Levine defends returning nursing home residents to facilities after coronavirus treatment: 'The virus was already there,' she says
Pennsylvania Department of Health Secretary Rachel Levine on Monday downplayed a point that critics of the state’s coronavirus response in nursing homes and long-term-care facilities regularly make: that returning residents who had been treated in hospitals for the virus to their homes at the facilities helped speed its spread.
She said that the state followed federal Center for Medicare and Medicaid Services guidelines that if a resident has tested positive for COVID-19 at a facility and then required hospitalization, that when they recovered, they were returned home to their facility.
She said the state instituted guidelines provided by the Centers for Disease Control and Prevention in early in March when the first cases were detected in Pennsylvania, including limiting outside visitors from entering long-term-care facilities.
“They contracted the virus in the facility. So it doesn’t mean they were bringing it to the facility. The virus was already there,” she said Monday during her daily press briefing.
However, others see it differently. State Sen. Doug Mastriano, a Republican from Franklin County, called for Levine’s resignation May 11, saying her actions were a major factor in the large number of COVID-19 cases and deaths in the state’s nursing homes.
“These failings are compounded by being complicit in the virus spreading through our elder care homes, triggered by unscientific and illogical directives, forcing them to readmit COVID-19 patients,” he said in part, adding, “Let me state this clearly, this order by Secretary Levine is responsible for the deaths of approximately 2,500 of our citizens, and displays the gross incompetence of someone unfit for office. The bottom line is Secretary Levine has failed to protect our most vulnerable population.”
On Thursday, U.S. Rep. Fred Keller and U.S. Rep. Scott Perry, whose district includes the Middletown area, sent a letter to Levine demanding more protections for nursing homes, as well as more transparency and accurate information.
The letter cited the March 18 Interim Guidance for Nursing Facilities during COVID-19 issued by the department, which states in part: “Nursing care facilities must continue to accept new admissions and receive readmissions for current residents who have been discharged from the hospital who are stable to alleviate the increasing burden in the acute care setting. This may include stable patients who have had the COVID-19 virus.”
“We respectfully request that the PA DOH work with the governor’s office to do everything in your power to protect our seniors living in these facilities from further harm. Specifically, we urge Pennsylvania to change the requirement that long-term care facilities admit/readmit COVID-19 patients and provide flexibility for facilities to make their own determination about whether to admit/readmit COVID-19 patients on a case-by-case basis, reflecting the unique resources and capabilities at each facility,” the letter states.
The letter also states that, despite Levine’s contention, neither the Centers for Disease Control and Prevention nor the Center for Medicare and Medicaid Services issued guidance mandating the states require nursing homes to accept COVID-19-positive residents.
“We are naturally confused about where the state is getting its information, why the rationale for these policies continued to change over time, and why this problem seems to be unique to Pennsylvania,” the letter states.
Levine said that, depending upon the circumstances, there are not many other options for nursing home residents when they are released from the hospital after treatment.
“We were very concerned at that time about patients in the hospital and overwhelming our hospitals, so if they just stayed in the hospital … first of all, you can’t just do that in terms of payment. But also we wouldn’t have throughput through the hospital. There are some facilities, nursing home conglomerates, that have a number of different facilities and are able to congregate people into different wings. Very small facilities can’t really do that. We worked with every facility to do the very best we can to protect everyone in the facility,” she said Monday.
She said many individuals with COVID-19 can be asymptomatic but very contagious.
“That’s how brave and courageous staff members who have dedicated their lives for caring for these vulnerable Pennsylvanians unknowingly spread COVID-19 into these facilities. It’s important to remember that for most residents of long-term-care facilities, this is there home. Therefore, following federal guidance from the Center for Medicare and Medicaid Services, if a resident has tested positive for COVID-19 at a facility and then required hospitalization because of their systems, when they recovered, they were returned home to their facility. It’s important to understand that this did not bring new cases of COVID-19 into the facility because that’s where the resident initially came in contact with the virus in the first place. When they got home, these residents were once again separated from others who were believed not to have COVID-19, just as they had been before they required hospital care,” she said.
When a long-term-care facility in Pennsylvania reports just a single case of COVID-19, the Department of Health reaches out to conduct an assessment of the situation and offers a number of resources to the facility, as needed, the department said. Those resources could include having the facility work with ECRI, the infection control consultant, with internal infection control teams, with the Patient Safety Authority, or deploying the Pennsylvania National Guard to assist with staffing.
Some facilities have turned down help, and Levine suspected they worried about being cited. But she said that is not the department’s intention.
She said the state has made about 1,800 shipments of personal protective equipment to facilities, including 2 million N95 masks.
It is continuing to implement its plans to test every long-term-care facility resident and staff worker.
She said testing will be individualized to each facility.
“If there’s a facility that’s had a lot of cases, then we’re going to want to be testing more. If there’s facilities in high-population-density areas that have had a high prevalence of COVID-19, we’ll want more testing. If they’ve had no cases in a rural area that has had very little COVID-19, then they need less testing. So we’re going to individualize that to the facility and their specific circumstances,” she said, adding: “One test is not conclusive. You need to keep doing tests.”
Levine said the state is seeing a “significant” decline in new cases and deaths at long-term-care facilities.
As of Monday, in nursing and personal care homes, there are 15,545 resident cases of COVID-19, and 2,663 cases among employees, for a total of 18,208 at 608 facilities in 44 counties. Out of the total deaths, 3,557 have occurred in residents from nursing or personal care facilities — 63.9 percent. That percentage had been about 69 percent several weeks ago.