One in five Florida nursing homes tell feds: We hardly have any gowns, masks

Another problem is federal data: Long-term care facilities appear to be submitting inconsistent and erroneous figures.
Sunstar employees walk gurneys into a wing of St. Mark Village nursing home in Palm Harbor on April 20 to evacuate residents who tested positive for COVID-19.
Sunstar employees walk gurneys into a wing of St. Mark Village nursing home in Palm Harbor on April 20 to evacuate residents who tested positive for COVID-19. [ CHRIS URSO | Times ]
Published Jun. 5, 2020|Updated Jun. 5, 2020

Nearly one in five Florida nursing homes say they do not have a one-week supply of protective gowns or the N95 masks recommended for care of patients with COVID-19, according to new data released by the federal Centers for Medicare and Medicaid.

A handful of nursing homes say they do not have any gowns or N95 masks at all.

The data, which is current through May 31, provides a glimpse into the conditions at nursing homes, which continue to be ravaged by the novel coronavirus even as much of the state reopens.

For months, front-line healthcare workers at nursing homes and other healthcare providers have sounded the alarm that shortages in protective equipment have forced them to reuse equipment designed to be used once, or use less-effective alternatives.

Related: The Scrapbook: What life has been like during the coronavirus pandemic

The state agency that regulates nursing homes, the Agency for Health Care Administration, requires homes to complete a daily report listing their shortages, and the Florida Division of Emergency Management has gone on so many frantic buying sprees to obtain protective gear that it repeatedly claims to have no shortages.

“We’re going to have 10 million masks in reserve by the time hurricane season starts,’’ said Jared Moskowitz, state emergency management director on May 6, adding that long-term care facilities would have “10 million masks by the end of this week.”

Hurricane season started this week.

Related: A hurricane during the pandemic would be bad. The economic crisis will make things worse.

However, the reports to federal regulators show Moskowitz’s claims may have been off the mark. A greater share of nursing homes in Florida said they lacked a one-week supply of N95 masks than nursing homes nationally, according to the data released Thursday. Roughly 10 percent of Florida nursing homes don’t have a one-week supply of eye protection and roughly 5 percent don’t have a one-week supply of gloves or hand sanitizer.

The numbers also stand in stark contrast to what Gov. Ron DeSantis has said in recent days about the state’s efforts to supply nursing homes with protective equipment.

While some facilities had the capacity to equip staff with enough masks, gloves and gowns, other facilities “just don’t have as much,‘’ the governor said in Orlando. “So we’re also putting the money where our mouth is. The state has delivered more than 10 million masks, a million gloves, half a million face shields and 160,000 gowns just to long-term care facilities throughout the course of the pandemic.’’

However, in interviews with the Miami Herald, nursing home staff described how protective gear has been either rationed or hoarded by management, leaving them exposed and working in fear. Administrators said they have received some supplies from the state emergency stockpiles, but it has been far short of meeting the need.

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Related: Got questions about Florida’s Phase 2 reopening? We’ve got answers.

As the governor announced that 64 of the state’s 67 counties would loosen social distancing requirements beginning June 5 — by reopening bars, nightclubs, theaters and bowling alleys — he emphasized that the danger of death from the virus is low for most people, except those living in long-term care homes.

“I think there’s probably a pretty clear distinction between fatality 65 and over, who are in long-term care facilities, versus 65 and over who are not, who are living independently,’’ DeSantis said.

He noted that only 15 percent of all COVID-19-related fatalities in Florida have been in ages 65 or below while “there have been more COVID-related fatalities over the age of 90 than the total number of COVID fatalities that have occurred in Florida under the age of 65.”

As the state has relaxed social distancing rules, cases and deaths among the most vulnerable continue to mount. As of Thursday, 1,332 people at long-term care facilities had died from COVID-19, more than half of all the deaths since the state started tracking deaths in March.

Dirty data

The federal data released Thursday represent an incomplete picture of the current state of affairs in Florida, as roughly one in seven nursing homes in the state failed to submit data in each of the first two weeks in which it has been required. While the federal government is giving facilities a two-week grace period, facilities will be penalized starting at $1,000 a week if they fail to submit data by Sunday, June 7.

The Fair Havens Center in Miami Springs, which has reported the most COVID-19-related deaths of any long-term care facility in the state — 33 — and has been sanctioned by Florida’s Agency for Health Care Administration, was among the 97 nursing homes that failed to submit data in the most recent week. The facility repeatedly hung up on a reporter for the Herald who called to request comment.

