Nursing homes avoid elderly people in hospital because of coronavirus


Carl Schoen’s mother, 99, has lived in a retirement home for five years. On March 13, she was taken to the emergency room at the Huntington Memorial Hospital in Pasadena with pneumonia.
She recovered quickly in a few days, but now the retirement home will not take her back because she cannot prove that she does not have coronavirus. It was tested 12 days ago, but the results are not yet known.

“They are very determined to say that until she gets the test result, she can’t come back,” said Schoen, who asked that her mother’s name and the establishment’s name care in northeast Los Angeles is not being released for fear of alienation. his caregivers.

Hospitals and nursing homes across the country are stuck in high-stakes battles over the plight of elderly patients amid the coronavirus pandemic.

Hospitals are desperately trying to free patients to free up space for an expected wave of COVID-19 victims. But nursing homes are reluctant to accept new patients – or even returning residents – until they are proven to be virus-free.

Dr. Michael R. Wasserman

Dr. Michael R. Wasserman, Geriatrician and President of the California Association of Long Term Care Medicine.
(Al Seib / Los Angeles Times)

Dr. Michael Wasserman, medical director of a nursing home in Reseda, said he would not accept any patient returning from a hospital until two negative coronavirus tests were done 24 hours apart .

The extreme vulnerability of elderly residents to the new virus makes taking a patient who may have the highly contagious pathogen “similar to premeditated murder,” he said.

Wasserman noted the devastation at the Life Care Center nursing home in Kirkland, Washington, the site of one of the first COVID-19 outbreaks in the United States. Two-thirds of residents and 47 workers fell ill and 35 people died.

“I’m afraid there are at least 50 additional Kirklands in California before this is done,” said Wasserman.

Wasserman, geriatrician for over 30 years and president of the California Assn. long-term medicine, has been in contact with state public health officials regarding advice to nursing homes. Their message, he said, was not clear and changed.

Nursing home workers in Eisenberg village examine all symptoms of coronavirus

People walk past the nursing home in the village of Eisenberg, where they check all new arrivals for coronavirus symptoms in Reseda.

(Jason Armond / Los Angeles Times)

“First, they told nursing homes to take patients from hospitals, then they told us not to take patients, now there are conflicting guidelines that say they are ready to take them,” said Wasserman.

But Wasserman agrees with doctors who say that nursing homes should not send residents to hospitals, even if they have symptoms of COVID-19, unless they are in urgent need of care.

“We have a comprehensive strategy on how to manage this in qualified nursing homes,” he said. “If you think someone has it, you have to contain it. We don’t want to send someone to the hospital unless they really need intensive care. ”

Once a patient has gone to hospital, he said, nursing homes have a moral duty to make sure they don’t carry the virus when they return, especially in a nursing home. establishment without evidence of contamination.

“If I knew someone was trying to send a COVID patient to my nursing home,” said Wasserman, “I would stand at the door and say,” Damn no, I’m not going to let you do this. . “”

The shortage of tests nationwide and long waits for results compound the problem as it can be difficult to prove that a patient who has been hospitalized is completely free from the virus.

Officials from the Los Angeles County Department of Health Services, the country’s second largest municipal health care system, have confirmed that they are experiencing the problem.

“DHS has encountered resistance from some qualified nursing homes to accept patients who have not tested positive for COVID-19,” said Charmaine Dorsey, director of patient and social support services for the department. “This has complicated our efforts to reduce the hospital census as we prepare for an increase in the number of patients.”

The health services department cares for more than 2 million people, many of whom are the poorest and most vulnerable in the county.

The situation is “particularly difficult for DHS because we have many patients with multiple medical and psychosocial comorbidities that make it difficult for us to place our patients in such facilities, even under normal circumstances,” said Dorsey.

Dorsey pointed to a letter that the California Department of Public Health sent to all nursing homes on March 20 asking them to “prepare to care for residents suspected or confirmed to have COVID-19” .

These tips are a “recipe for disaster,” said Michael Conners of the California Advocates for Nursing Home Reform. “It could expose every resident to infection and death.”

Kristen Knapp, spokesperson for Florida Health Care Assn., Who represents the vast majority of state nursing homes, said hospitals were in dire straits. But his organization advises members to be “adamant” about the need for testing for returning residents.

“We are caring for a very vulnerable population, so our goal is to do everything we can to prevent the virus from entering the building. We are really focused on that, ”said Knapp. “If they come out, we ask that they be tested before coming back. ”

Not all nursing homes in Los Angeles are so strict.

The Crenshaw Nursing Home sent a resident to hospital on Friday for a blood transfusion. She returned Saturday. The home did not require a negative test, said Halem Crowe, director of nurses, but made sure the woman had no symptoms of coronavirus.

Since Monday, the house has not sent anyone to the hospital. If a resident needs an IV or X-ray, they get it from the nursing home, a change made to limit exposure to the coronavirus. “We don’t want our residents to take something outside and bring it here,” said Crowe.

Veteran emergency doctor at a community hospital in the Sacramento area, speaking on the condition that his name not be used, said that his hospital was inundated with nursing home residents with minor cold symptoms .

“They cough several times and they are sent,” he said. And then house administrators refuse to let patients return without a negative coronavirus test, a process that can take around a week at his hospital, he said.

“They are not sick enough to need hospitalization,” said the doctor, who described the patients as a “massive drain” at a time when hospital staff are preparing for a wave of lifelong coronavirus or to death.

Over the weekend, he said, a nursing home sent an elderly woman to the emergency room by ambulance for mild flu symptoms. Doctors ordered several tests, including the coronavirus, and sent her home.

The next day, the administrators dismissed her and told her to keep her until the hospital could prove that she did not have the virus. The doctor said he had no choice but to admit it.

“It’s been six days of nursing and a bed for someone who really needed to be separated from the others,” he said. ” Yes [the woman] lived at home, I would say, “Go home and put yourself in the room and have chicken soup.”

He said that even if some patients end up being positive, the hospital should only be reserved for people with breathing difficulties and other serious conditions.

“There is nothing wrong with what these facilities call 911. They remove a person from their establishment for at least five hours and lighten the staff,” he said.

Almost two weeks after taking the coronavirus test, Carl Schoen’s mother – who is blind and has hearing loss – remains trapped in hospital in a negative pressure isolation room for COVID patients. He said she could not have visitors and sometimes had to be restrained to avoid falls.

A nurse told the family on Wednesday that she clearly does not have COVID, Schoen said. That afternoon, a doctor informed Schoen’s family that the specimen sent to the laboratory had been lost. The results of a new test would take at least three days.

The situation is “crazy,” said Schoen: “I have a hospital room where they can place a real coronavirus patient.”


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