nursing homes

Hogan, Biden Target Vaccination Rates at Nursing Homes with New Policies

August 19, 2021 by Maryland Matters

Frustrated by the slow pace of employee vaccinations at some Maryland nursing homes and a small number of hospitals, Gov. Lawrence J. Hogan Jr. (R) announced on Wednesday that workers will soon be required to show proof of protection from COVID-19 or undergo weekly testing.

An executive order that Hogan signed will take effect on Sept. 1 and will apply to all 227 of Maryland’s nursing homes.

“We are concerned that the delta variant surge has led to an increase in infections among staff at nursing homes, which has been a consistent source of outbreaks,” the governor said.

Hogan also said the state will be “redoubling our enforcement actions” for nursing homes that do not comply or which “persistently fail to report their vaccination data.”

The state is doubling fines and increasing civil penalties for recalcitrant operators, the governor said.

While 79% of all nursing home staff have been vaccinated — and 18 facilities are at 95% or higher — others have lagged significantly.

For weeks leading up to Hogan’s announcement, the state health department has issued lists of the “Top 10” and “Bottom 10” skilled nursing home facilities as ranked by staff vaccination rates.

On Monday, the lowest-scoring facility on the state’s list, Oakwood Care Center in Middle River, reported that just 40% of its staff had been vaccinated. The tenth-worst nursing home had a vaccination rate of 59%. More than two dozen failed to report data, according to health officials.

Hogan called the failure to get staff vaccinated “unacceptable.” He accused unvaccinated workers of “endangering the lives of nursing home residents.”

The governor’s order also requires all staff in all Maryland hospitals to receive their first dose of a COVID-19 vaccine by September 1 or face mandatory testing.

In a statement, Bob Atlas, the head of the Maryland Hospital Association, noted that Hogan’s order would apply only to five percent of state’s medical workforce.

“On June 7, two and a half months before the Governor’s mandate, Maryland hospitals took this step to ensure the safety of their patients, employees and communities,” he said.

“Hospitals that employ approximately 95% of hospital workers in the state already have instituted a mandate or stated an intention to require COVID-19 vaccination for all employees and clinical team members.”

Hogan acknowledged that the University of Maryland Medical System, Johns Hopkins Medicine, MedStar, and GBMC Healthcare have already “led by example.”

“But not every hospital has taken action and some continue to have far too many unvaccinated health care workers, needlessly exposing their vulnerable patients… to COVID-19 and the delta variant,” he added.

Joseph DeMattos, Jr., head of the Health Facilities Association of Maryland, praised the governor for his action, saying, “your announcement today will save lives.”

DeMattos said the state faces “several challenging weeks” battling a delta variant surge “that promises to be extremely challenging.”

As Hogan continues to flirt with a potential presidential bid in 2024, he stepped up his criticism of the White House on Wednesday, calling on the Biden administration to immediately make booster shots available for seniors and and people with compromised immune systems, seek full FDA approval of vaccines, and “expedite” approval of vaccines for children age 5-11.

Biden announces federal efforts

Just after Hogan’s press conference on Wednesday, President Biden announced at a White House press conference that nursing homes will be required to ensure staffers are vaccinated against COVID-19, or risk losing federal Medicare and Medicaid dollars.

Under the new nursing home policy, the U.S. Department of Health and Human Services will develop regulations to require vaccinations of nursing home staffers as a condition of participating in Medicare and Medicaid programs.

“I’m using the power of the federal government as a payer of health care costs to ensure we reduce those risks for our most vulnerable seniors,” Biden said during the news conference detailing new federal actions.

“If you visit, live or work in a nursing home, you should not be at a high risk of contracting COVID from unvaccinated employees,” Biden added.

The new federal mandate is the latest vaccine requirement from the Biden administration. The Department of Veterans Affairs has required health care workers to get vaccinated, and all federal workers must either prove they have been vaccinated or face masking and testing requirements.

The nursing home vaccination requirement that Biden announced Wednesday will apply to staffers in 15,000 facilities, which employ approximately 1.3 million workers and serve approximately 1.6 million residents, according to the White House.

Biden acknowledged that while he has limited authority to require COVID-19 vaccines, he will be looking for additional ways to boost vaccination rates.

He praised governors and mayors — including those in Maryland— for enacting certain vaccine requirements, and said the federal government will be covering all costs related to National Guard missions related to the coronavirus pandemic.

Since the beginning of the pandemic, more than 133,000 nursing home residents and nearly 2,000 nursing home staffers have died as a result of COVID-19 infections.