The data itself is riddled with inconsistencies and what seem to be obvious errors. Numerous facilities show far more deaths in the federal data than they have reported to the state.

None more so than the Sunset Lake Health and Rehabilitation Center in Venice, which is listed as having 103 COVID-19 deaths among residents in the federal data but hasn’t reported any deaths to the state. The facility did not provide comment to the Herald.

The 103 deaths is more than have been reported in all of Sarasota County, where the home is located.

Related: Florida medical examiners were releasing coronavirus death data. The state made them stop.

Other facilities said the higher totals in the federal data were a mistake.

Though it has reported a total of three resident deaths to the state, the Bentley Care Center in Naples is reported as having 55 resident deaths from COVID-19 in the federal data. The facility said the state figure is correct.

The Gulf Shore Care Center in Pinellas Park has reported eight resident deaths so far to the state, a far cry from the 44 deaths in the federal data.

Louise Merrick, the home’s executive director, said the facility has now had a total of 12 resident deaths.

“But it was not 44, thank goodness,” she said.

In a call with reporters Thursday CMS officials indicated that the data would likely have flaws.

“We’re going to continue to work on scrubbing the data,” said Seema Verma the administrator of CMS. “We may find issues as we go on, but we wanted to be as transparent as we can be with the American people.”

The Florida Health Care Association, a nursing home trade group, said in a news release the numbers show Florida has fewer deaths per capita among nursing home residents than nursing home dwellers in the nation at large, an indication that Florida staffers are doing “an incredible job.”

Former Kansas Gov. Mark Parkinson, president and CEO of the American Health Care Association, said the new nationwide comparison supports the need for additional resources sought by nursing homes since the beginning of the pandemic.

Elder-care advocates applauded the release of the data but questioned whether CMS is doing enough to go after negligent homes.

“We’re getting our first real sense of the magnitude of the problem because we are seeing the numbers across the board for every state,’’ said Brian Lee of Families for Better Care, an advocacy organization for families and residents of nursing homes.

“The bad thing is, we are still missing a lot of data and even CMS recognizes this is wildly erratic. Consumer’s don’t have a good feel about which homes have an outbreak.”

Lee said he was surprised at how little enforcement action was occurring by federal regulators at a time when an infectious disease has caused a staggering number of deaths in nursing homes in Florida and other states.

For example, federal regulators cited only three Florida nursing homes for putting patients in “immediate jeopardy’’ for negligent actions. Each of them — Heritage Park Rehabilitation and Healthcare in Fort Myers, Encore at Boca Raton Rehabilitation and Nursing, and Palm Garden of Vero Beach — was cited in March for violations and none were COVID-19 related.

“COVID made nursing homes and assisted living facilities killing factories, and what you’re not seeing in the data is the reality of what the situation is,’’ he said.

The data is the result of new rules from the Centers for Medicare and Medicaid Services requiring nursing homes — but not assisted-living facilities — to report virus death data to all residents and their families, as well as directly to the Centers for Disease Control beginning on May 1.

While the state has prohibited visitors to nursing homes, assisted living facilities and other long-term care facilities, it has refrained from requiring that all residents and staff be tested, unless they are transferred from a hospital.

Now, the equipment shortages could complicate the ability of nursing homes to comply with a rule that was modified this week by the Agency for Health Care Administration.

The agency prohibits hospitals from discharging COVID-19-positive residents back into the long-term care facilities except under certain conditions. If a patient has never tested positive for COVID-19 and is tested, the hospital can release the patient back to a nursing home while they await the results of the test if the nursing home has sufficient protective gear and an isolated room.

“As long as there are no symptoms or reason to suspect the patient may be positive, they may be admitted to the long-term care facility into a single-person room or in a separate observation area so the resident can be monitored for evidence of COVID-19,’’ the Agency for Health Care Administration wrote in its revised rule this week.

However, it added, “facility staff should wear an N95 or higher-level respirator [or facemask if a respirator is not available], eye protection [i.e., goggles or a disposable face shield that covers the front and sides of the face], gloves, and gown when caring for the resident while awaiting test results.”

The Agency for Health Care Administration has established five nursing homes dedicated exclusively to housing long-term care residents who are suffering from the effects of the virus and DeSantis said the state is hoping to establish several more facilities.

“That’s very, very important because allowing folks to stay in long-term care facilities, if they’re not appropriately isolated, you know that will lead to spread going forward,’’ he said.

This story was written by Miami Herald reporters Ben Wieder and Mary Ellen Klas.

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