778 Virginia Hospital Patients Discharged to Nursing Homes

Source: “COVID Utilization and Hospitalization Trends,” PowerPoint presentation by David Vaamonde, vice president-data analytics.

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.

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13 responses to “778 Virginia Hospital Patients Discharged to Nursing Homes

  1. Is data available regarding where these patients were before their hospital stay?

    If they went to the hospital from a “skilled nursing facility” then it would make sense for them to return to that facility upon release from the hospital.

  2. Eight months into the pandemic and Virginia’s data is perpetually suspect. Here’s one example from August …

    https://richmond.com/news/virginia/data-backlog-pushes-friday-spike-in-statewide-covid-19-cases/article_fbf548fb-5739-57db-a8ce-0a4a7cb7c128.html

    That spike is due to a two-day backlog of information that should have been reported Wednesday and Thursday, combined with Friday’s normal count, the health department said. It caught the issue late Thursday, the result of a “system performance configuration.”

    Let’s be honest, Ralph Northam is just plain incompetent.

  3. I can’t speak for VDH reporting choices/ data definitions. But I understand “skilled nursing” and “nursing homes” to be distinct. I liken skilled nursing to temporary in-patient rehab; Medicare only covers up to 20 days of “skilled nursing.” After that point, the patient is discharged to long term care, a residence, a nursing home, etc. The skilled nursing faclities that I know of require a negative covid test for admission and do not allow any visitors.

  4. According to the list about 60 were discharged back into law enforcement custody, presumably to be incarcerated at the state or local level. Outbreaks there are a problem, too — any confined indoor quarters. I guess it would be an interesting cost calculation. Keeping them in hospital for far longer to be sure they are clear would add up. The question is, when does Medicare or Anthem say “we won’t pay?”

  5. Hospitals are expensive places and they are not an appropriate place for someone who needs to be in a skilled nursing home or a longer-term place.

    And when Medicare stops paying – then it falls to the individual to pay and if they cannot then Medicaid pays.

    Did the pandemic expose flaws in how we do continuity of care – perhaps in ways similar to how it exposed other issues with things like education, rent, electricity, etc?

    It did and not just in Virginia.

    But for some reason – we have to keep going back to flog the various institutions, hospitals, nursing homes that had problems.

    I just don’t see the purpose of doing that when New York, Washington, and even Maryland have had their similar problems.

  6. Don’t worry. It’s “Totally Under Control”.

  7. Is anyone else having issues accessing the blog? When I go to the website it shows only the Asian post from several days ago. I have to go to it to see the more recent posts.

  8. yes…. also getting “bad requests”….

  9. Missing responded to links, e.g., “XXX replied to your comment Have you bought your “Trump Defeats COVID-19”

    for the last 3 days. Seems to be this site only.

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