Coronavirus Patients Caught In Conflict Between Hospital And Nursing Homes

COVID-19

April 1, 2020

A wrenching conflict is emerging as the COVID-19 virus storms through U.S. communities: Some patients are falling into a no man’s land between hospitals and nursing homes.

Hospitals need to clear out patients who no longer need acute care. But nursing homes don’t want to take patients discharged from hospitals for fear they’ll bring the coronavirus with them.

“It’s a huge and very difficult issue,” said Cassie Sauer, president of the Washington State Hospital Association, whose members were hit early by the coronavirus.

Each side has legitimate concerns. Hospitals in coronavirus hot spots need to free up beds for the next wave of critically ill patients. They are canceling elective and nonessential procedures. They are also trying to move coronavirus patients out of the hospital as quickly as possible.

The goal is to “allow hospitals to reserve beds for the most severely ill patients by discharging those who are less severely ill to skilled nursing facilities,” Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said a few weeks ago as the federal agency relaxed rules restricting which Medicare patients can receive nursing home care.

Nursing homes are alarmed at the prospect of taking patients who may have coronavirus infections. The consequences could be dire. The first nursing home known to have COVID-19, the Life Care Center in Kirkland, Washington, saw the virus spread like wildfire. It killed 37 people.

“We’re looking at case fatality rates of 30, 40, 50% in nursing homes when coronavirus gets introduced,” said Christopher Laxton, executive director of AMDA — the Society for Post-Acute and Long-Term Care Medicine, which represents nursing home medical directors.

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