The virus has greatly impacted Michigan facilities — with some in metro Detroit hit very hard — but the state has yet to tally the total nursing home residents who have tested positive for COVID-19 since the crisis began.
(TNS) — Thousands of nursing home residents across Michigan have fallen ill from the novel coronavirus and hundreds have died, but the true toll remains unknown because of the lack of available statewide data.
While it's clear the virus has greatly impacted facilities throughout Michigan — with some in metro Detroit hit especially hard — the state has yet to tally how many total nursing home residents have tested positive for COVID-19 since the crisis began.
What the state has provided are one-day snapshots showing the current number of COVID-19 cases among residents at nursing facilities, including hubs accepting COVID-19-positive patients from local hospitals and other nursing facilities. Not included are the cumulative number of residents at each facility who contracted the virus, how many residents have recovered and the number of those who have died.
State health officials have acknowledged shortcomings in the data collection — confirming to the Free Press they had not initially asked nursing facilities to provide cumulative data on COVID-19 cases among residents — but said changes are coming.
Additional information will be collected from nursing facilities, including the cumulative data, to align with federal reporting requirements of nursing home data, state health officials said.
"We're on a path," Robert Gordon, director of Michigan's Department of Health and Human Services, told the Free Press on Tuesday. "We're doing significantly better reporting than we were a month ago and we expect to be doing significantly better reporting two weeks from now than we are today."
Nursing home residents across Michigan have been isolated from having direct contact with their families since March, when restrictions on in-person visits were implemented to mitigate the spread of the virus. Statistics released by government agencies is one way for families seeking information to see the impact COVID-19 has had on nursing homes where their loved ones reside.
The state health department first began publicly releasing data on nursing facilities last month, after the governor signed an executive order requiring nursing homes to report all presumed positive COVID-19 cases to the state.
"There were concerns about requesting cumulative data retroactively and placing undue burdens on facilities that need to spend their time serving patients vs. filling out forms," Lynn Sutfin, a spokeswoman for the state health department, said in an email, adding the department was also working with existing system limitations to collect the data.
"The data collection was intended to inform current needs and assist the department in targeting our resources appropriately. We believed when we launched the reporting requirement that the current information was the best information for the state to collect and act on," Sutfin said. "We’ve since recognized the value, for both the public and state, in also collecting the cumulative information."
Erin Emerson, director of the state's Office of Strategic Partnerships and Medicaid Administrative Services, said the state will soon roll out new reporting requirements to include data on cumulative cases and more specific information about staff shortages.
Sutfin said nursing homes will continue to report to the state, which will forward the information to the CDC.
According to the state, more than half of the listed nursing facilities reported no current COVID-19 cases among residents as of Thursday. That does not mean, though, that facilities have not been impacted by COVID-19 infections among residents or staff.
Local health department data shows cases have been widespread. Wayne County, which does not include cases from Detroit because the city has its own health department, has reported that nearly 40% of all of the county's COVID-19 deaths have been nursing home residents. And the Detroit Health Department has reported case and death totals for all of the city's 26 nursing homes.
The state reported that, as of Thursday, two Detroit nursing homes — Riverview Health and Rehab Center North and Riverview Health and Rehab Center South — had 16 and zero active COVID-19 cases among residents, respectively.
Meanwhile, the Detroit Health Department reported cumulative numbers showing Riverview North had seen a total of 83 residents test positive for COVID-19 and 23 residents die, as of May 8. Riverview South, the data showed, has had 50 residents test positive and 14 COVID-19 deaths during the same period.
Richard Levin, the CEO for Riverview Health, said the facilities have provided data, adding that information provided by others about the facilities is being reviewed.
"We care deeply about our residents, their families and friends, and continue to take measures daily to adapt to, meet or exceed the ever-changing recommendations and requirements issued by various state and federal agencies for the care, treatment and protection of our residents and staff," he said in a statement.
Dr. Carla Bezold, the city's chief epidemiologist, said in a statement that data on nursing home cases and deaths are based on facilities self reporting and supplemented by information from the Michigan Disease Surveillance System. Each week, the numbers of cumulative cases and deaths are summarized and reviewed with the facilities before being published, she said.
She said facilities may vary in how they gather, collect, and report information. Some individuals who are transferred between facilities are in the case counts for both locations, she said.
"The goal of gathering any public health information," Bezold said, "is to make decisions that save lives.”
While Detroit and county health departments in metro Detroit have tracked the deaths of elderly residents in senior living facilities — grim statistics that stretch into the hundreds — the state health department has not published data on the deaths of nursing home residents.
