Florida’s list of elder care homes with COVID-19 is incomplete

Two days after the release of the list, some are questioning whether the list is complete and why it doesn’t contain more useful information.
Two Sunstar Paramedics' supervisor vehicles are seen outside of St. Mark Village nursing home Monday, April 20, 2020 in Palm Harbor. Several residents were transported from St. Mark Village Monday to local hospitals. It is presumed the residents had tested positive for COVID-19 or coronavirus.
Two Sunstar Paramedics' supervisor vehicles are seen outside of St. Mark Village nursing home Monday, April 20, 2020 in Palm Harbor. Several residents were transported from St. Mark Village Monday to local hospitals. It is presumed the residents had tested positive for COVID-19 or coronavirus. [ CHRIS URSO | Times ]
Published Apr. 21, 2020|Updated Apr. 21, 2020

TALLAHASSEE — In late March, recordings from Hollywood emergency dispatchers showed that an employee of the Lincoln Manor assisted living facility, a home with a politically connected owner, had tested positive for COVID-19 and that two residents had been removed after exhibiting symptoms consistent with the coronavirus.

On Saturday, Gov. Ron DeSantis, after resisting for weeks, released a list of elder-care homes that had a resident or staff member test positive for the novel coronavirus since March 2. By Tuesday, the list had 313 names, but Lincoln Manor wasn’t one of them.

Two days after the release of the list, some are questioning whether the list is complete and why it doesn’t contain more useful information.

Other states have published similar but more complete lists of elder-care homes, with added information about how many COVID-19 cases and deaths per facility.

Florida officials have been collecting data since the outbreak began but refused requests from the news media and elder-care advocates to release the information to the public. When the governor on Saturday ordered Surgeon General Scott Rivkees to stop withholding the information, the list of long-term care facilities with positive COVID-19 cases was made public for the first time.

However, the list, presented as a pdf rather than a spread sheet of numbers, is not without flaws. (To read the list, click here.)

At least four facilities that have notified families members they have a positive cases were not on the list, family members told the Times/Herald.

Excluded from the list is Lincoln Manor in Hollywood, operated by Larry Sherberg, one of the Florida long-term care industry’s most powerful leaders, and an outspoken advocate for relaxing industry regulations. He confirmed to the Miami Herald in March that an employee had tested positive for COVID-19 but said the two residents ultimately tested negative.

In addition to Lincoln Manor, readers have told the Herald that they know of positive cases at the Fair Havens Center in Miami Springs, Edgewater in Boca Raton and Harbours Edge in Delray Beach. A spokesperson for Harbour’s Edge confirmed the home has one resident in residential living who is self-isolating in their home.

Efforts to obtain comment from the other homes were unsuccessful. The Department of Health did not answer questions about why Sherberg’s home or the other facilities were excluded.

In the past three days, the state added 24 new long-term care facilities to the list for reporting positive COVID-19 cases, according to a Times/Herald analysis. DOH also removed 14 homes from the original list, bringing the net total to 313. The agency has provided no explanation for the changes.

It is hard to overstate the degree to which residents of elder-care facilities are vulnerable to the coronavirus outbreak. Of the 27,058 recorded positive cases in Florida as of early Tuesday, 1,928 were in long-term care facilities and the numbers are climbing. That’s 7 percent of the overall cases.

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But of the 823 Florida deaths recorded, 204 were in long-term care facilities. That is nearly 25 percent.

The governor last week ordered the National Guard to create “strike teams” to conduct aggressive testing of all residents and staff.

While elder-care advocates would like to see more provided, including information on deaths, number of cases per home, staff infections vs. residents, severity of cases and how many tests were administered, the industry is not happy for other reasons. Industry trade associations representing nursing homes and assisted living facilities say the incomplete lists could allow people to draw inaccurate conclusions about the safety of their residents and are asking state officials to do better.

The DOH web site includes a disclaimer: “listed facilities may or may not currently have positive cases of COVID-19 in residents or staff” but says nothing more.

At The Palace in Homestead, the Florida Department of Health asked if they had anyone willing to be voluntarily tested.

“They told me nobody was willing to take them up on their offer,’’ said Marilyn Bustamante, chief nursing officer. So they selected 10 residents and 10 employees who were showing no symptoms and included a resident who had recently returned from the hospital and had been isolated for 14 days. The only person who tested positive was the resident who returned from the hospital.

