Discharging COVID-19 Patients To Nursing Homes Called A 'Recipe For Disaster'

April 20, 2020

In some parts of the U.S., the desperate need to slow the spread of the coronavirus is coming into conflict with the scramble to find more hospital beds.

Nursing homes have been the sites of some of the earliest — and deadliest — outbreaks of COVID-19. Some people who run such facilities are understandably leery of accepting new patients who might spread the virus.

Nonetheless, some of the largest states are now ordering nursing homes to accept patients who have been discharged from the hospital but are still recovering from COVID-19.

These state directives have been strongly condemned by the Society for Post-Acute and Long-Term Care MedicineDr. Sabine von Preyss, chief medical officer for Avalon Health Care Group and president of the society's Washington state chapter, says that a distinction must be made between nursing homes that have suffered COVID-19 outbreaks and those that are still virus-free.

"The question is, should we be forced to introduce a disease with such deadly potential into a population that has been sheltered?" says von Preyss. "And my experience tells me that would be ill-advised."

Also, it won't even help overcrowded hospitals, says Dr. Michael Wasserman, who heads the California Association of Long Term Care Medicine.

"If you push folks out of the hospitals to make space and you push them into nursing homes a couple weeks later," Wasserman says, "for every one of those you send to the nursing home, you may get 20 back in the hospital."

New York and New Jersey both have ordered nursing homes to admit patients regardless of their COVID-19 status. California had a similar directive. And then suddenly, as of March 30, it didn't. After a couple of days of outcry from the medical community, the state softened its instruction.

It now says that a nursing home "can be expected" to receive residents who test positive for the virus if it is able to follow the infection control guidelines from the Centers for Disease Control and Prevention.

Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform, isn't satisfied with the change. That's because the state let stand the emergency waivers that allow nursing homes to temporarily expand capacity and reduce staff.