778 Virginia Hospital Patients Discharged to Nursing Homes

Written for Bacon’s Rebellion by James A. Bacon

A large majority of the patients treated for COIVD-19 and released from a Virginia hospital between April and June this year went directly home. But a significant number — 778 — were transferred to a “skilled nursing facility,” according to data contained in a Virginia Hospital and Health Care Association webinar delivered yesterday.

That raises a question. What were the protocols for discharging and transferring patients to nursing homes? What assurances were there that transferred patients were no longer infectious?

(Update: A commenter suggests that I may be improperly conflating “skilled nursing facilities” with “nursing homes,” so the reality may be more complicated than I have portrayed in this post.)

We know that an order by New York Governor Andrew Cuomo compelled hospitals to release elderly COVID patients into nursing homes early in the epidemic, resulting in a catastrophic spread of the disease among the state’s elderly. I know of no such order given by Governor Ralph Northam, and it is entirely possible that none of the patients released to long-term care facilities were infected. I’m simply asking the question.

Forty-nine percent of all COVID-19 deaths reported in Virginia were associated with nursing home outbreaks, according to Virginia Department of Health data. (The percentage was higher early in the epidemic.) And as Carol Bova reports in the previous post, outbreaks are still occurring in nursing homes. Her column focuses on the continued problem some facilities are having obtaining Personal Protective Equipment (PPE), despite Northam administration efforts to improve the supply chain.

The VHHA data cited above raises another theoretical possibility: that infected patients were readmitted from hospitals to nursing homes. I trust that no Virginia hospital would knowingly discharge an elderly patient who still had the virus. But, as VHHA chairman Mike McDermott emphasized in his webinar remarks, the hospital industry projects that, even after accounting for federal relief aid, Virginia hospitals will suffer $3 billion in COVID-related losses this year. Some hospitals will survive just fine, but others are in survival mode. Could hospitals have had an incentive to discharge some patients early?

Consider that 821 COVID patients were classified as “medically indigent/free/self pay/self-insured.” They represented a dead financial loss to hospitals. Consider that another 850 COVID patients were on Medicaid, which consistently reimburses hospitals for less than the cost of providing health care.

Let me be clear: I’m not accusing the hospitals of prematurely discharging COVID patients for financial reasons. Rather, I’m asking what protocols are in place to ensure that doesn’t happen. The fact is, COVID-19 remains a threat to Virginia’s elderly, especially those in long-term care facilities. The health department needs to check off the boxes. If the appropriate protocols are in place and premature discharges are not a problem, we can give the hospitals a pat on the back and move on to the next box on the list.