State officials Monday were scrambling to find about 1,000 skilled nursing beds for recovering COVID-19 patients across Massachusetts, raising the possibility of relocating hundreds of nursing home residents in a first-in-the-nation plan to relieve pressure on hospitals bracing for a surge of new patients.
The goal, Governor Charlie Baker said at a news briefing Monday afternoon, is to “ensure that we have the right kinds of beds in the right places to serve people once the surge arrives.” Baker said the plan could also prevent the state from having to force nursing homes to accept patients who are recovering from COVID-19, and who might trigger outbreaks among vulnerable senior populations.
Some Massachusetts senior homes are already facing a frightening surge in coronavirus cases. The Jack Satter House in Revere has eight hospitalized residents with COVID-19 and five residents who have died, a spokeswoman said Monday.
One of the largest outbreaks is at Williamstown Commons in the Berkshires, where 21 residents and four staff have tested positive, and another 20 residents are awaiting test results. One resident has died.
The Baker administration’s initiative could leave many nursing homes in Massachusetts and beyond with an agonizing choice: Whether to uproot residents so their facilities can be converted to recovery centers, or risk admitting discharged hospital patients who need oxygen and physical therapy but still may be contagious and could infect healthy residents.
Baker said the pilot site, Beaumont Rehabilitation and Skilled Nursing Center in Worcester, which is moving patients to sister nursing homes in central Massachusetts, could be ready by Thursday but will only handle about 150 patients. He didn’t identify other sites state officials are looking at in the Boston area, Cape Cod, and Western Massachusetts, or indicate how soon they could be turned into coronavirus-dedicated facilities.
Massachusetts appears to be the first state to establish dedicated recovery centers for COVID-19 patients, but other states such as Florida and California are examining the idea as they respond to the pandemic, said Mark Parkinson, president of the American Health Care Association, a national trade group for skilled nursing homes.
Parkinson said his industry would like to avoid state mandates, such as one ordered by the state of New York last week, that require every nursing home to admit discharged hospital patients even if they’ve tested positive for COVID-19, haven’t got test results, or haven’t been tested.
“This is a good step and a smart step, and Massachusetts is leading the way,” Parkinson said, noting that nursing homes in Massachusetts have a lower occupancy rate on average than the 80 percent to 85 percent rate nationwide, giving them more spare beds to work with in setting up recovery centers. “The worst-case scenario is to admit COVID-positive patients into facilities that aren’t equipped for them, and where the virus could spread.”
But the relocation of residents in Worcester has already prompted protests from families who say they weren’t given advance notice. And some say the move, though necessary, could risk causing “transfer trauma” in old and frail patients.
“There’s no perfect solution with this surge of patients coming,” said David Grabowski, health care policy professor at Harvard Medical School, who studies long-term care. “Massachusetts deserves a ton of credit for getting out in front of this. But I’d prefer they use other facilities, like closed nursing homes or hospitals at specialized sites, without moving longer-stay nursing home residents. It’s very disorienting for residents to switch environments and caregivers.”
Baker, in his Monday briefing, said that while state officials are considering alternatives, it may be easier to convert existing sites with staff and infrastructure in place to handle post-acute care than to use shuttered sites. The recovery sites will have to be up and ready in short order, he said, because health care authorities project the largest surge in patients hospitalized with COVID-19 will come between April 7 and April 17.
In a statement, a spokeswoman for the state Executive Office of Health and Human Services said: “While this will be temporarily disruptive for current residents of these facilities, this is an important initiative that will relieve the growing demand for hospitals that are equipped to care for individuals with the greatest medical need."
In Worcester, where Beaumont began moving 147 patients on Saturday into sister sites and other nearby senior care homes, the plan grew out of an urgent call last Wednesday between Eric Dickson, chief executive of UMass Memorial Health Care, the largest hospital system in central Massachusetts, and a group of nursing home operators in the region.
“We can predict the load of patients we’ll be seeing,” Dickson said, noting that UMass Memorial and its partners are already repurposing a downtown Worcester auditorium to handle the overflow and creating a COVID-positive homeless shelter. “We already have patients who are recovering who need to go to a skilled nursing facility, but none of the nursing homes want to take them. We recognized this was a gap in care.”
Dickson said Matt Salmon, president of Salmon Health & Retirement, which owns the Beaumont home nearest the flagship UMass Memorial hospital, ultimately stepped up and agreed to relocate residents there to sister Beaumont nursing homes in Westborough and Northbridge as well as other facilities with excess capacity in the area.
While patients recovering from viruses typically are no longer contagious three to five days after their acute symptoms abate, Dickson said, hospital officials believe they’ll have to discharge some patients during the coming surge before they’re able to determine whether they test positive for the virus.
“We’re the pilot,” Dickson said, noting the plan was approved by state public health officials who began searching for other potential recovery centers. “The faster we get this set up, we’ll share what we’re learning with the rest of the state.”
Other senior care facilities are taking different measures to segregate patients infected with the virus from healthy patients. Hebrew Senior Life has set up a separate 24-bed unit for recovering virus patients at its campus in Roslindale.
“We’re doing what we can in this global pandemic,” said Mary Moscato, president of Hebrew SeniorLife Health Care Services and Hebrew Rehabilitation Center.
But protecting patients has been an enormous challenge for many facilities, whose residents are among the most vulnerable to serious illness or death from a coronavirus infection. Williamstown Commons has sectioned off residents who tested positive into a special unit of the nursing home. Visitors have not been allowed at any of the homes for about two weeks.
Hunt Nursing and Rehabilitation Center, in Danvers, which houses about 109 people and is owned by the same company as Williamstown Commons, reported nine positive cases on Monday. Ten additional residents there are awaiting test results.
The Charlwell House in Norwood, where two residents died last week, has not conducted more testing and a spokesman said Monday no new residents have exhibited symptoms. That home has about 107 residents.
This story has been updated to reflect that there are no staff cases of coronavirus at the Jack Satter House in Revere.
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