Nursing Home Task Force recommends 28 reforms

From MLive Report

Residents of Michigan nursing homes should be allowed outdoor visits with friends and family, and be given the option of indoor visitation, according to a state task-force report released this week.

The state also needs to ensure that all nursing homes have access to personal protective equipment, such as masks, and coronavirus diagnostic testing for staff and patients with rapid turnaround of results, the report says.

In all, 28 recommendations were included in the report by the Michigan Nursing Homes COVID-19 Preparedness Task Force. The 20-member group was created in July to advise the Michigan Department of Health and Human Services on how to best address the coronavirus pandemic in regards to nursing homes, which have been disproportionately impacted by the virus.

Since the start of the pandemic, nursing-home residents and staff have comprised 12% of Michigan’s confirmed coronavirus cases and 32% of deaths.

The task force was headed by Dr. Betty Chu, senior vice president and chief quality officer for Henry Ford Health System in metro Detroit, and Roger Mali, owner of Mission Management Services, which operates long-term care facilities around the state.

Melissa Seifert, AARP Michigan Associate State Director for Governmental Affairs, is a member of the task force.

The recommendations were unanimously endorsed by task-force members with one exception: The placement of nursing-homes residents who have tested positive for COVID-19.

Currently, Michigan allows nursing homes to house residents with coronavirus if those patients can be properly quarantined. It also has created regional hubs that can take in coronavirus-positive patients. That policy has been sharply criticized by Republican lawmakers, who have pushed MDHHS to create separate facilities for nursing-home residents with coronavirus.

The task force reports recommends that Michigan push hospitals to keep nursing-home residents hospitalized with coronavirus until they are no longer required to be quarantined, and provide funding for that if need be.

When that’s not possible, the task force report said, the state should establish a system of Care and Recovery Centers, which would essentially be a restructuring of the current regional hub system. There’s been criticism the current hubs were picked because they had excess capacity, and were more likely to be substandard. The task force recommends creating a new screening process, with an emphasis on high-quality care as well as the ability to keep coronavirus-positive patients completely separate from other nursing-home residents.

The majority of task-force members agreed that in “exceptional circumstances,” a nursing home not designated as a Care and Recovery Center should be allowed to house a COVID-positive patient if it’s deemed in the best interests of the patient and the facility can prove it can offer adequate isolation.

However, the Resident Placement Workgroup “were not able to reach consensus on a specific recommendation related to the admission of COVID-19-positive individuals at non-CRC facilities,” the report said. “The issue was presented to the full Task Force membership for discussion” and the final recommendation reflects the majority vote.

Resident Placement Workgroup did recommend the state “continue to explore the option of creating dedicated COVID19 facilities.” However, the report said, “This option presented substantial procedural challenges that may not allow for timely implementation if we are faced with a second wave this fall.”

Those challenges include the tasks required for establishing a new long-term care facility, such as licensing, management, certificate of need, staffing, resident transfer, procurement of supplies, and ancillary services, the report said.

“While these options may not be feasible for an upcoming second wave, the state should explore the necessary changes in policy that would allow for the establishment of these options in preparation of a future pandemic or surge, particularly in urban areas,” the report said.

The report also offered recommendations in three other areas, which are summarized below.

Quality of life

Along with the political fight over placement of COVID-positive nursing home residents, one of the biggest controversies involving nursing homes and the pandemic are the current strictures on visitors and activities.

The task-force report notes the concerns about the impact of social isolation on nursing-home residents, and how the coronavirus-related restrictions could be accelerating residents’ decline.

Many nursing-home residents currently are limited to virtual visits or visits where the resident remains in the facility and communicates through a window to a visitor who remains outdoors. Nursing home residents also have been limited in their ability to socialize with other residents in their facility.

The restrictions on visitors were extended last Friday in a new round of executive orders by Gov. Gretchen Whitmer. A press release accompanying the order said MDHSS can make exceptions to the order and is authorized to gradually reopen visitation “as circumstances permit.”

The task force report says outdoor visits should be “allowed and strongly encouraged by providers,” and residents should be provided “with the option to participate in indoor visitation,” based on guidelines provided by the federal Centers for Medicare & Medicaid Services.

In addition, the task force recommends resumption of small-group activities and “limited communal dining” where social distancing is observed; improving opportunities for virtual visits over the Internet; ensuring residents have access to services such as dental care and physical therapy, and designating “visitation volunteers” as essential workers.

Resource availability

The report emphasized the need for personal protective equipment for nursing-home staff, saying such shortages were a “glaring” issue this past spring, as well as the need for access to diagnostic tests with quick turnaround.

The task force said the state needs to assure that nursing-homes are a high priority for PPE and diagnostic tests, and suggested the state should designate certain laboratories that can prioritize rapid turnaround of test results for nursing homes.

Also, the task-force recommendation that MDHHS lessen the reporting burden on nursing homes by switching to weekly instead of daily coronavirus reports in regions with low or moderate risk.

In addition, MDHHS should review what information is being sought from nursing homes now and eliminate any questions involving information not being used, the report said.

Staffing

One of the biggest challenges facing nursing homes right now is adequate staffing, particularly in regards to hiring and retention of nursing-home aides, the report said.

The task force suggested that the state create a new website for certified nursing assistants; launch a public-service campaign to promote working as a CNA, and make sure there are adequate training programs for CNAs.

The report also said that current staff needed to be supported, including provisions for paid time off and pay hikes, plus be given opportunities for career advancement.

“Nursing facility staff should be provided with adequate paid leave time for the duration of the public health emergency to mitigate the toll on their emotional and physical health,” the report said. “This will allow CNAs who fall ill or need time off due to personal issues the freedom to prioritize their own physical and mental health without jeopardizing the safety of residents who rely on staff for care.

“The workgroup further recommends expanding the $2-hour wage increase to all individuals working in nursing facilities,” the report said.

In summarizing its recommendations, the report said that “protecting the health, safety and wellbeing of seniors and the most vulnerable residents remains a top priority.”

But the challenges involved in preventing the spread of COVID-19 in nursing homes are formidable including national supply chain shortages of personal protective equipment (and testing supplies, staffing challenges, and increased infection control needs,” the report said.

“Federal leadership on how best navigate the COVID-19 pandemic in nursing homes has been in short supply. Although Michigan has weathered an initial wave of COVID-19, available data and research suggests the virus is surging in other parts of the country. A second wave of COVID-19 in Michigan therefore remains a deadly threat, especially to nursing home residents.”

In addition to Chu and Mali, task-force members included two Republican lawmakers, state Sen. Curt VanderWall and Rep. Hank Vaupel, and two Democrats, state Sen. Rosemary Bayer and Rep. Lisa Love.

It also included MDHHS director Robert Gordon; Orlene Hawks, director of the Michigan Department of Licensing and Regulatory Affairs, and Salli Pung, who heads the Michigan Long Term Care Ombudsman Program.

-- Julie Mack, MLive