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 Over the past week, the Northbridge Health Care Center has taken in
46 patients who have recuperated enough from COVID-19 - the disease
caused by the virus - to be discharged from a local hospital but are
still contagious. Understandably, their long-term care facilities
were anxious about readmitting them.
The use of two floors at Northbridge to care exclusively for
patients with COVID-19 is part of Connecticut's "ground war" against
a problem vexing officials across the United States: where to send
recovering patients who might still infect others if returned to
their original place of care, said Barbara Cass, a state health
department official who oversees nursing homes.
The state is building a network of such facilities to act as a kind
of step-down unit upon discharge from a hospital that could
eventually accommodate more than 1,000 people.
While they will take in an array of patients, a primary focus is
protecting nursing homes, which account for as much as half of the
coronavirus-related deaths in the state.
"Thirty days into this, there is still lots of fear and lots of
unknowns," Cass said in an interview. "The overall goal is to
address the surge in hospitals, so that someone who arrives at
hospital that is acutely ill can have a bed."
How states approach this challenge could determine how well they
quell the growing crisis at long-term care facilities, which are
breeding grounds for the highly contagious virus given the
vulnerable older age of the residents, close living quarters and
shared staff.
While New York has mandated facilities take back coronavirus
patients discharged from a hospital as long as they can provide
adequate care, Connecticut is among a handful of states seeking to
sidestep that risk.
It has tapped Northbridge and six other nursing facilities as
COVID-19 recovery centers, with seven more being considered. To
date, 119 patients have been transferred to the three sites
currently open, a spokesman for the health department said.
Andrea Iacomacci, senior manager of care coordination at Bridgeport
Hospital, said while a few nursing homes have started taking back
patients, she has sent about 10 to Northbridge and would send more
there in the coming weeks. The transfers have helped the hospital
reduce its number of COVID-19 patients to 191 from a peak of 225 a
week ago, she said.
Similarly, St. Vincent's Medical Center has sent eight COVID-19
patients across Main Street to Northbridge, among the dozens who
have been cycled out of Hartford HealthCare's seven hospitals who
would otherwise have had remain until they tested negative for the
virus.
"We have people who were essentially sitting in the hospital waiting
for negative testing to be transitioned to a nursing facility," said
David Santoro, vice president of business operations at Hartford
HealthCare Integrated Care Partners. "This is a way to get the
patients moving to a lower level of care."
'IT'S IN OUR BUILDINGS'
According to a survey of data by ABC News published on Friday, there
have been at least 10,631 coronavirus-related deaths among long-term
care residents, about a fifth of fatalities nationwide.
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Data released by Connecticut on Friday underscored the depth of its crisis, with
768 coronavirus deaths attributed to nursing home residents as of April 22,
accounting for a staggering 50% of COVID-19 fatalities.
Interviews with more than a dozen people involved with Connecticut's plan
revealed the challenges they faced in settling on a strategy, especially
following new guidance from the U.S. Centers for Disease Control and Prevention
(CDC) last month.
On March 30, the same day Connecticut's health department sent a letter to
relatives of nursing home residents flagging the need for "extreme precautions"
that could involve splitting them into COVID-negative and COVID-positive homes,
the CDC issued guidance indicating a high risk of people without symptoms
spreading the disease.
That helped prompt Connecticut's health department to assume the virus was
everywhere. On April 11, another letter went out informing families that,
instead of transferring residents, they would cordon off COVID-positive patients
within their current homes.
"There has been a breach. It's in our buildings," said Matthew Barrett, chief
executive of the Connecticut Association of Health Care Facilities, a trade
organization that worked with the state on its plan. "Unknown is presumed
positive."
Connecticut is not alone in this approach. Rhode Island has repurposed a
facility in Pawtucket to accept COVID-19 patients from the hospital, while
Alabama is allowing nursing homes to put beds in separate locations for COVID-positive
residents rather than take them back right away.
But Connecticut has been particularly aggressive and vocal about pursuing this
path.
When all the planned recovery facilities are up and running, the state will have
800 beds available, with a goal of adding 375 more, said Av Harris, a spokesman
for the Department of Public Health.
One of those facilities is Silver Hill Hospital, which specializes in treatment
of psychiatric and drug-dependent patients. It converted a former acute care
unit and could welcome its first COVID-19 patients this week.
The unit's former inhabitants, some at risk of suicide, had already been moved
to a renovated farmhouse on its sprawling campus in New Canaan, a wealthy
commuter town about 50 miles (80.47 km) north of New York City.
"The space was ideal if someone wanted to come in and use it for COVID," said
Andrew Gerber, its president. "This is a time where you have to be flexible and
think outside the box."
(Reporting By Nathan Layne and Jessica Resnick-Ault; Editing by Bill Berkrot)
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