The Biden administration also announced a plan Wednesday to begin offering COVID-19 booster shots to Americans starting Sept. 20, with the scheduling of the additional shot to be based on when a person was fully vaccinated.

The new round of jabs will be extended to those who received the two-dose vaccine from either Pfizer or Moderna, and can be taken eight months after an individual’s second dose.

The more than 13 million Americans who received the one-dose shot from Johnson & Johnson may also need boosters, but will not yet be eligible.

Federal health officials said they are awaiting data from J&J in the next few weeks before urging additional doses. The J&J shot wasn’t approved until March, so those who received it will not hit eight months past inoculation until November.

The new booster rollout plan is subject to formal authorization from the Food and Drug Administration and the Centers for Disease Control and Prevention’s vaccine panel.

Those agencies will hold public meetings before the booster rollout can begin. Meanwhile, vaccine manufacturers are expected this fall to seek approval for administering shots to children under 12, who so far have not been eligible.

By Bruce DePuyt/Maryland Matters and Laura Olson/States Newsroom

Reports Look at Health Safety Issues at Nursing Homes Owned by Investment Firm

December 21, 2020 by Spy Desk

A report in the Washington Post today by Rebecca Tan and Rachel Chason included health safety issues at Peak Healthcare at Chestertown.

The Post joins Barron’s and other news sites that have been examining the Portopiccolo Group, an investment firm that owns and operates numerous nursing homes in several states, including across the Mid-Shore.

The Washington Post reported Dec. 21, 2020, that:

• Portopiccolo bought three Maryland facilities from Genesis HealthCare and others from Autumn Lake Healthcare, including its facility in Chestertown. (Autumn Lake’s Chestertown facility had a COVID-19 outbreak in mid-April, about a month before it was bought and rebranded as Peak Healthcare at Chestertown.)

• Employees at Portopiccolo-owned facilities said they were asked to work after testing positive for COVID-19 and said the company “scrimped on supplies, including cutlery, cleaning materials and clothing for residents.”

• Kent County health officials intervened at the Chestertown facility in mid-May after learning an infected employee was still working.

• The Chestertown facility was fined $730,000 for not fixing or reporting that its water heater was broken from July to September. The firm is disputing the fine.

According to an Aug. 6, 2020, report in Barron’s:

• The Portopiccolo Group, a private-equity firm, has bought numerous nursing homes since 2016 and its president and CEO, and Portopiccolo’s affiliated companies, own or operate about 100 facilities under dozens of names.

• The firm has focused on lower-quality nursing homes and its purchases have continued even as some of its facilities have dealt with COVID-19 outbreaks and staff shortages.

On June 12, 2020, The Charlotte Observer reported on nursing homes owned by Portopiccolo in North Carolina:

• At that time, a nursing home owned by Portopiccolo in Salisbury, N.C., had had the state’s worst COVID-19 outbreak.

• Two residents had sued the facility and its corporate owners, claiming it was understaffed by poorly trained workers and did not have necessary supplies.

COVID-19 Resident Deaths at Autumn Lake at 15

May 6, 2020 by Spy Desk

COVID-19 has caused the deaths of 15 residents at Autumn Lake Healthcare at Chestertown, according to the state’s coronavirus website.

The novel coronavirus has infected 55 residents and 13 staff members at the facility. The data is updated weekly on Wednesdays.

Five residents and one staffer at the Resorts at Chester Manor also have contracted the disease.

The state data does not include Heron Point, where at least three cases — two patients and one staffer — previously had been reported.

In neighboring Queen Anne’s County, four staff members at the Corsica Hills Center have tested positive.

Statewide, about 22 percent of confirmed COVID-19 cases are among residents and staffers at congregate living facilities, such as nursing homes, assisted living facilities, state and local facilities, and group homes with 10 or more occupants.

There are 6,268 cases related to such facilities — 4,342 residents and 1,926 staffers.

Slightly more than 60 percent of Maryland’s 1,338 COVID-19 deaths are related to congregate living facilities; 793 residents and 11 staff members have died.

Maryland’s New COVID-19 Focus? Outbreaks at Nursing Homes, Poultry Plants

April 30, 2020 by Maryland Matters

Patients at Maryland nursing homes account for almost half of the state’s COVID-19 deaths since March, and about a fifth of the state’s more than 20,000 active cases ― and those numbers are likely to increase with an executive order mandating universal testing.