Officials recently said there had been 687 COVID-19-related deaths reported by skilled nursing facilities, as of May 10, but Gordon cast doubt on the accuracy of that statistic during a state Senate oversight committee hearing last week.
“I do not stand behind that number as an accurate and full accounting of COVID-related nursing home deaths," he said during the hearing Wednesday. “I’m confident that number is an undercount.”
Officials have said there may have been inconsistencies with the way facilities were reporting: Some were reporting the daily number of deaths, while others might have been reporting cumulative counts.
Gordon said the department is working to improve the quality of the data.
"The full picture," he said, "is one that we will get over time."
Meanwhile, local health departments in metro Detroit have identified thousands of infections and hundreds of deaths linked to senior living facilities.
In Macomb County, there are 74 care facilities that have had COVID-19 cases, 1,083 confirmed cases and 277 deaths as of Wednesday, a spokesman said. Those numbers include only residents, he said. Facilities include nursing homes, assisted living centers and senior living facilities. In Oakland County, as of Wednesday, there had been 1,661 reported positive cases among residents and 540 cases among staff at senior living facilities, which includes independent living, skilled care, nursing homes, rehabilitation centers, assisted living and memory care facilities, a county spokesman said. He said there have been 421 deaths linked to the facilities. In Wayne County, which does not include cases from Detroit, nearly 40% of all deaths in the county — 381 of 965 total deaths as of Saturday — had been nursing home residents. And 11% of the county's total cases — 936 out of 8,808 — have been identified as nursing home cases. In Detroit, as of May 8, more than 1,200 residents across the city's 26 nursing homes had tested positive for COVID-19, according to Detroit Health Department data. That could include individuals counted more than once after being transferred from one facility to another, a note on the publicly available data says. The data also shows 293 nursing home residents who tested positive have died.
In Detroit, the city tested all of the city's nursing home residents. Last week, Detroit’s Chief Public Health Officer Denise Fair said the city was shifting its focus to test thousands of senior citizens who live in apartment buildings. The city also plans to distributed masks, gloves and hand sanitizer to seniors living in these communities, she said.
Carolyn Johnson, whose mother, Mildred Hill, died after testing positive for COVID-19, said she appreciated Detroit Mayor Mike Duggan publicly releasing cases and coronavirus-related deaths associated with each of the city’s nursing homes.
Hill's family had wondered how rampant the disease was at the nursing home where she had lived. They said she lived at Riverview Health and Rehab Center North in Detroit. After falling ill, she was rushed to Ascension St. John Hospital in late March and later diagnosed with coronavirus, her family said. Hill, who was 75, died April 7.
Hill's family wore masks and gloves to her funeral. No more than 10 people could be in the room at one time. Johnson, 51, of Eastpointe, said she couldn’t walk up to the casket or touch her mother’s body as she mourned because of precautions taken during the pandemic. She also couldn’t go to the cemetery where her mother was buried.
This past Mother’s Day was Johnson's first without her mom.
“It was a hard Mother’s Day,” she said.
Gov. Gretchen Whitmer last week extended an executive order aimed at protecting residents and staff at long-term care facilities. It says facilities are to report all presumed positive COVID-19 cases to the state health department, "with any additional data required under DHHS guidance."
The order is effective through Wednesday. Case data has not been reported by some facilities, according to the state's website. So far, no penalties have been imposed for non-reporting, Sutfin, the state health department spokeswoman, said.
“We will likely explore this in the future,” she said in an email. “But first (we) wanted to work with facilities/associations to understand the reporting challenges and barriers to doing so before we turned to a strict enforcement approach.”
The state also is collecting information on regional hubs, which are nursing facilities with the capacity to care for those affected by COVID-19. Sutfin said in many cases that means the facilities have closed units with separate entrances and a dedicated staff.
Sutfin said the majority of hub residents have been discharged from hospitals, while some are transfers from other nursing facilities.
Prior to the COVID-19 outbreak, federal regulations already required nursing homes to have written procedures regarding infection control, including reporting possible communicable disease or infections to local and state health authorities. Expanded federal regulations published at the end of April, mandate nursing homes to report, among other things, the number of confirmed or suspected COVID-19 infections and deaths to the CDC in order to support nationwide surveillance of COVID-19 and increase transparency.
