Nursing Home Data Raises New Questions about COVID-19 Policy

by James A. Bacon

The Virginia Hospital and Healthcare Association has just published a data dashboard focusing on Virginia nursing homes. And the picture it presents is very different from that of the state’s acute care hospitals.

While acute care hospitals have solved their shortages of personal protective equipment, the nursing homes have not. According to the VHHA dashboard, 11 nursing home report difficulty obtaining N95 masks, four obtaining surgical masks, three obtaining gloves, seven obtaining face shields, and 18 laying hands on gloves.

Another noteworthy reveal from the data: The number of active COVID-19 patients currently in nursing homes is almost as large as that in acute care hospitals — 1,427 in nursing homes yesterday (and published today) compared to 1,502 in acute care hospitals.

The dashboard also tells us that 520 nursing home patients have recovered from COVID-19, compared to 4,107 who have recovered from acute care hospitals.

The data originates from the Virginia Healthcare Alerting and Status System (VHASS), a program funded by the Assistant Secretary for Preparedness and Response, a division of the U.S. Department of Health and Human Services. The dashboard reflects data voluntarily supplied by 190 of Virginia’s 287 nursing homes.

Bacon’s bottom line: Some obvious questions:

Why haven’t we seen this data before?

We know that the over-80 population accounts for literally half of all COVID-19-related deaths in Virginia (532 out of (1,014). A large percentage, if not the vast majority, reside in nursing homes or assisted living facilities. According to the Virginia Department of Health dashboard, outbreaks at nursing homes account for 595 of the state’s deaths.

To a large extent, the COVID-19 epidemic in Virginia is a nursing home epidemic — just as it is across the country. Now we find out that a significant number of nursing homes are having difficulty acquiring personal protective equipment.

Has the Northam administration dropped the ball on nursing homes?

Given the outsized role of nursing homes in the COVID-19 epidemic, it seems odd that this information hasn’t been made available until now, and that the VHHA was the entity to publish the data. By taking this action, one might speculate that VHHA is putting subtle pressure on the Northam administration to pay more attention to nursing homes because that’s where the worst problem is.

And the most important question of all: What does this mean for rolling back the shutdown?

If more than half of all COVID-19 deaths in Virginia can be traced to nursing homes, isn’t that where we should be focusing our attention? If you take Northern Virginia out of the equation and nursing homes out of the equation, what kind of public health threat does COVID-19 pose to Virginians? Is there even a flicker of a justification for the emergency measures now enacted?

There are currently no comments highlighted.

37 responses to “Nursing Home Data Raises New Questions about COVID-19 Policy

  1. re: ” Has the Northam administration dropped the ball on nursing homes?”

    I thought the nursing homes were primarily private sector… no?

  2. The Governor does not seem to have a problem with proclaiming edicts for “non-public, private sector businesses”. How about the news media? Have they been asleep at the switch on this topic as well?

    • The Govt DOES have the legal power to decide what restrictions are necessary for public safety. That does NOT mean it is responsible for needed resources of private sector businesses.

      That’s not just Virginia or Northam. That’s pretty standard across the country.

      • Such a shameless apologist. It’s like Fox News and Trump.

        • No apologies at all. We play this game about “private sector” and govt responsibilities and I’m pointing out that the idea that because the govt has laws that – that makes them responsible for resourcing private businesses is patently untrue.

          If this were true – then why isn’t the Govt responsible for ALL private businesses that need PPE – like dentists and doc-in-the-box and others, barbers, tatoo…

          That’s not apologizing – that’s laying out some basic facts which some disregard in the name of ideology and blame.

      • The Governor and Government don’t have the legal authority to shutter private business unless they are in violation of the law or martial law has been invoked.

        Pretty standard across the County Lawsuits should be filed, because there isn’t a State where the Governor isn’t overstepping their britches.

        • But you’d be wrong. Clearly they do. And law suits already filed have failed.

          Any govt has the right to shutter any business in a declared emergency.

          Even Jim Sherlock agrees with this. He says the law needs to be changed… but the law right now does support it and has for some time – ever seen what happens in a hurricane or flood or other disaster?

          • I’m wrong? Humm I seem to understand that until the Supreme Court the United States rules on a Lawsuit it’s very much alive.