Gov. Lawrence J. Hogan Jr. (R) issued the executive order on Wednesday, which will require universal testing of all staff and residents at nursing homes throughout the state.

As of Wednesday morning, the state reported 471 deaths from the novel coronavirus connected to nursing homes, as well as 4,369 confirmed cases of the virus.

Statewide, there were at least 20,849 confirmed cases of COVID-19 as of Wednesday morning, and 985 Marylanders have died from the virus since mid-March.

Hogan said the state will begin deploying a portion of the testing kits recently bought from South Korea to hotspots throughout the state, including nursing homes and the Eastern Shore, which is home to one of the country’s fastest-growing COVID-19 infection rates because of outbreaks among poultry workers at plants in Delaware, Maryland and Virginia.

As of Wednesday, there were 262 confirmed cases of COVID-19 associated with poultry workers in Maryland, which is one reason the infection rate in Wicomico County is now the fifth-highest in the state.

On Wednesday, Hogan and 17 other governors from states with meat and poultry processing plants had a call with the White House, to discuss outbreaks and protection of the nation’s food supply.

“These outbreaks are not only a serious public health concern, they’re also a potential threat to Maryland’s leading agricultural industry and to our nation’s essential food supply chain,” Hogan said.

The state is opening a new drive-through testing site this week at Arthur W. Perdue Stadium in Salisbury to test workers at the Perdue plant in Salisbury and the Amick processing plant in Hurlock.

The state has sent epidemiologists to the Shore to help with testing and contact tracing, and a Maryland Incident Management Team is coordinating response efforts with a team from the Centers for Disease Control and the Federal Emergency Management Agency.

The state is also creating teams to respond to COVID-19 cases at nursing homes.

With the start of universal testing, any nursing home workers who test positive will be sent immediately to isolation. Nursing home residents will be evaluated for symptoms of the virus daily.

Each nursing home in the state will be required to create a staffing plan and the state has coordinated more than 260 nurses and aides to be part of “bridge teams” that would go into understaffed nursing homes to continue care in the event of an outbreak.

At a briefing of the Joint COVID-19 Response Legislative Workgroup on Wednesday morning, Senate President Bill Ferguson (D-Baltimore City) expressed concern about the substantial number of confirmed cases being reported in nursing homes.

“This is rapidly evolving,” he said. “I hope that we are learning the right lessons with nursing homes because it’s probably the tip of the iceberg of … isolated communities that are in close proximity that when things spark, it can get out of control really quickly.”

Testing at nursing homes will be prioritized based on an imminent outbreak or a current rising threat, Hogan said.

State officials did not immediately know how many tests will be required for the Eastern Shore and nursing home hot spots.

Hogan said the state will maintain access to the testing kits from South Korea, which can process up to 500,000 tests. Other areas where testing kits will likely be deployed include Prince George’s County, which is home to the highest number of confirmed cases in Maryland (at least 5,738), and for increased testing of health care workers throughout the state.

Hogan said targeting and isolating outbreaks could help Maryland move further into a phase of economic recovery.

“We are no longer just playing defense — we are going on offense against this virus, attacking from every angle with everything we’ve got,” he said.

Hogan said he plans another public briefing on reopening plans next week.

By Danielle E. Gaines and Hannah Gaskill

Gov. Hogan Directs Health Dept. to Release Nursing Home Data on COVID-19 Cases

April 28, 2020 by Spy Desk

Gov. Larry Hogan has directed the Maryland Department of Health (MDH) to take the necessary steps to publish data related to COVID-19 cases and fatalities associated with nursing homes, assisted living facilities, and other facilities providing congregate living for residents.

This week, the state’s coronavirus resource page, coronavirus.maryland.gov, will begin displaying available data for individual facilities, including cases and fatalities.

“As we plan our recovery, we are taking additional steps to protect our most vulnerable citizens, including older Maryanders,” Hogan said. “Keeping Marylanders informed and being transparent with the facts continues to be at the heart of our response to COVID-19. We are grateful to the staff in our nursing homes working around the clock to save lives.”

This is the latest in a series of steps Hogan has taken to address COVID-19 cases in nursing homes. On March 10, just a few days after declaring a state of emergency, Hogan met with leaders of the long-term care community to field their concerns and affirm the administration’s commitment to the wellbeing of Maryland’s seniors. That same day, MDH issued strong guidance to long-term and continuing care facilities to restrict visitation and begin implementing infection control protocols.

