Hospitals in New York are banned from discharging patients to nursing homes unless they have first tested negative for COVID-19, under a new order announced by Gov. Andrew Cuomo yesterday.
Roughly 25% of all reported COVID-19 deaths in New York State so far have been long-term care residents, drawing increased scrutiny in recent weeks from state health officials.
The order seems to walk back a March 25 State Health Department directive requiring nursing homes them to accept people who test positive for COVID-19 — including COVID-positive patients from hospitals, whether or not the patient was previously a resident of the nursing home.
But Melissa DeRosa, secretary to the governor and head of the state’s COVID crisis team, insisted the new order did not reverse the March 25 directive.
“The two orders coexist,” DeRosa said. Nursing homes are not still allowed to discriminate against COVID-positive or suspected-positive people, she said.
“This puts the obligations on hospitals, which is saying a hospital cannot release a COVID patient into a nursing home until they test negative,” DeRosa said.
“However — as the governor has said 17 times — a nursing home cannot accept a patient if they cannot care for them,” she said. “You have to cohort the patients, there has to be segregated staff, you have to have the appropriate level of PPE, and if you cannot meet those standards, you call DOH and DOH finds a facility for them,” DeRosa said.
When questioned on the March 25 health department directive by reporters at his daily briefing yesterday, Cuomo at first denied knowledge of the directive. “I don’t know the March 25…” he began, turning to aide Jim Malatras for an answer — rather than Commissioner of Health Dr. Howard Zucker, who leads the agency that issued the directive and was present at the briefing.
Malatras, a longtime Cuomo aide who was named president of Empire State College last year, was called in to work on the governor’s COVID crisis team in March — initially, at least, to help local governments develop plans related to school closures.
Nursing homes “still can’t discriminate against a patient based on COVID status,” Malatras replied. “This is saying to hospitals if you have a COVID patient…they should test negative before being discharged from the hospital itself.”
Cuomo said it was “always the case” that hospitals “don’t have to discharge to a nursing home. They can discharge to any one of our other facilities” — just as it has always been the case that nursing homes who could not care for COVID-positive patients could have asked DOH to transfer them to a different nursing home or one of the state’s “other facilities.”
Nursing home administrators told RiverheadLOCAL last week they were never made aware of “other facilities” available to receive COVID-positive transfers.
The executive director of the New York State Health Facilities Association, an association of long-term care facilities across the state, said the association had little information.
“I think the Department of Health and the governor’s office is making an effort to make those types of facilities available,” Stephen Hanse said in a phone interview last Tuesday.
“I think it’s something that is starting to grow,” Hanse said. “I think there’s at least three in the downstate area right now — three or four — and there’s one in western New York.”
In response to a request for the names and locations of facilities available to receive transfers of COVID-positive patients, Department of Health spokesperson Jill Montag said in a May 5 email:
“We have identified a facility on Buffalo Ave in Brooklyn that had been used previously as a low acuity facility and has a capacity of 281 beds. Additionally, should capacity be needed, we have South Beach Psychiatric Center on Staten Island and SUNY Downstate Medical. Both are healthcare facilities that were previously focusing on COVID-19-only care and are ready to assist with nursing home residents, as needed.”
Montag did not answer a question asking how many patients have been transferred to such facilities.
A request for copies of any directives issued by DOH to nursing homes regarding the availability of facilities capable of providing care for COVID-positive residents did not produce any documents.
Montag issued this statement: “The Department of Health is in daily conversations with facilities statewide to identify existing facilities with capacity and will assist with transfer as needed. Looking at existing facilities that are close to home – particularly in Upstate communities – is a good first option.”
The governor said yesterday the new order will “reduce the burden on nursing homes across the board because they’re not going to get any COVID-positive people from a hospital.”
But he pushed back on the idea that requiring nursing homes to admit COVID-positive people was a mistake.
“First of all, if you look at the facts — which is always fun —look at how many persons we have in nursing homes, look at the percentages of our deaths vis a vis other states,” Cuomo said.
New York, the epicenter of the coronavirus outbreak in the U.S., with 335,395 confirmed cases and 21,478 fatalities to date, has reported 5,403 long-term care deaths as of May 9. While that is the highest number of long-term care COVID deaths in the country, New York does not have the highest ratio of long-term care facility deaths as a share of total state deaths.
In New York, roughly 25% of all reported COVID-19 deaths have been long-term care residents.
Other states have reported much higher ratios. In New Jersey — the state with the second-highest number of long-term care COVID deaths — about 53%, or 4,855, of its 9,225 total deaths to date have been in long-term care facilities.
“So whatever we’re doing has worked — on the facts,” Cuomo said.
“Second,” the governor said, “at one time, hospital beds were precious. When we started this, remember, the whole question was will we have enough hospital beds. We were in a scramble to provide more hospital beds.
“So, the last thing you’d be doing would be gratuitously saying we’re going to keep a person in a hospital bed who didn’t need a hospital bed and could be cared for in another facility,” Cuomo said. “It would be reckless and it would be negligent because we needed the hospital bed so badly,” he said.
“What were saying today is, we have excess capacity all across the board and the hospital can discharge to another one of our facilities — they don’t have to discharge to a nursing home they can discharge to any one of our other facilities,” Cuomo said, adding, “which was always the case.”
New York is one of 14 states in the nation that have not reported the number of COVID cases in long-term care facilities. New York began reporting long-term care COVID deaths by county on April 13. On April 16, the state began reporting confirmed COVID deaths in individual long-term care facilities. On May 5, the state started reporting presumed COVID deaths as well, adding 2,765 fatalities to the state’s tally of long-term care deaths during the crisis.
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