Questions, Fears Surround Bay Area Nursing Homes' Acceptance Of COVID-19 Patients
by Maria Medina and Abigail Sterling
SAN FRANCISCO (KPIX 5) -- Nursing homes have had to adopt "no visiting" policies as a precaution to keep the coronavirus out. But some nursing homes are ramping up plans to bring infected patients in, including building special COVID-19 wings to help out during the pandemic. But families of current residents see the move as fueling the pandemic instead.
Our KPIX 5 cameraman got a very unwelcome reception this week at the St. Francis Convalescent Pavilion in Daly City. Employees came out and yelled at him and one even came right up to him and put his hand on our camera, a violation of social distancing protocols.
The nursing home is building a special wing for COVID-19 patients that are discharged from hospitals but still need intensive care. And they're not the only ones.
"It's a bad idea, it's a dumb idea," said retired physician Teresa Palmer. Her mother lives at the San Francisco Campus for Jewish Living that is also building a COVID-19 wing.
"She's 102, going up on 103. Her personal philosophy is she's planning not to die," said Palmer.
Her mother Berenice has been happy and healthy at the home for years. "She's still walking all over the campus with a walker. She has her favorite places to sit in the sun," said Palmer.
But now Palmer sees a threat. She believes the 30-bed COVID-19 ward that just opened is much too close for comfort. "Are they going to hire separate nurses, activity therapists, physical therapists, rehab specialists? This is unrealistic," said Palmer.
The California Department of Public Health earlier this month told skilled nursing facilities that they have to accept COVID-19 patients discharged from hospitals. Then the agency backed off somewhat, saying the facilities "can" take patients. A spokesperson told us many skilled nursing facilities have "stepped forward" to do so.
"I think it's more likely that facilities that take COVID-19 patients are stepping into it as opposed to stepping forward," said Tony Chicotel with California Advocates for Nursing Home Reform. "Everything we're seeing in the nursing home world suggests that this spreads like a conflagration through the facility," said Chicotel.
A recent Medicare survey of infection control measures conducted in nursing homes after outbreaks found 36 percent of facilities did not follow proper handwashing guidelines. Another 25 percent failed to demonstrate proper use of personal protective equipment.
Chicotel worries there's a profit motive for some of the new COVID wings, that is not in the best interest of current residents. "It's not a hidden fact that patients coming from hospitals who qualify for Medicare are significantly more lucrative than the residents that they probably currently have in the building," said Chicotel.
We wanted to ask St. Francis Convalescent Pavilion about that but they didn't want to talk to us.
Later the nursing home's administrator Steve Black sent us a statement saying in part: "St. Francis Convalescent Pavilion is following state and federal guidance to be prepared to care for COVID-19 positive patients ... The unit is self-contained and the staff working the unit will not enter the rest of the building."
The San Francisco Campus for Jewish Living says it has set up a separate area on campus as well, with dedicated staff that has received additional training. So far two COVID-positive cases have been accepted from a local hospital.
Spokesperson Marcus Young told us: "We are in active communication with the San Francisco Department of Public Health and other state and government agencies, and we are working very closely with these agencies to follow best practices in infection prevention and control."
Palmer is not reassured. "The lives of nursing home patients are worth something and they need to act like it," she said. As for her mother, Berenice: "I am angry, I am helpless. I don't want my mom to die," said Palmer.
We reached out to the California Association of Health Facilities, the industry group that represents nursing homes in California. They told us they do not support the placement of COVID-19 positive patients in skilled nursing facilities. The San Francisco Campus for Jewish Living is not one of their members.
