventilation systems and the like as you seemed to imply but rather via the very person-to-person caregiver contact that you pointed to as the primary source of transmission.
I refer you to my previous posts in this very thread, specifically #28 and 35, where I talked about how ventilation systems do not appear to be a primary vector. It is person-to-person contact that is the primary source, and staff who blithely assume neither they nor the patient in their charge are infectious are more likely to spread it than staff who know what they're dealing with.
  #42  
Old 05-11-2020, 05:21 PM
DSeid's Avatar
DSeid is offline
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,978
Quote:
Originally Posted by Fotheringay-Phipps View Post
After 5,000 deaths, state changes nursing home policy

Cuomo is backing off this in a weird, face-saving way. The original regulation remains in place, and nursing homes are still barred from refusing Covid patients. But he's adding a new regulation on the hospitals, which bars them from releasing Covid patients to nursing homes. ...
I don't see it as "backing off" so much as responding to current facts on the ground, as made sense in my hypotheticals given previously:

Quote:
Originally Posted by DSeid View Post
So let’s play some different hypothetical circumstances.

Hospital capacity not near capacity. For sure keep until considered as no significant risk of contagion. Open debate if one asks for negative PCRs or 10 days from onset 3 days no fever and consistent improvement of symptoms. When back still good PPE use etc.

No room at the inn to accept patients getting sick in nursing homes. Patient from nursing home who was admitted sick now afebrile and improving to no longer needing hospital care but not completely resolved. No place to send if nursing home won’t take back. No room for new sicker patients if they don’t leave. Much less likely contagious than the newly sick person in the nursing home. What to do?


BTW, best hopes for your being negative!
NYC hospitals are now not near capacity. For sure keep until considered as no significant risk of contagion, or send to a COVID-19 specific step down facility, and determining that lack of significant contagion risk with a negative PCR.

Past diagnosis of COVID-19 is still NOT an acceptable reason to refuse admission by a nursing home.

FlikTheBlue, you were negative I hope?
  #43  
Old 05-15-2020, 04:35 PM
FlikTheBlue is offline
Guest
 
Join Date: Dec 2010
Posts: 2,166
Quote:
Originally Posted by DSeid View Post
I don't see it as "backing off" so much as responding to current facts on the ground, as made sense in my hypotheticals given previously:



NYC hospitals are now not near capacity. For sure keep until considered as no significant risk of contagion, or send to a COVID-19 specific step down facility, and determining that lack of significant contagion risk with a negative PCR.

Past diagnosis of COVID-19 is still NOT an acceptable reason to refuse admission by a nursing home.

FlikTheBlue, you were negative I hope?
Negative 3 separate times. It’s been crazy around here. Governor Abbott has orders all nursing home patients and staff tested. For me that meant once at each of the facilities I visit with different owners. So far we’ve had 5 different facilities with one or two patients test positive and only one with a larger outbreak.

ETA. I agree that past diagnosis with Covid-19 is not an acceptable reason to deny admission. The issue for me is those with currently active infections.

Last edited by FlikTheBlue; 05-15-2020 at 04:39 PM.
  #44  
Old 05-22-2020, 12:05 AM
russian heel is online now
Guest
 
Join Date: Jun 2013
Posts: 2,107
At what point do we ask nursing homes to do their job, which is to take care of sick elderly patients, rather than just pointing fingers at the governors who asked them to do so? I have little sympathy for an industry with a history of mentally and physically abusing patients, underpaying and overworking their staff, and gouging families out of every last penny by using guilt. Now they have been trying to hide infection and deaths from C19 that took place in their overcrowded and inadequate buildings.

Yeah yeah yeah I know there are a lot of good facilities but overall there’s too many disgraceful stories and I feel a certain group out there is using this situation for political gain when maybe we need to take a closer look at this industry.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 01:12 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2020, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright © 2019 STM Reader, LLC.

 
Copyright © 2017