            They do not, there is no provision in a state of emergency to shutter business because something could happen. A state of emergency provides funding resources and gives the GA and Governor latitudes that normal operations don’t. None of those is the shuttering of private business.

            https://law.lis.virginia.gov/vacodepopularnames/emergency-services-and-disaster-law/

            “Even Jim Sherlock agrees with this. He says the law needs to be changed… but the law right now does support it and has for some time – ever seen what happens in a hurricane or flood or other disaster?”

            He agrees the Law is vague and that’s the context that is being used to usurp peoples rights. He doesn’t agree the Governor has the power to pick and choose who the winners and losers are.

            The Law does not, and would only require a legal challenge like Wisconsin and Michigan before it. PA’s case will be heard by the Supreme Court, they merely declined to invoke a stay without merit.

            Hurricanes and Floods don’t grant the Governor the power to shutter business, that’s up to the owner. That is also for a set amount of time, you have zero understanding of Declarations of Emergence. The only grounds on which a Government could shutter business at the Federal or State level would martial law. Given it’s case history, it wouldn’t stand either.

          • re: ” The only grounds on which a Government could shutter business at the Federal or State level would martial law. Given it’s case history, it wouldn’t stand either”

            Shutdowns already happen fairly routinely right now:

            Headline: “Health Department Shuts Down Three Restaurants With Imminent Health Hazards
            Plus another restaurant comes within two points of a shutdown”

            Notice that this is happening BEFORE anyone is harmed.

            One could argue, and some do, that the Govt has no authority to do this but in the real world, the govt does this and last I heard, the courts have not ruled it illegal or unconstitutional and this happens thousands of times a year and so far not a single court challenge that has made a dent in it.

            The idea that the govt DOES have the ability to shut down an individual restaurant over safety concerns but could not shut down all of them is likewise ludicrous. The loss of electricity or water/sewer to multiple businesses DOES result in all of them being shut down until they can safely open again. Entire regions that have loss power can and are shut down.

            The simple reality is that Govt does have this power separate from martial law, despite anti-govt types claiming otherwise.

            It’s okay to assert that the Govt should not have that power – but it’s not okay to make false claims that it does not because of ones own non-factual beliefs.

          • Just because something is routine doesn’t mean it’s Constitutional. That’s how not it work, as everything is Constitutional until it’s challenged in Court.

            You are again conflating two separate things. The Health Department sets standards for Restaurants. Those businesses know of and have to adhere to those standards to operate. If they are in violation, they are fined and given time to remedy, if the violation is so egregious they are forced to shutter immediately until they comply and are reinspected. They were shuttered for a known condition that existed.

            Those two separate events aren’t even in the same world.

            “One could argue, and some do, that the Govt has no authority to do this but in the real world, the govt does this and last I heard, the courts have not ruled it illegal or unconstitutional and this happens thousands of times a year and so far not a single court challenge that has made a dent in it.”

            What exactly is this saying? It’s not anything that I can discern it’s circular.

            In two current instances, Governors and their agencies have been found exceeding their authority. I’ll also notice, that you didn’t again address the link to the Law and point out where it gave the authority to shutter private business (I’ll take that as your concession you were wrong).

            “The idea that the govt DOES have the ability to shut down an individual restaurant over safety concerns but could not shut down all of them is likewise ludicrous. The loss of electricity or water/sewer to multiple businesses DOES result in all of them being shut down until they can safely open again. Entire regions that have loss power can and are shut down.”

            Again, conflating arguments that aren’t even tangentially related. The utilities observation is false, it’s the entity that shutters themselves, as is with Natural Disasters. The Governor nor the Government shutter those business, they do it themselves.

            They do not legally have the authority outside of martial law, period end to story your arguments are completely absurd and invalid.

            “The simple reality is that Govt does have this power separate from martial law, despite anti-govt types claiming otherwise.

            PS that’s a ad hom and therefore personal attack, I’m glad we could put the thinly veiled statements aside. You don’t like Civil Liberties, that’s your prerogative, however those of us who do aren’t anti-government. We believe that the Government should operate in the boundaries defined by the Constitution.

            “It’s okay to assert that the Govt should not have that power – but it’s not okay to make false claims that it does not because of ones own non-factual beliefs.”

            That again, is the second ad hom attack. So, we’ve established your modus operandi as being strawmen and ad hom attacks, both of which are logical fallacies.

            I didn’t make false claims and you’ve failed to prove otherwise. Now, I could go down the ad hom road as you have, but I will not because it doesn’t do me a lick of good.