Statement from St. Francis Convalescent Pavilion:
"Our world is facing an extraordinary healthcare crisis and St. Francis Convalescent Pavilion is following state and federal guidance to be prepared to care for COVID-19 positive patients. Last week government officials were warning local hospitals in the most strenuous terms that the hospitals may quickly be overrun by Covid-19 patients and they were looking for skilled nursing facilities to help by admitting stable Covid-19 patients in an extreme surge. St. Francis Convalescent Pavilion has dedicated an area of the facility to treat any of its residents who test positive for COVID-19. This dedicated isolation area is set up to reduce the risk of COVID-19 spreading to any other patients residing within the facility. The unit is self-contained and the staff working the unit will not enter the rest of the building. We have systems and protocols in place in accordance with County Public Health, CDPH and CDC guidelines to protect our patients and staff from the spread of this infectious disease. Additionally, we work with infectious disease physicians and experts who are intimately involved in providing continuous guidance and training on the management and care of infected residents and staff. These practices include the use of protective equipment and clothing, isolation of anyone that is infected, heightened attention to signs and symptoms that may manifest a concern for infection, and a heightened focus on personal hygiene and facility cleanliness. We are screening all staff and individuals entering the facility in addition to limited visitation. We have established clear lines of communication to all levels of staff, physicians, hospital staff, the County Health Department, and the California Department of Health Services. Nothing is more important than the safety and care of every person to which we are entrusted, and of our valued and committed staff who are working tirelessly despite daunting circumstances."
Statement from the San Francisco Campus for Jewish Living:
From our modest beginnings in 1871, we have grown and diversified to provide services for many different older adults with multiple and unique care and service needs and at various income levels. As the COVID-19 situation continues to evolve rapidly, our focus and priority have been, and will continue to be, taking proactive measures to protect our residents, patients, and staff.
As a healthcare organization, we follow the direction of the government agencies we work with, and the All Facilities Letter (AFL-20-33) from the California Department of Public Health (CDPH) specifically instructs Skilled Nursing Facilities to prepare to accept COVID-19 patients as follows:
"SNFs can be expected to accept a resident diagnosed with COVID-19 and who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow Centers for Disease Control and Prevention (CDC) infection prevention and control recommendations for the care of COVID-19 patients, including adequate supplies of personal protective equipment (PPE)."
We are in active communication with the San Francisco Department of Public Health (SFDPH), CDPH, and other state and government agencies, and we are working very closely with these agencies to follow best practices in infection prevention and control. We currently have no known patients or residents with facility-acquired COVID-19 on campus, and we have admitted two patients to date from one of our partner hospitals.
Our campus is uniquely set up to accommodate this demand. We have identified an area on the campus with private rooms and private bathrooms where we can safely separate and cohort these patients, with dedicated clinical staff who have been given additional training and education. These preparations will help us protect our current patients, residents and our staff while the COVID-19 patients receive the care and services that they require.
We are partnering with local hospitals and SFDPH to follow specific protocols to accept COVID-19 patients being discharged from these institutions into our care, and SFDPH will review and approve each discharge to our Campus. We remain grateful to our donors for their support in this unprecedented time, and to our incredible staff for their courage, dedication, and the exceptional care they deliver to all those in need.
Statement from the California Association of Health Facilities:
The California Association of Health Facilities does not support the placement of COVID-19 positive patients in skilled nursing facilities. We understand some facilities are considering the admission of COVID-19 positive patients. This is only acceptable if a facility has a separate wing or separate space, the proper equipment, adequate staffing and adheres to CDC infection prevention guidelines.
We are not aware of any SNFs that are taking COVID-19 positive cases. We have heard that some larger buildings with separate floors or wings are in discussion with their local public health departments and the state Department of Public Health about the possibility of accepting coronavirus patients should the need arise.
The Medicare rate is always greater than the Medi-Cal rate and most of these patients would be accessing Medicare benefits.
Statement from the San Francisco Department of Public Health:
The decision about whether to take COVID-19 patients is made between the state and the skilled nursing facility. We at the local level are not identifying individual institutions, that is up to them. However I would stress it's very important to have some SNFs that take these patients when they no longer require hospital care, in order to provide the right level of care for the patients and to decompress the hospital system so that hospitals are ready for a surge. Skilled nursing facilities are a crucial part of the health care system and care for a vulnerable population.
Letter from CANHR to the California Department of Public Health
Letter from Health Professionals to the Governor regarding Skilled Nursing Facilities