Whitmer order sets up COVID-positive nursing units in Michigan

Gov. Gretchen Whitmer has signed an executive order to loosen some restrictions inside nursing homes, expand reporting on COVID cases, and — drawing from recommendations from a recent task force — establish Care Recovery Centers that would care only for nursing home residents with COVID-19.

The eight-page order, released Wednesday, is an extension of earlier requirements for nursing homes and other long-term care facilities.

It does not provide details on what Care Recovery Centers will look like. But on Aug. 31, the Michigan Nursing Homes COVID-19 Preparedness Task Force recommended Michigan create such centers from the state’s regional hub program — a network of nursing homes that also accepted COVID-positive patients. The task force recommended the state choose facilities based on their “ability to designate an entire wing, separate unit, or building for the care and isolation of COVID-19-positive residents.” 

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The Care Recovery Centers (CRC) are a sort of “second-generation” to the regional hub system established at the height of the pandemic, Bob Wheaton, spokesman for the Michigan Department of Human Services, told Bridge Michigan on Thursday.

The new centers, established with “with strengthened guidance and protocols,” can operate either as a separate wing in existing facilities or as stand-alone centers. The state has more time now to carefully choose what facilities operate them, based on — as an example — whether those facilities have been previously cited for having inadequate staffing levels, he said.

Republican critics of Whitmer’s nursing home policies have pushed the state to operate at least one COVID-only facility for nursing home residents in each of the state’s eight health care regions. But Whitmer has resisted that approach, saying homes can serve COVID-positive residents in areas that are isolated from the rest of a nursing facility.

The order Wednesday also ends earlier instructions that nursing homes  “cancel” communal dining and activities. The new order allows facilities to instead “limit” communal dining and activities. On Sept. 10, Whitmer also allowed nursing homes to begin outdoor visits.

The newest order also beefs up reporting by adding legal guardians, health proxies, and prospective residents and staff to the list of people who must be notified that a resident or staff has tested positive for COVID.

The facility must “post a notice in a conspicuous place near the main entrance” alerting others to a confirmed COVID case for 14 days after the last positive test result, and must alert prospective residents and staff of the presence of a case under the order.

The bolstered reporting is part of “overhauling” the state’s reporting requirements since April, MDHHS Director Robert Gordon told Bridge.  

In an interview Wednesday, Gordon said the state is now boosting efforts to make sure long-term care facilities beyond nursing homes adequately report cases to the state.

For six months, confirmation of the spread of COVID-19 within the state’s assisted living facilities and other long-term care facilities has been frustratingly incomplete. The state has released bare bones, cumulative data mostly from the state’s tightly regulated skilled nursing facilities, but has not consistently done so for other long-term care facilities, such as Homes for the Aged and Adult Foster Care Homes.

Such information is important “to the people that are most affected by cases — residents, the residents’ guardians, visitors,” spokesman Wheaton said Thursday.

While the state lists 4,429 facilities licensed as Homes for the Aged or Adult Foster Care Homes, just 75 to 90 of those facilities have been regularly reporting data even though they have been required to do so, Wheaton told Bridge.

Ultimately, the information from those sites, adding to the data already submitted by nursing homes, could provide a more complete look of COVID activity among the state’s elderly. 

Under the stepped-up reporting efforts outlined by Gordon, virus data, including deaths, in a variety of long-term care facilities, will be made public in a way similar to the nursing home data now reported on the Michigan coronavirus webpage, Erin Emerson, director of MDHHS’s Office of Strategic Partnerships and Medicaid, told Bridge, adding to Gordon’s comments.

All licensed long-term care facilities — nursing homes, homes for the aged, adult foster care and assisted-living facilities — will be required to report weekly under the new guidelines, rather than daily as they now are. This will allow the state more time to validate data and — most importantly for the public — allow the state to report totals by week rather than only cumulative cases as it now does.

That means a visitor to a nursing home reporting more than 100 cases cumulatively, for example, will also be able to determine whether any new cases have been reported in the past week or so, arguably a more accurate gauge of the safety risks at that time. 

Small group adult foster care homes will likely not fall under public reporting requirements. Some Adult Foster Care homes, for example, serve as few as three people and there are few staff and visitors. Publicly releasing data at those small homes threatens privacy, Gordon said.

Gordon noted that some facilities may market themselves as “assisted living,” “retirement homes,” or “senior living,” but aren’t licensed and, therefore, aren’t regulated by the state. While they, too, must alert staff, residents, guardians, and prospective residents and staff of confirmed COVID cases under the executive order, there is no mechanism in Michigan to track whether they are reporting those cases to the state.

“There are thousands of other homes where older residents live and they get some help, but [those facilities] have no more relationship with the state than you or I do as homeowners or renters,” Gordon said, adding that MDHHS would “welcome” legislative efforts to change that.