By Howard S. Krooks, Esq., CELA, CAP, Partner, Elder Law Associates PA
There’s no question that COVID-19 has hit the country’s vulnerable nursing home and long-term-care (LTC) community extremely hard over the past few months. People aged 65 and over and those with chronic medical conditions, such as heart disease, diabetes, and respiratory illnesses, are at the highest risk of contracting the virus. And many of the 1.3 million nursing home residents in the country fall into these two categories. It has been a particularly a bad situation in Florida.
As of the end of July, data from Florida Health’s official Covid-19 response page show 4% of the state’s nursing home residents (5,609 out of 140,296) and 3% of facility staff (6,227 out of 196,302) have contracted the virus. Nursing home residents and staff members continue to be stricken disproportionately across the country. According to the Kaiser Family Foundation, in a recent AARP article on AARP.org, two out of five U.S. deaths from COVID-19 have occurred in nursing homes and other LTC facilities across the country.
Sick with Nowhere to Go
For the first few months of this virus, elderly sick LTC residents were caught in the middle of a heated dispute between their nursing homes and hospitals as they recovered from the virus. Some states mandated that hospitals should discharge these still COVID-19-positive residents back to their LTC facilities to open up beds for other patients who needed more acute care. LTC facilities didn’t want them returned so quickly because they were concerned that these newly discharged patients might spread the disease to their other high-risk residents and staff members. They were very resistant about taking the patients back in until they were completely recovered.
The virus itself hasn’t been making things any easier lately as a surge continues in the South and West, with Florida seeing a surge of 74% in July. This is even after Florida Gov. Ron DeSantis made the decision to cloister ill nursing home residents in dedicated Covid-19 isolation centers after they have been discharged from hospitals. DeSantis created these isolation centers to try to stem the spread of the virus in LTC facilities and provide for the appropriate care and recovery of these elderly COVID-19 patients, some of whom remain positive with the virus but are not sick enough to warrant being in a hospital. According to Florida’s rules, a patient must test negative for the virus twice within a 24-hour period before being allowed back into their permanent nursing home or assisted living facility.
Florida’s COVID-19 Isolation Centers – A Less Than Perfect Solution
The Florida isolation centers are specifically intended for those LTC residents recovering from COVID-19 who need a nursing facility level of care after a hospital discharge. These isolation centers are supported with Medicaid dollars.
Currently, there are 22 of these regional centers in the state, including eight in Southeast Florida (Miami-Dade, Broward and Palm Beach counties). In just a short period, these isolation facilities have taken in hundreds of Florida’s elder COVID-19 patients after discharge from hospitals. Not everyone is a fan of these isolation centers, however. The problem is that several of these facilities have spotty-at-best records with numerous health citations reported over the years. Several are on the state’s watch list for not meeting the state’s minimum standards. And now, some of these facilities have reported double-digit COVID-19-related deaths and numerous positive residents. It’s unknown how the state selected and vetted these facilities to be part of their isolation centers or how they are separating the COVID-19 patients from the rest of their residents.
Despite more of these regional isolation centers being added all the time by Florida’s Agency for Health Care Administration (AHCA), there are still very few of these centers in other parts of the state, with only three in the Orlando area to cover all of central and north central Florida, two in the Panhandle, one in the Jacksonville area and a handful on the Gulf Coast.
Long-Distance Transfers Possible
This means that if you’re an LTC facility resident with coronavirus and don’t live near one of these regional centers, you might end up being discharged from the hospital and transferred to an isolation center far from home and your loved ones (perhaps even several hours away). The Jacksonville area facility, Dolphin Pointe, is the regional facility for SEVEN counties in North Florida. According to the AHCA, they will be seeking additional funding from the federal CARES Act to expand and support these isolation facilities going forward.
The patients at these centers, while recovering from the virus, are feeling the strain of being isolated, lonely and separated for a prolonged period from their friends, family members, and facility staff members that they’re familiar with. This disruption can be particularly confusing and terrifying for people with memory issues. The separation is emotionally taxing on family members as well – not knowing exactly where their loved one is or how they’re faring from the virus, and not being able to hug or connect with their loved ones.
Visitor Restrictions Weighing on Everyone
LTC facilities in Florida continue to restrict visitors as they have since March, allowing only compassionate, end-of-life visits for those residents who are near death. To combat the loneliness and anguish some residents feel, facilities are setting up video and phone calls with the residents and family members, allowing “drive-through” parades of family members, doing Facebook Live events showing their residents in their daily activities and at fun events, and are orchestrating other ways for residents to keep in communication with their loved ones the best they can, but the situation has been hard on everyone.
Gov. DeSantis announced just recently he was considering implementing ways for people to be able to visit their loved ones in LTCs again, despite more than 1,400 facilities reporting cases of the coronavirus. “We’ve got to figure out a way to not only protect folks from the virus but also address some of the serious emotional damage that has been done by our countermeasures to the virus,” DeSantis said at a roundtable discussion in Jacksonville on Aug. 4. The new measures may include installing rapid testing machines at these facilities, allowing outdoor visits, wearing personal protective equipment (masks, gowns, gloves), temperature checks and more.
There are no easy answers here but we’re staying on top of all of the information available here at Elder Law Associates PA, and we’re here for you and your family if you need us. For more information about the virus in the state of Florida, go to www.floridahealthcovid19.gov, call 1-866-779-6121 or email firstname.lastname@example.org, or for details about the Medicaid Covid-19 isolation centers in Florida, visit www.ahca.myflorida.com/covid-19.info.shtml.