On April 5, Hogan announced a new wave of safety measures, directing expedited testing for symptomatic residents, personal protective equipment for staff, and the creation of separate observation areas for COVID-19 patients.

On April 7, Hogan announced first-in-the-nation, statewide strike teams to support facilities with testing, infection control protocols, and on-site medical triage. The teams are comprised of members of the Maryland National Guard, representatives of local and state health departments, and EMS clinicians, as well as doctors and nurses from local hospital systems.

For COVID-19 resources, including case counts and clinician guidance, visit coronavirus.maryland.gov.

State: Health Depts. Won’t ID Nursing Homes with COVID-19 Cases

April 24, 2020 by John Griep

Medical privacy laws and a lack of any public health benefit are key reasons why additional details are not released about patients with confirmed cases of COVID-19.

“The virus is in our community and it is spreading,” William Webb, Kent County’s health officer said Friday. “We want everyone to realize this is a serious situation and to practice social distancing and all of the recommendations that have been made over and over.”

Kent County saw a large increase in the number of confirmed cases between Wednesday and Thursday.

“We’re trying to spread the message that the virus is in our community and we should treat everyone as a potential carrier,” he said, noting social distancing, frequent hand washing and use of face masks has been urged for weeks. “Many people are asymptomatic and don’t know they’re infected.”

Webb said the health department focuses on public health exposure.

“When we get a positive test result, we make sure we contact the individual as quickly as possible” to make sure the person quarantines or self isolates, he said. Patients are asked about anyone with whom they came into close personal contact.

Close personal contact includes touching and shaking hands or being within six feet for at least 10 minutes.

“Obviously, we don’t want to identify specific individuals and we don’t want to give out details that could identify” a patient, Webb said.

In addition to medical privacy laws, there is little public health benefit to knowing who has tested positive and where they have been. And knowing too many details might be counterproductive.

“When we get into a lot of details, it creates a false sense of security,” Webb said.

He said area residents should take personal responsibility and make sure to follow the recommendations of health officials, including social distancing, frequent hand washing, and wearing face masks in public.

Confirmed cases and deaths in Kent County essentially doubled on Monday, when the county announced 15 COVID-19 cases — 12 residents and 3 staffers — at Autumn Lake Healthcare at Chestertown. One of the residents died from the virus.

A state strike team responded Sunday to the facility, assessing it and testing 60 patients and staffers, according to reports.

On Thursday, Kent’s confirmed cases had another big jump — from 36 to 64 — a nearly 78 percent increase. Webb could not comment Friday on whether the additional positive cases were related to Autumn Lake.

Since Monday’s announcement of the cases at that facility, the state health department has instructed local health departments not to identify nursing homes or other facilities where residents or staff have tested positive for COVID-19.

The Kent County Health Department announced that policy guidance from the Maryland Department of Health in a Friday statement.

“The Kent County Health Department continues to work closely with the Maryland Department of Health to support COVID-19 preparedness and response capacity in all nursing home facilities,” according to the statement. “Since releasing initial information regarding the outbreak at Autumn Lake Healthcare in Chestertown, all Local Health Departments have been provided policy guidance from the Maryland Department of Health (MDH), and it is our intent to follow that guidance.”

In accordance with the MDH guidance, local health departments “will not routinely disclose identifying information about nursing homes or other congregate living facilities in which residents and/or staff have tested positive for COVID-19,” according to the statement. “The disclosure of this information serves no public health purpose and could lead to the identification of specific persons who have tested positive for the disease.

“Cases of COVID-19 are closely monitored by public health authorities across Maryland, and the State continues to evaluate additional measures to protect the public and the facilities’ residents and staff,” according to the statement. “If further actions are needed to protect the public’s health and/or residents and staff of these facilities, the State will take those actions. If the disclosure of specific information is needed to protect the public’s health and/or residents and staff of these facilities, it will be
disclosed.”

On Thursday, in a list of frequently asked questions about the strike teams, the state health department said Maryland has 227 nursing homes and more than 160 have confirmed cases of COVID-19.

“To date, the strike teams have been involved in more than 40 visits to various congregate living facilities across the state, including nursing homes,” according to MDH.

Other FAQs included:

What are nursing home “strike teams”?

To provide immediate intervention in nursing homes and other congregate living facilities where COVID-19 is confirmed to be present, Governor Hogan implemented “strike team” operations to assist with assessment, testing and clinical care for individuals in nursing homes, including:

● Assessment teams to quickly evaluate each situation on-site, to determine equipment and supply needs

● Testing teams to identify those in close contact with a confirmed case and collect and send out specimens to produce the fastest results available

● Clinical teams to provide on-site medical triage and to stabilize residents

Do strike teams help in places other than nursing homes?