          • Ad Hominem? 🙂

            okay… no forget it…

            If a health dept can close down a restaurant for what they say is unsafe conditions for the public – and building inspectors can do the same – are they not the Govt?

            Are you disputing whether the govt has had – for a LONG TIME the authority to do this or are you arguing that they do but you don’t agree?

            The latter. correct? Because by now, over the decades, surely there have been court challenges and if they still have that authority – then it must have been found legal and Constitutional.

            As I said, you surely are entitled to your points of view but you can’t change the facts on the ground – Govt has the authority to close down a restaurant – period. That’s a true statement.

          • Implying that I’m “anti-government” is indeed a personal attack, do you require the definition of that fallacy? Instead of addressing my opinion you differed to “anti-government”.

            The Health Department can only close down that entity for a violation of the standards set in place, it’s not a in arbitrary reason and again not related.

            I can’t fathom how the concept of rules and regulations being violated is not even remotely the same as a Government mandated shutdown with arbitrary means. If the standards were equal, all businesses would’ve shuttered, that has not and was not the case.

            “Are you disputing whether the govt has had – for a LONG TIME the authority to do this or are you arguing that they do but you don’t agree?”

            I’m disputing the fact that you can’t seem to validate your opinion on the matter, outside of martial law Governors, Government nor POTUS’s cannot shutter private businesses. There is no legal power vested in any Law that provides that authority outside of martial law.

            “The latter. correct? Because by now, over the decades, surely there have been court challenges and if they still have that authority – then it must have been found legal and Constitutional.”

            Again, reconstruct to a coherent statement.

            A violation of the Health Code is not the same, I’m sorry that you lack rational to understand that.

          • If you are opposed to the govt – it is fair to label that as anti-govt.

            It’s a description of a behavior not a personal attribute.

            If I called you a stupid dumbass – THAT’s an AD Hominem for sure.

            But saying that folks who hold anti-govt views are anti-govt is not

            re: ” The Health Department can only close down that entity for a violation of the standards set in place, it’s not a in arbitrary reason and again not related.”

            who set those standards?

            Who defines the standards and are those standards changeable as circumstances can infuence?

            Again – you can call any standard “arbitrary” and do – but the fact is that the govt can and does set standards for closures and the fundamental point is that the Govt CAN DO THAT and DOES DO THAT.

            Now tell me why you think they cannot or should not?

            That would be YOUR OPINION – not the facts and realities.

        • You forgot nuisance nightclubs.

        • I’m not opposed to the Government, again that was a Strawman you created.

          Um in fact when you cannot address a persons position (strwman you previously setup) and you call them anti-government, it is indeed a personal attack and therefore ad hom.

          Only if you uttered those word following the inability to refute my argument, otherwise they are fair game. I have a string of adjectives that I could throw at you, many I learned in the Army.

          Umm the FDA and USDA sets those standards (hence the Food and Drug Administration and US Department of Agriculture titles), were you expecting someone else?

          https://www.usda.gov/our-agency/about-usda/laws-and-regulations

          https://www.fda.gov/regulatory-information/fda-rules-and-regulations

          I’m going to assume, that wasn’t how you believed it was done? It’s not generated by fiat, I assure you.

          The notion that you must close down because someone might have a highly contagious virus is the very definition of arbitrary, and again noted remotely related to the Health Inspector.

          Again, you cannot seem to understand your arguments don’t circle the square, they aren’t related tangentially or otherwise.

          Mom and Pop hardware stores, barbershops and place of worship aren’t food serving establishments.

          No those are indeed facts, I’m sorry they are inconvenient to you. Would you care for anymore lessons you failed to attain in grammar school?

          • Oh you are opposed to GOvt, no question at all…

            and whether it’s a restaurant or other establishment, they all have to have occupancy permits and licenses…

            You just disagree on the terms and authority but ultimately the govt does have that authority.

            That’s the fact.

          • “Oh you are opposed to GOvt, no question at all…”

            Says you, and guess what you’re wrong again.

            Oh gee another personal attack, you’re on a roll little fella.

            I also thoroughly enjoy you not addressing a single thing you get provided, it’s almost like you either don’t want to understand it or can’t.

            Occupancy permits are based off of fire code, that’s OSHA and NFPA. You really can’t make a coherent argument, and aren’t even remotely as intelligent as you believe yourself to be.

