Ombudsman Defends Nursing Home Decisions During Pandemic
Michigan’s Long-Term Care Ombudsman, Salli Pung, says she believes the “best decisions” were made about the placement of COVID-19 patients in nursing homes given the information and resources that were available at the time.
“If we had the opportunity to create nursing homes that were isolated simply for residents with COVID-19, we would all pick that,” Pung told the House Joint Select Committee on the COVID-19 Pandemic Sept. 15. “We would want that for them because that would be the safest, but I don’t know that we had that opportunity to do that and staff it and meet residents’ needs because staffing is critical at this time. There are not people beating down the doors to work in nursing homes, unfortunately.”
She also had reservations about the field hospitals that the state set up, like the one established in the TCF Center in Detroit.
“I was concerned that it wouldn’t meet the residents’ needs for safety and access to services and supports that they needed. Things as simple as utilizing the restroom might have been really challenging in that type of a setting. But at the same time, I, of course, had concerns that we wouldn’t want to be introducing COVID-19 into a building. So, if a resident came from a facility with COVID, readmission seemed like the right thing to allow because they came from that facility to the hospital and the exposure already occurred in the facility.”
The committee was questioning Pung about recommendations included in the Governor’s task force on nursing homes.
Select Committee Chair Matt Hall (R-Emmett Twp.) noted that the majority of recommendations included in the task force report regarded quality of life for residents in nursing homes. Pung was chair of the task force subcommittee regarding the quality of life.
She explained that many nursing home residents have been living in isolation for five months, interacting only with nursing home staff.
“Starting in March, our program experienced a significant increase, a nearly 95 percent increase in our call volume from the same time from the previous year . . . About 50 percent of those calls had to do with questions or concerns regarding COVID-19 isolation and quarantine, which would be expected at that time,” Pung said.
The recommendations included in the task force report included allowing outdoor visits with relatives, allowing for the creation of pods within nursing homes so that residents can interact with small groups of other residents, and increasing use of virtual visits and window visits with families.
But Pung also noted that virtual visits do not work well for all nursing home residents. Patients with dementia may not understand what is occurring during a virtual visit.
The Select Committee planned more questions for Department of Health and Human Services Director Robert Gordon on the state’s handling of nursing homes during the pandemic.
Survey: 10% Sometimes Or Never Mask Up; 40% Say ‘Nothing’ Would Motivate Them
For the 10 percent of Michiganders who sometimes or never wear a mask in public, 40 percent said nothing would motivate them to do so, but the state is backing an ad campaign to make the pitch that wearing masks will help protect and restore freedom.
The Michigan Department of Health and Human Services is spearheading a $5 million ad campaign announced Sept. 14 informed by research that polled more than 2,000 Michigan adults in July about their mask usage during the COVID-19 pandemic.
While 72 percent of Michiganders “always wear a mask in public,” another 18 percent said they usually wear masks, followed by 7 percent who say they sometimes do and 3 percent who said never. The findings, presented by Brogan & Partners to the DHHS, were based on an online survey conducted of 2,047 people 18 or older between July 8-13.
Within the combined segments of people who said they sometimes or never wore masks, 40 percent said nothing would motivate them to wear a mask in indoor public spaces and crowded outdoor places, followed by 39 percent who would be motivated if they were denied entry or service by a business, and 16 percent if they saw how their local community was affected.
Out of the same group of people, 33 percent said they don’t believe mask-wearing helps and 31 percent said it’s their right to choose.
Yet the video ads announced Sept. 14 “try to speak directly” to those who aren’t motivated to wear masks, said Robert Gordon, director of the DHHS, who spoke with MIRS about the campaign launch.
Gordon said those who fell into that category said they were concerned “masks infringe on their freedom,” so they made ads that featured veterans “who have been willing to risk their lives for freedom to talk about what masks mean for them” and that they think masks are important for protecting freedom.
For instance, in the ad titled “Freedom,” three people are featured, each identified as a member of one of the branches of the armed forces.
A Black man identified as Aqeel, a staff sergeant for the Marines, says in the ad, “this pandemic has tried to take away our freedom to live, to play, to work and follow the American Dream.” Later, the ad features a white male Marine sergeant named William and a white female Air Force sergeant named Debra.
The ad script then goes, “So to regain my freedom and to protect yours,” followed by each of them saying, “I choose. . . to wear a mask. Exercise your right to do what’s right for your community and country.”
Another ad, titled “Exercise Your Right,” follows the same script, except that it features only the white male Marine.