The CDC and Centers for Medicare and Medicaid Services "can introduce innovative solutions to stop the spread of COVID-19 and better prepare and equip facilities to keep residents and staff safe during the pandemic," Scott Pauley a CDC spokesman, said in an email. “The data will also help to inform federal, state, and local public health response by providing information on cases/outbreaks in these facilities, staffing shortages, the status of personal protective equipment (PPE), ventilator capacity and supplies."
CMS plans to publicly report the data collected by CDC in a few weeks, he said.
Timothy McBride, co-director of the Center for Health Economics and Policy at Washington University in Missouri, said key information he would look for at nursing facilities is the rate of change or number of new cases. He said this would allow health officials to see whether they need to change their planning and allocate additional resources.
Michigan and local health departments are doing that with the statewide and community totals to determine whether the curve of new cases is flattening.
McBride said it's the job of public health departments to coordinate public health data. He said Missouri — like Michigan — is near the bottom in terms of public health dollars. “Per capita spending in public health, that's part of the underlying problem,” McBride said of Missouri.
Nationwide, Michigan ranks 43rd for state and federal dollars dedicated to public health at $58 per person, according to America’s Health Rankings, a 2019 report from the United Health Foundation, a nonprofit providing health-related information to policymakers and the public. The national average was $87 in public health spending per person.
For two nursing homes in Riverview, the outbreak has taken its toll.
Rivergate Terrace and Rivergate Health Care Center, located on the same campus, and both Life Care Centers of America facilities have each seen a number of cases. Data provided by Life Care Centers of America illustrates the impact on residents and staff.
Timothy Killian, public information liaison for Life Care Centers of America, told the Free Press in an email Friday that Rivergate Health Care Center has had a total of 107 residents positive for COVID-19 over time. He said 22 residents have recovered and 17 have died and 68 were still positive as of Friday. At Rivergate Terrace, 93 residents had been positive in total, 35 had recovered, 33 have died and 27 were still positive as of Friday, Killian said.
Christine Martin said her husband, Gordon, has lived at Rivergate Health Care Center for seven years and tested positive late last month. She said he is asymptomatic and has been moved into a COVID-19 ward. Martin said she used to frequently visit her husband, who she said was placed in the facility after suffering a brain aneurysm and two strokes.
Martin said she wants facility staff to be more accessible.
“When I call there, I want them to not push me from phone to phone and give me a recording and they don’t get back to me," she said. "I want them to be available to us to vent our concerns.”
According to Killian, dozens of staff members at both facilities also had fallen ill.
Inspection records from April on the Michigan Department of Licensing and Regulatory Affairs’ website reviewed by the Free Press show both Rivergate Terrace and Rivergate Health Care Center failed to properly maintain infection control practices.
Gowns used as personal protective equipment were stored in doorways of 11 confirmed and presumptive positive COVID-19 residents’ rooms and shared between staff at Rivergate Terrace, a report said. Also, medical equipment was not being properly sanitized between isolated and non-isolated residents, the document said.
The facility took action, including removing used gowns from residents' rooms, disinfecting all multi-resident used equipment and educating staff on issues like personal protective equipment policy and COVID-19 outbreak policy, the report says.
The inspection report from Rivergate Health cited several deficient practices, including failing to ensure staff adhered to droplet precautions while passing out meals to residents. A worker went into several rooms to deliver food without wearing a gown or gloves, but had on a mask and hair covering, the report said. The worker later said she didn’t know she should gown up when entering “droplet precaution” rooms, but now knows that she should.
Inspections at facilities are common and infection control is "the most common concern," Killian said in an email. He said results are taken seriously.
"We cannot speak to specific investigations that are ongoing; there is a process by which we work with our oversight agencies to correct any issues addressed," he wrote. "We are confident that we are in full compliance with both State and Federal guidelines."
As to the allegations of a lack of personal protective equipment, Killian said with the global pandemic, there was an unprecedented demand for the equipment in all industries.
"As a result, our own ability to have all the PPE needed for an entirely new and unprecedented level of infection control were initially constrained," he said. "At no time did we lack the needed PPE to care for COVID positive patients."
Martin said her husband was tested for COVID-19 last month and she has inquired about having him retested. As of Thursday, she said she did not have an answer.
As to the nursing home's response to the coronavirus, she said "they handled it very poorly in the beginning. Very poorly.”
Killian said the nature of the virus is still being discovered and guidelines continue to emerge.
"The coronavirus outbreak happened to us," he said, "not because of us."
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This article originally appeared on Detroit Free Press: When it comes to nursing home deaths, state data tells only part of the story
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