Michigan is not the only state allowing nursing homes to accept COVID-19 positive residents

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Lee Chatfield, the Republican Speaker of the Michigan House of Representatives, criticized Governor Gretchen Whitmer’s approach to handling coronavirus outbreaks in the state’s nursing homes in a July Facebook post. Chatfield wrote that Whitmer’s “failed policy” makes Michigan’s approach unique. “We remain the only state in the country that still imposes this reckless policy,” Chatfield wrote.

He seemed to be pointing to Michigan’s policy of allowing nursing homes to accept COVID-19-positive residents.

An editorial by the Detroit News published in early August made a similar claim. It said that with the exception of Whitmer, “all other governors have backed down and changed course when they saw the consequences” of allowing “infected nursing home residents back into their facilities.”

And appearing on WWMT last week, Michigan Republican Party Chair Laura Cox said Michigan is “the only state in the nation that is continuing this very, very bad policy.”

But Michigan is not the only state in the U.S. that allows COVID-infected residents admission or readmission into nursing homes. A handful of states -- including California, Minnesota, New Jersey and Pennsylvania -- currently allow nursing homes to admit residents infected with COVID-19 under certain conditions.

The policy addresses a thorny problem: If nursing home residents hospitalized with COVID-19 are are medically stable enough to be released, where should they go? Staying in the hospital takes up needed bed space and medical resources, but going back to nursing homes could risk infecting others.

<strong style="margin-right:3px;">More: Feds to Whitmer: Turn over COVID-19, nursing home data. She blasts back response.

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What is Michigan’s policy regarding COVID-infected nursing home residents?

At the outset of the pandemic, Whitmer required hospitals to discharge medically stable, long-term care facility residents back to their facility only if it had a dedicated unit to isolate and care for COVID-infected residents with available bed capacity.

Otherwise, hospitals were ordered to discharge the patient to a regional hub established for isolating recovering nursing home residents infected with COVID-19 who do not require hospital care.

Since Whitmer signed an executive order in late May, nursing homes in the state are required to make “all reasonable effort” to create a dedicated unit to isolate COVID-affected residents. Nursing homes can only create a dedicated unit if it is able to implement infection control procedures and provide appropriate PPE to employees staffing the unit.

Hospitalized COVID-affected residents who are medically stable can only be discharged to nursing homes capable of isolating the resident. And nursing homes can admit new and returning COVID-19-positive residents so long as the facility has the ability to provide adequate infection control and have separate units for these residents or are a regional hub.

Do any other states have a nursing home policy similar to Michigan’s?

In California, nursing facilities cannot discriminate against new residents or returning residents based on a confirmed COVID-19 infection. The state requires nursing facilities to take steps to prevent the spread of COVID-19, including designating a separate space to care for incoming COVID-19-positive residents and dedicating staff to care for these residents. Under these conditions, nursing homes can accept new and returning residents who are infected with COVID-19.

In Minnesota, nursing homes also can accept COVID-19-positive residents so long as the nursing home can follow CDC prevention and control guidelines and can transfer residents to a separate unit dedicated for housing COVID-19-positive residents.

New Jersey’s Department of Health has directed nursing homes in the state to enact a response plan to separate symptomatic and COVID-infected residents, those exposed to COVID-19 and all others as well as dedicate staff to caring for each cohort. As of August 17, 20 facilities were not accepting new admissions because they could not meet the department requirements.

And in Pennsylvania, patients with COVID-19 can be discharged to a nursing facility that is able to adhere to infection prevention and control recommendations.

So Michigan is one among a handful of states allowing nursing homes to accept COVID-19-positive residents.

Backlash to this policy

Whitmer has faced fierce backlash from Republican politicians in Michigan and Congress for her response to dealing with COVID-infected nursing home residents. On Wednesday, the U.S. Justice Department announced it is requesting data from Michigan, New York, New Jersey and Pennsylvania, which it accuses of requiring nursing homes to admit COVID-19.

“We’ve always followed the CDC guidelines. We’ve never required a nursing home to take a COVID-19 patient,” Whitmer said in defense of her executive orders in an interview with WDET.

“Every step of the way, we’ve made decisions with the best information that was available, but if I could go back in a time machine with the knowledge we have today back three months ago, would some decisions be different? Yes,” she added.

In late July, Michigan’s Legislature passed a bill that would have required nursing homes to transfer COVID-infected residents if the nursing home is unable to house the COVID-infected resident in a physically separate building.

Whitmer vetoed the bill after the Michigan Senior Advocates Council -- which advocates for the state’s senior population -- lobbied against the legislation. In a letter outlining her decision, Whitmer wrote that the bill was “based on the false premise that isolation units created within existing facilities are somehow insufficient to protect seniors.” Whitmer also opposed the bill because it did not require consent, doctor approval or notification to the patient or their family prior to the transfer.

As of Wednesday, roughly 33% of Michiganders who have died from COVID were nursing home residents. On August 31, the Michigan Nursing Homes COVID-19 Preparedness Task Force, established by Whitmer through an executive order, will propose an action plan to Whitmer on how best to prepare nursing homes for a future wave of COVID-19 cases. The plan will likely paint a clearer picture of whether Whitmer’s policy has had a significant impact on deaths from COVID-19 in the state’s long-term care facilities.

New York, which once allowed COVID-infected patients to be discharged from hospitals to nursing homes, recently undertook an analysis of its response. The New York State Department of Health found that its initial policy of barring nursing homes from refusing to admit medically stable COVID-infected residents did not cause an increase in nursing home infections or fatalities.

Clara Hendrickson fact-checks Michigan issues and politics as a corps member with Report for America, an initiative of The GroundTruth Project. Contact Clara at chendrickson@freepress.com or 313-296-5743 for comments or to suggest a fact-check.

This article originally appeared on Detroit Free Press: Michigan is not the only state allowing nursing homes to accept COVID-19 positive residents

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