            It does not, and clearly you would’ve learned that had you bothered to read what you were cited. The Government exists by the consent of the people.

            Facts, are not something you’ve touched in a long, long time.

  3. re: ” He agrees the Law is vague and that’s the context that is being used to usurp peoples rights. He doesn’t agree the Governor has the power to pick and choose who the winners and losers are.”

    Then, if true, why is he proposing a “fix”?

    I think there may well be more court action but at the end of the day, in a dire emergency where people can die – we’re not going to deny govt the ability to preserve lives…

  4. James Wyatt Whitehead V

    Mr. Bacon this post is important. The data brings everything into a clear focus for me.

  5. The Governor indicated in today’s news conference that if a nursing home is short PPE, that means they haven’t asked for what they need from the state stockpile, which he claims is now adequate. Fairly soon into this, good or bad, the government took over control of PPE distribution, and that’s probably good because the price gouging would have been worse otherwise. Plenty of stories about promised shipments being diverted and redirected by the feds.

    From the beginning, government at all levels has failed to see the nursing homes (not the hospitals) as the key battleground, the place where the battle was lost (if lost in that state or region.) And I still think that since government is the key bill-payer for that industry, and also directly controls so many facilities, an element of CYA has been present.

  6. Nursing homes were NEVER designed to deal with highly contagious coronavirus – not in their physical design nor their operational procedures.

    They often have two and even three people to a room.

    Few have separate wings dedicated for infected people much less dedicated staff and other equipment. And I doubt that few had the type of PPE that would be needed for coronavirus. Folks have been making the point that elective surgery did not have coronavirus PPE.

    Not just in Virginia – virtually everywhere in the US including places like New York, California, Washington State, etc.

    In fact, New York was actually sending recovering coronavirus victims to nursing homes early on!

    Nursing Homes are between the devil and the deep blue sea when it comes to whether they are private or govt controlled/regulated.

    We like to pretend they are private sector but at the same time we blame govt when they fail… both sides of the fence stuff.

    I’d bet if someone is going to build a new nursing home, they’re not going to build it like they have been built – lessons learned.

    And I’ll bet that come the next GA, that there are going to be a passel of new bills introduced and fast and furious response by the nursing home lobby folk.

    And I do doubt that only the most partisan are going to say “this is Ralph Northams fault”.

  7. Nonsense, Larry. Nursing homes are required to use strict infection control and prevention procedures. That so many haven’t, and have been cited for deficiencies, and continue to operate with less than adequate staffing was a disaster waiting to happen. And it did.

    The emphasis of holding companies buying up distressed nursing homes is on making a profit, not taking good care of residents.

    • Carol – what I’ve read is that infection control for coronavirus is much harder than what is typical done for infection control in general.

      Like in hospitals where coronavirus is segregated – regular infection control is not effective.

      For instance, PPE for coronavirus is different than for regular infection control – e.g. PPE for elective surgery will now also have to be changed for a higher grade.

      Typically where you have coronavirus – you don’t have patients with it in the same wing or hall as others without it.

      Typically – in a healthcare facility – there are separate areas for those with coronavirus.

      Typically in facilities where there is coronavirus – all the equipment like wheel chairs, etc are not mixed…

      Most nursing homes are not set up that way. They’re having to reconfigure them.

      In nursing homes that I have been in, I’ve never seen separate, segregated hallways for infection control.

      This issue spans almost all the other states …. and even facilities with good ratings have had the problem…

      My bet is that from now on, they will have to, and it’s probably going to increase costs.

  8. Hallways are the least of it. When basic handwashing is ignored, when a place is dusty and dirty, when ventilation pathways aren’t considered, when tubing from catheters drags on the floor, when cpap tubing does too, when gloves aren’t taken off before opening doors, when when there’s no damn soap in bathrooms……it’s not rocket science to expect a contagious virus to spread.

    • true – but even when they don’t have the problems you cite, they will still fall short when dealing with coronavirus.

      The standard infection practices are not sufficient when dealing with coronavirus – and many nursing homes that had done OK and got decent ratings also ran into trouble with coronavirus.

      That’s true in acute care hospitals also where what they do for coronavirus exceeds what they do for normal infection control.

      Hospitals actually set up segregated wards with air-locks or similar. I don’t know of any nursing home that does that as a standard practice.

Leave a Reply