“She never showed any symptoms and has since tested negative twice,” Bustamante said. That single test is the only reason The Palace at Homestead appears on the list, she said. “We have no active COVID-19 cases in any of our communities.”

Veronica Catoe, CEO of the Florida Assisted Living Association, the industry trade group, said they have “determined that there are numerous errors on the list.”

“We have identified several instances of ALFs that are on the list but have not had a single case of COVID-19 infection,’’ she said. “In one instance, an ALF may have been put on the list because a third-party vendor who had visited the facility later tested positive, but there was no transmission of the virus. Third-party health care services to meet the medical needs of residents is another entry point of potential infections in our communities.”

The Florida Health Care Association, which represents nursing homes and assisted living facilities, has a similar complaint.

“We looked over the list and heard from some of our members who felt they shouldn’t be included on that list,’’ said Kristen Knapp, spokesperson for the FCHA. “We share the governor’s desire for transparency but I think the governor would benefit from a more consumer-friendly report.’’

For example, the list shows positive cases since March 2 but “today is April 20, we have facilities whose staff tested positive April 1 and they haven’t been in the building since March 30,’’ she said. “I’m not sure the list, as it is, is of value to the public.”

Knapp acknowledged the list does show that among the vast majority of the long-term care homes — 3,500 of them — no residents or staff have tested positive for COVID-19. “That is the peace of mind that they have been craving,’’ she said.

But the state’s list also leaves people with little information about whether residents are still vulnerable in those facilities, she said.

Nick Van Der Linden, spokesman for LeadingAge, which also represents elder-care homes, said his group, too, has questions about the accuracy of the list.

“We have asked the Department of Health to provide us with the criteria that were used,’’ he said. “We remain in close communication with our members and DOH, and will resolve any discrepancies should they arise.”

Some facilities have chosen to give families and the public more information than the state has released.

For example, at Freedom Square, a large senior-living campus in Pinellas County, administrators there reported on Sunday it had 39 residents and 19 employees who have tested positive for COVID-19 and three patients have died.

Executive Director Michael Mason went beyond the state’s reporting by posting on the home’s website that 124 residents and patients and 136 members of the staff had been tested and 95 residents at one building were relocated to area hospitals and facilities. “This specific building, along with the entire campus of Freedom Square of Seminole is undergoing enhanced cleaning procedures,’’ he wrote.

Meanwhile, the industry is concerned that as the cases among the elderly keep rising, the governor and his healthcare advisors aren’t paying attention to their calls for needed protective supplies and crucial tests.

“Over and over, I hear government officials and news media calling for the protection of the most vulnerable in our nursing homes and assisted living facilities. Yet, the most critical element for the protection of our elderly — testing — is non-existent during this crisis,” said Joseph Catania, president and CEO of Catholic Health Services. “Testing of the elderly should have been a priority, not an afterthought.”

Catoe, of the Florida Assisted Living Facility Association, agreed.

“Perhaps the top weapon in this pandemic war is testing — especially now that we know that some people may be infected and communicable but asymptomatic,’’ she said. “The limitations on testing have been one of the greatest impediments to keeping COVID-19 out of our long-term care facilities or controlling its spread.”

Knapp, of the Florida Health Care Association, said that while hospital staff are commended for their heroic efforts to save people, healthcare workers in nursing homes and assisted living facilities “are being villainized.”

Staffers at a nursing home in Madison County where residents have tested positive for COVID-19 were told they could no longer bring their children to a local day care, she said.

“Long-term care is being criticized and villainized on a daily basis and we are at the front line,’’ she said.

She also said the state is sending mixed messages. First Surgeon General Rivkees told facilities they could wear handmade masks to fill the gap in supplies and a day later the Centers for Disease Control and Prevention “says you can’t wear a cloth mask.”

“Give us some direction,’’ Knapp said. “We need supplies. We need more testing. We’re glad the National Guard is coming in because we’ve been asking for testing for a long time....But some facilities are going through 1,000 gowns a day. We are caring for a very vulnerable population. We need staff to feel they are protected.”

Jared Moskowitz, Florida director of Emergency Operations, told the Times/Herald on Tuesday they have heard their call and on Monday delivered 5 million masks, 200,000 face shields and 500,000 gowns to long-term care facilities around the state, more than doubling the supplies the state had previously provided them.

Miami Herald staff writer Bailey Lefever contributed.

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