Yes. Gov. Hogan recently expanded strike team operations to include other facilities where those at highest risk for adverse COVID-19 outcomes live, including assisted living facilities and group homes for medically fragile children.

Who are the strike team members?

The composition of these teams varies depending on the specific nature of the mission and the needs of the facilities’ residents. Members may include National Guard personnel, representatives of local and state health departments, EMS and clinicians from local hospital systems.

In partnership with the Federal Emergency Management Agency (FEMA) and the U.S. Department of Health and Human Services (HHS), Maryland has also augmented these teams with three federal Disaster Medical Assistance Teams (DMAT) made up of physicians, paramedics and safety officers.

Gov. Hogan Takes Aggressive Action to Protect Nursing Home Residents, Staff Amid COVID-19 Outbreaks

April 5, 2020 by Spy Desk

Gov. Larry Hogan today enacted an emergency order to protect residents and staff at Maryland nursing home facilities, and bolster the state’s mitigation and suppression efforts amid outbreaks of COVID-19.

Effective immediately, new directives will require facilities to direct all staff who interact with residents to wear personal protective equipment, create separate observation and isolation areas for residents, and expedite all testing through the Maryland State Public Health Laboratory.

Gov. Larry Hogan

“As we have been saying for several weeks, older Marylanders and those with underlying health conditions are more vulnerable and at a significantly higher risk of contracting, getting more severely ill, and dying from this disease,” Hogan said. “Of major concern is that we currently have cases or clusters of cases at 81 nursing homes and long-term care facilities across the state. Our highest priority is keeping Marylanders safe, and we will use every tool at our disposal to protect the most vulnerable among us.”

On March 10, the Maryland Department of Health (MDH) issued strong guidance to long-term and continuing care facilities to restrict visitation and begin implementing infection control protocols.

Today’s directives requires nursing home facilities to adjust and strengthen their policies, protocols, and procedures in line with all state and federal guidance related to COVID-19, and immediately adopt a series of enhanced protective measures:

PERSONAL PROTECTIVE EQUIPMENT FOR STAFF. All personnel who are in close contact with residents of nursing homes shall wear personal protective equipment (PPE), including a face mask, appropriate eye protection, gloves, and gown. The PPE should be worn at all times while providing care to residents in the facility and personnel should follow CDC guidance for using personal protective equipment. Facilities must use the process established by MDH to request PPE from the state.

EXPEDITED TESTING FOR SYMPTOMATIC RESIDENTS. All facilities must use the most expeditious means available for testing. This includes using either a COVID-19 test kit provided by the state laboratory or another lab to send specimens to the state laboratory for expedited COVID-19 testing of residents and staff. Symptomatic residents of nursing homes and long-term care facilities are among the patient groups prioritized by the state laboratory, alongside hospitalized patients and symptomatic health care providers and first responders.

SEPARATE OBSERVATION AREAS. All facilities must designate a unit of staff who are assigned to care for known or suspected COVID-19 residents; designate a room, unit, or floor of the nursing home as a separate observation area where newly admitted and readmitted residents are kept for 14 days on contact and droplet precautions while being observed every shift for signs and symptoms of COVID-19; and designate a room, unit, or floor of the nursing home to care for residents with known or suspected COVID-19.

PLACEMENT OF DISCHARGED PATIENTS. MDH’s Office of Health Care Quality will assist acute care hospitals, if necessary, in discharging patients who require nursing-home level care. Facilities must cooperate with the Office of Health Care Quality and hospitals in the placement of discharged patients.

RIGHT OF RETURN FOR RESIDENTS. Nursing home residents admitted or seen at a hospital for COVID-19 must be allowed to return to the nursing home as long as the facility can follow the approved CDC recommendations for transmission-based precautions. If the residents must temporarily go to other facilities, every effort must be made by the receiving and original nursing homes to transfer the residents back to their original nursing homes as soon as possible.

Governor Hogan’s order makes compliance with these directives mandatory. Anyone who knowingly and willfully violates this order is guilty of a misdemeanor and upon conviction is subject to imprisonment not exceeding one year, or a fine not exceeding $5,000—or both.

All of Governor Hogan’s emergency orders and proclamations are available here. For COVID-19 resources, including case counts and clinician guidance, visit coronavirus.maryland.gov.

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