Other traits uncovered among the sometimes and never crowd include that 56 percent were in the 35-54 age range, 60 percent were parents, 69 percent were female (the survey as a whole featured 72 percent females and 28 percent males responding), and most were employed with a household income below $50,000, although Brogan & Partners noted the employment and household income trends didn’t waver much from the total sample of people.
The DHHS is funding the campaign, which bears the message “Spread Hope, Not COVID,” which research found to be the message that performed best, including with the never- and sometimes-mask folks, who were more “positively inclined to support this message” than the always-wear-a-mask segment.
Asked about the research, Gordon highlighted that it was interesting that African-Americans were more likely than everyone else to wear a mask. The number of Blacks who have died or gotten sick from COVID-19 is larger than their share of the state’s population.
The state is using a portion of the federal CARES Act funding to push the message until possibly the end of December. Gordon said the money being used for the campaign can be used broadly to fight the virus.
Asked why an ad campaign was chosen, Gordon said, “We know messages are really powerful, media is really powerful.” The campaign will operate through broadcast, outdoor, social and digital media channels, as well as the news media.
The DHHS director said Michigan has “come a long way” in addressing COVID-19, but that it “remains a threat to every Michigander.” He said everyone shares the goal of reopening the state, and that everyone has been touched by it, whether by losing a loved one or by losing “our whole lives.”
He said the state did hit a plateau in cases for several weeks, but “we’re also under a lot of pressure right now,” pointing to the fact that schools are coming back and people are moving more indoors with the colder weather.
A third ad, “Spread Hope,” shows an empty Ford Field, restaurant, school, and people putting on masks, as the narrator says, “this is just an intermission. Hope is setting the stage of our comeback.”
The campaign is expected to be backed by what has been described by Gordon as a broad coalition of 50 healthcare, business, education, senior citizens, and labor groups, who have said they will help “amplify the message.”
DHHS Warns Against Outdoor Dusk Activities In These 9 Counties
When it comes to COVID-19, being indoors with a lot of other people isn’t as safe. Now, for people in places where a mosquito-borne illness is popping up, being outside isn’t as safe, either.
The Michigan Department of Health and Human Services is encouraging local officials in counties where Eastern Equine Encephalitis (EEE) has been confirmed to consider postponing, rescheduling or cancelling outdoor activities occurring at or after dusk, particularly those involving children.
That includes sports activities, which were just recently reinstated for most of the state by Gov. Gretchen Whitmer after being restricted due to COVID-19 concerns.
As of Sept. 10, EEE has been confirmed in 19 horses in nine counties in Michigan—Barry, Clare, Isabella, Jackson, Kent, Mecosta, Montcalm, Newaygo and Oakland.
This is twice as many animal cases as the same time last year, and additional animal cases are under investigation, according to DHHS.
To date, no human cases have been identified. But, Chief Medical Executive Dr. Joneigh Khaldun said in a statement, “People get EEE the same way horses do—from the bite of an infected mosquito—so a case in a horse means people in that area are also at risk.”
The DHHS is recommending the cancellation of late-night outdoor activities until at least the first hard frost of the season, and out of “an abundance of caution to protect the public health.”
EEE is one of the most dangerous mosquito-borne diseases in the United States, with a 33 percent fatality rate in people who become ill. Persons younger than age 15 and over age 50 are at greatest risk of severe disease following infection.
Last year, the state initiated aerial spraying in parts of the state to try curb EEE.
Signs of EEE infection include the sudden onset of fever, chills, body and joint aches, which can progress to a severe encephalitis, resulting in headache, disorientation, tremors, seizures and paralysis, according to the DHHS.
97% Of School-Related COVID Cases Tied To Colleges
The state Sept. 14 released school-specific COVID-19 outbreak information for the first time, and of the 1,412 cases associated with 32 new and ongoing outbreaks, 97 percent of cases are tied to colleges.
Leading the way is Grand Valley State University, which has 438 cases associated with it.
Behind GVSU is Central Michigan University with 271 cases, Adrian College with 229 cases, Michigan State University with 203 cases, and then the University of Michigan with 77 cases.
The state list released today lists 32 outbreaks. However, Michigan Tech is listed as being associated with six different outbreaks—one listed at the campus address and then five others associated with Greek houses, but the addresses of those homes were not listed.
The total among all the outbreaks is 35 cases for Michigan Tech, tied with Midland’s Northwood University.
When high school, middle school, preschool, and elementary school settings are combined, there are 33 cases total tied to outbreaks at 11 buildings.
