New York State's nursing home body-count must already exceed
Howard Zucker's Scarlet Letter
March 25, 2020 New York States Health Department issued the
urgent Advisory: Hospital
Discharges and Admissions to Nursing Homes. Nursing
Home (NH) Administrators, Directors of Nursing, and Hospital
Discharge Planners needed to carefully
review this guidance.
expectations regarding nursing home acceptance of
residents returning from hospital and nursing home
acceptance of new admissions, the Advisory orders:
must comply with the expedited receipt of residents from
hospitals to NHs.
No resident shall be denied re-admission or admission to the
NH solely based on a confirmed or suspected diagnosis of
Hospital Administrators are given discretion
over assessing patient fitness for transit and over choosing
which patients to send. Thereafter:
resident shall be denied re-admission or admission to
the NH solely based on a confirmed or suspected
diagnosis of Covid-19. NHs are prohibited from requiring
a hospitalized resident who is determined medically
stable to be tested for Covid-19 prior to admission or
Withering denunciations of this Advisory
appeared instantly. A March
29, 2020 joint statement (Society for Post-Acute and
Long-term Care Medicine; American Health Care Association;
and National Center for Assisted Living) references the then
ongoing Covid-19 outbreak at a Washington nursing home which
killed 40 and sent half the residents to emergency wards.
The joint statement also relays CDC data
indicating that, within geriatric facilities, Covid-19s
case-to-fatality rate exceeds 15%.
The statement further cites a March 27, 2020
CDC finding that 57% of Covid-19-positive nursing home
residents remained asymptomatic for up to a week. During
this incubatory period such residents: have
potential for substantial viral shedding.
The authors rejected the re-purposing of New
Yorks nursing homes into frontline quarantines. New York
nursing homes were already encountering critical shortages,
or complete depletions, of personal protective equipment (PPE).
Staffing shortages were exacerbated by Covid-19 outbreaks
among workers and by school closures which threw many into
childcare crises. Poorly trained workers were doing shifts
at multiple homes.