One-third of all COVID-19 deaths in Michigan occurred among residents and staff of the state’s 450 nursing homes, according to the first detailed accounting of the pandemic’s deadly toll in nursing homes.
The numbers are staggering: 1,947 residents and 20 staffers died. In many counties, 50 percent or more of coronavirus deaths were traced to nursing homes.
In many homes, the grief was profound. According to the state, 33 nursing homes suffered 20 or more deaths related to the coronavirus.
While grim, the figures released by state health officials Monday account for just a portion of COVID-19 deaths involving residents in long-term care facilities. Michigan has still not said how many cases or deaths have been recorded in hundreds of other facilities that house seniors or the disabled, such as homes for the aged or assisted-living centers.
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Even among nursing homes, there are some questions whether the state numbers released Monday are accurate. For example, the state is reporting that the Boulevard Temple nursing home in Detroit had zero deaths. Yet the city’s own nursing home report shows 18 deaths there. At another Detroit nursing home, the state shows more deaths than the city recorded.
Still, the numbers produced a more tangible portrait of COVID-19 suffering at nursing homes than previously disclosed.
“I feel conflicted because now that we have the data, it’s tragic,” Alison Hirschel, managing attorney at the Michigan Elder Justice Initiative, said of the nursing home numbers.
She added, though, that she was encouraged by an executive order signed Monday by Robert Gordon, director of Michigan Department of Health and Human Services, that mandates regular testing of staff and residents — what Hirschel called “the single most important” part of any response to control the viral spread of the virus within nursing homes.
Nursing homes face a $1,000 fine each day they don’t comply — a “significant” penalty, Hirschel said. The state also could “stop or hold Medicaid payments,” according to the order.
The state has been reporting confirmed cases of COVID-19 in individual nursing homes for weeks, but Monday’s report is the first comprehensive accounting of deaths. In several counties, nursing homes were the main source of coronavirus infections and deaths in a state that has recorded more than 60,000 cases and 5,772 deaths.
For instance, in Berrien County along Lake Michigan in southwest Michigan, 41 of the county’s 57 deaths were in nursing homes. Of those, 36 were in two facilities in Benton Harbor and Niles.
In Marquette County, 8 of the 11 deaths were among residents at the Norlite Nursing Center.
And in Livingston County, a largely suburban county outside Detroit, 27 deaths occurred in three nursing homes — equal to the county's total — including 10 in a facility that acted as a “hub” for COVID-19 cases. Some of the deaths at the "hub" locations were residents of other counties.
Statewide, 200 residents and three staffers who died were in 17 hub facilities scattered across Michigan.
The most nursing home deaths occurred in metro Detroit, with Wayne, Macomb and Oakland counties reporting 710, 377 and 307 nursing home deaths respectively, or 32 percent of all deaths in those counties.
Legislators had crictized a Whitmer administration policy that had required nursing home to accept recovered COVID-19 patients if they had enough personal protective gear on hand. On Monday the admistration changed that policy to say they were only required to accept those patients if they had a dedicated COVID-19 wing.
Testing — and a hammer
Gordon said in a media call Monday the state waited to impose the testing order until it could assure nursing homes would have “adequate access” to tests they need to comply with the mandate.
“Hindsight is always 20-20,” Gordon said, referring to how the state has handled COVID-19 outbreaks in nursing homes across the state.
Hirshel said the move to mandatory testing is crucial because “we can’t get our arms around the problem if we don’t know who is COVID-positive and who isn’t,” she said.
The head of a lobbying group for a nursing home industry group in Michigan acknowledged that the threat of a $1,000 fine is “probably what’s needed” if facilities fail to comply with the state’s orders.
Testing, too, is “essential,” because staff and residents may be asymptomatic or pre-symptomatic, slipping through screening and spreading infection long before the first symptom is reported, said Melissa Samuel, president and CEO of the Health Care Association of Michigan, which represents more than 350 of the state’s nursing homes.
“If testing had been widely available from the outset, you would not have had such significant spread,” Samuel said. “Testing is the key, and it’s absolutely the path forward.”
Additionally, homes must file timely reports on case counts, personal protective equipment and staff shortages at nursing homes.
The order issued Monday requires weekly testing of any resident or staff member with symptoms or suspected exposure, and weekly testing of all previously negative residents and staff in homes with any positive cases until 14 days after the most recent positive result.
Nursing home facilities must submit plans for testing by June 22 and to put those plans in place by June 29, under the MDHHS order.
MDHHS also announced it would provide staff help for nursing homes with staff shortages, beginning in Southeast and West Michigan, by providing registered nurses, certified nursing assistants and personal care aides for up to 14 days of homes experiencing shortages.
Detroit facility had many deaths, staff complaints
The death count includes 43 residents at a Detroit nursing home, Ambassador Villa, the focal point of a complaint in April by the union that represents staff, alleging the home violated state and national guidelines for COVID-19.
The 43 deaths is the most at any single nursing home, records show, though the city of Detroit reports a far lower number, 27 deaths, at the facility.
According to the Service Employees International Union, the facility’s owner, Healthcare Michigan, refused to tell workers if they tested positive for the coronavirus and told one employee to return to work even though the worker had possible coronavirus symptoms. The union also alleged the home was short of protective gear.
“One employee forced to work … was still suffering from a shortness of breath, unable to taste or smell, still has somewhat of a cough and a temperature of 99.5 degrees,” the union said.
The nursing home at the time posted on its website this message: “We understand that this is a time of anxiety and concern for many. Our reliance on factual data and scientific evidence allows us to implement changes aimed at minimizing the potential of exposure to COVID19 and planning for the care and treatment of any resident who may test positive for the virus.”
The home Monday did not immediately respond to a request for comment.
Despite advances, data gaps remain
But Monday’s long-awaited disclosure of nursing home deaths still leaves a large reporting gap for tens of thousands of vulnerable Michigan residents.
MDHHS has yet to disclose COVID-19 cases and deaths at adult foster care homes, homes for the aged and unlicensed assisted-living centers — that combined have the capacity to house far more seniors and disabled residents than the state’s roughly 450 nursing homes.
While Michigan nursing homes have a capacity of 46,000 residents, combined capacity at these other facilities exceeds 56,000.
MDHHS spokesperson Lynn Sutfin told Bridge the department launched “a reporting structure” for those facilities to identify COVID-19 cases and deaths on May 22 and expected the first reports on COVID-19 cases to come in by early June.
MDHHS, she said, “plans to take some time to review and validate this information. At this point, we do not have plans to post the information on the website, but will be discussing this when the data is more complete.”
Throughout Michigan, 7,163 nursing home residents were infected with the coronavirus, as well as 3,133 staff members, according to state data released Monday. That total of 10,306 nursing home cases is more than the overall number of coronavirus cases in 14 states.
The numbers mean that roughly 1 in every 6 nursing home residents statewide contracted the new coronavirus.
The scale of the nursing home deaths is, unfortunately, not surprising: People 70 and older comprised nearly 70 percent of all COVID-19 deaths in Michigan.
Seniors have been particularly hard hit by COVID-19, a respiratory illness that has ravaged much of the globe, including the United States.
According to an analysis in early May, 42 percent of the nation’s COVID-19 deaths were residents living in nursing homes and assisted-living facilities. The New York Times reported that same month that, based on its own database, nursing home residents and staff made up 1 in 3 of the nation’s COVID-19 deaths.