Hospitals Support, Trial Lawyers Oppose New Immunity Bill
New legislation designed to give health care providers immunity from COVID-19 related claims from March 9, 2020 to July 15, 2020, was opposed Sept. 9 by the Michigan Association of Justice in the House Judiciary Committee.
Rep. Roger Hauck’s (R-Mt. Pleasant) HB 6159 is the Republicans’ latest attempt to give hospitals and nursing homes some legal cover from claims that they failed to prevent a patient from contracting the coronavirus.
The Hauck bill is heralded as being closer to Gov. Gretchen Whitmer’s original emergency executive order signed under the powers given her by the 1976 Emergency Management Act than a Sen. Mike MacDonald bill that Whitmer vetoed several weeks ago..
It allows for more judicial discretion in what could be immune while MacDonald’s bill was more explicit in defining certain activities.
The Michigan Health and Hospital Association is supporting the bill on the basis that the virus is killing people, not the health care provider.
“Michigan’s healthcare providers and facilities faced an unprecedented challenge due to the COVID-19 pandemic,” wrote MHA government and political affairs senior director Adam Carlson. “Best practices continually changed and difficult decisions were constantly made with no playbook to rely on. Dozens of other states have realized the pressure this placed on providers and have pass statutes similar to HB 6159.”
But MAJ President Donna MacKenzie argued that the bill is unnecessary. The 1976 Emergency Management Act can arguably give providers these protections, she said, and granting immunity retroactively is “not legally valid.”
She said the bill would give further protections for “bad nursing homes,” seven of which have had more than 100 COVID-19 positive residents and one of which had more than 200 positive residents.
“This is unacceptable,” MacKenzie wrote. “Nursing homes should not get a free pass for this type of neglect, especially during a global pandemic, when the need to comply with health and safety standards is at an all-time high.”
Finally, to only allow lawsuits in cases of “gross negligence” is a “nearly impossible” standard to meet under Michigan law, she said. The nursing home would need to be found to have acted so recklessly as to show a “substantial lack of concern for whether an injury results.”
Henry Ford Health System CEO: Clear Supply Chain Not Pandemic-Ready
The head of the Henry Ford Health System said Sept. 2 this year has demonstrated that the world’s health care supply system was not pandemic-ready.
“It is very, very clear that the global supply chain that supports the health care industry is not sufficient for a global pandemic,” Wright Lassiter III, said Sept. 2 during a Detroit Chamber program on Finding Balance: Economic Forces and Public Health Outcomes. “It’s very, very clear that leaders like myself had to put into place plans to secure PPE [personal protection equipment] in a manner we’re not used to.”
The forum included Lassiter and Dr. Joneigh Khaldun, the state’s chief medical executive and chief Deputy Director for Health at the Michigan Department of Health and Human Services. It was moderated by public radio’s Rick Pluta.
Besides supply issues, which Lassiter said he remained concerned about until June, today his concern is helping health care workers who suffered enormous mental strain during the height of the pandemic.
“Our health care teams are in a bit of post-traumatic stress syndrome,” Lassiter said. “They love what they do, they love their patients, but they’re concerned about their own mental health.”
To highlight the situation, Lassiter said when the orders came down to clear the hospitals for a surge of COVID patients, many health care providers were there holding the phone so the ill and dying could talk to their families for the last time.
On the pandemic overall, Khaldun repeated that the United States was “painfully slow in developing testing” in the early days of February and March.
“In the early days, in February, the only lab able to test for COVID was the federal lab in Atlanta,” she said. “It was very likely we had people in our state that had mild symptoms and simply could not get tested. I think we all know what happened from there.”
On the CDC’s suggestion to no longer test asymptomatic patients, Khaldun said Michigan will continue to test for asymptomatic patients and follow up quickly on outbreaks to manage the disease going forward. She did add that she’s concerned about the possibility of a fall surge in cases as residents move inside and the state enters the flu season.
On the pending or possible reopening of gyms, Khaldun said doesn’t believe the Governor has made her final decision on reopening gyms and other businesses. She described the state’s case status as a “plateau.”
Lassiter, who serves as an advisor to the governor on when and how to re-engage the economy argued it’s all about the “balance” and that the governor is listening to the right people and the state is benefiting.
“When you look at the data of how we were able to control the spread of new cases, Michigan has outperformed the majority of states,” he said. “I know there is always a challenge of what gets opened when, but my feeling is we’ve done a good job of balancing. This is a matter of where there is no playbook, there is no guide that you can go back to and say ‘this is what happened last time’.”
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.