Updated 9:57 a.m. Wednesday
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When Diane Judson found out that her mother’s long-term care facility would start accepting COVID-19 patients, she thought she must have heard wrong.
“It seemed hazardous, to say the least,” said Judson, whose 94-year-old mother has vascular dementia and has lived at the Powerback Rehabilitation Center in Center City Philadelphia for three years.
The 150-bed facility typically takes patients discharged from the hospital after surgery or injuries who still need care and time to recover before going home. But it also houses a floor of long-term care patients like Judson’s mother.
Half of Philadelphia’s 206 COVID-19 deaths have been nursing home residents, and two-thirds of the total deaths have been people over 70.
The center’s executive director, Jennifer Valinoti, told family members over a Zoom call on Tuesday that Powerback has not yet admitted COVID-19-positive patients from hospitals but that it will begin soon. She said that those patients will not reside on floors with patients who are at this point negative, and that an elevator will be designated for COVID-19 patients. Valinoti assured family members that the facility staff had adequate personal protective equipment to be able to change it frequently between patient visits.
In the face of overburdened hospitals, nursing homes around the country have struggled with the question of whether and how to accept COVID-19 patients who are improving in the hospitals but still require care. In large part, the conundrum is what has helped spur the creation of overflow spaces, designed to take in patients that require intensive care but not hospitalization. Philadelphia’s space for this, Temple’s Liacouras Center, is able to start accepting patients as soon as Thursday.
As of Tuesday, there were 1,361 cases of COVID-19 being treated in hospitals in the Philadelphia region. City Health Commissioner Thomas Farley said that while some hospitals are busier than others, none are at capacity, and that 37% of hospital beds are still available regionwide.
Valinoti told Powerback family members that for those uncomfortable with the situation, relocating their loved ones is an option. But she added that it’s her understanding that most long-term care facilities in the Philadelphia region have at least a few COVID-19 patients or, like Powerback, will begin accepting such patients from the hospitals.
Philadelphia Department of Public Health representative James Garrow said that the department had no regulatory authority over hospital transfers. He said that he knew hospitals have been sending stable COVID-19 patients requiring less intensive care to rehabilitation centers to recover, but that the department had not heard about it happening where there were long-term residents.
“I know of no situation where we would agree to import currently COVID-positive patients into a nursing home,” Garrow wrote in an email. “We’re trying our damnedest to keep COVID OUT of nursing homes.”
Judson said relocating is a bad option for her mother, Margaret Judson, for whom the disruption in care staff and setting would be troubling.
“Here’s my mother, she’s been cared for by people she knows for several years now,” said Judson, who is 70. “I just don’t believe they’re taking the best interests of the people who’ve lived in this facility for a long time into account.”
Many patients still go in and out of the facility to receive dialysis and chemotherapy treatments, and administrators told families on Monday that five existing patients had also tested positive for the coronavirus. Those individuals were transferred to the COVID positive unit, according to the center’s administrators.
Since visitation is completely restricted, families can’t see what’s going on behind closed doors.
“I cannot go to her, I cannot hold her hand,” Judson said. “The idea of my poor sweet, devoted mother drowning when no one is with her is a terrible thing.”
This article was updated to add additional comments from the city Department of Public Health.
Powerback is run by Kennett Square-based Genesis HealthCare, which operates 400 short-term, long-term and specialized-care facilities across 26 states. In 2018, USA Today rated Genesis among the worst companies to work for, as determined by staff reviews from the website Glassdoor. It was the only health care company to make the list.
Representatives for Powerback did not respond to multiple requests for comment.
Though Powerback’s move to accept COVID-19 patients may be worrisome to loved ones like Judson, it is in line with state guidelines. The Pennsylvania Department of Health issued guidance to nursing homes, informing them that they must continue to accept new admissions and receive readmissions for current residents who have been discharged from the hospital, who are stable, to alleviate the burden in acute-care settings.
“This may include stable patients who have had the COVID-19 virus,” state health department representative Nate Wardle wrote in an email. “So yes, the department is aware that this could and would be happening.”
In Montgomery County, Kasey Meyers’ mother told her something similar was occurring.
“I thought she didn’t know what she was talking about,” Meyers said.
But when she called the facility, Silver Stream Nursing and Rehabilitation in Spring House, Meyers was told that the center would be admitting 25 new COVID-19 patients from hospitals. At the time, there were zero positive cases in the center.
“They were being really careful not contaminating the center,” Meyers said. “Why would you mess it up?”
Meyers said that she made a fuss, and that Silver Stream was able to work with the state Department of Health to find another place for the patients. But an administrator there told her eventually, they probably wouldn’t have a choice.