Advocates for nursing home residents have raised concerns that some facilities being used by Florida officials as isolation units for those who test positive for the coronavirus have a checkered history of citations. Despite official assurances that the facilities have been fully vetted, it's a move they say could further endanger those who are already highly vulnerable.
“Some of these centers are nursing homes that have been repeatedly fined or sued for negligent acts, including failing to institute adequate infection and disease control precautions,” said David Brevda, an attorney at the Boca Raton-based Senior Justice Law Firm. “We are dealing with numerous COVID-19 cases, and we have seen clients put into these amorphous 'isolation' centers. The rules and regulations governing these facilities are fast and ever-changing.”
Four of the 23 Florida facilities set aside to serve as isolation centers for elderly coronavirus patients are on the Florida Agency for Health Care Administration (AHCA) watch list for either failing to comply with the state’s minimum standards or operating under bankruptcy protection during the past 30 months. They are among the seven isolation facilities being used that currently hold ratings of “below average” by Medicare. One of the nursing homes, Avante at Boca Raton, was fined for more than $76,000 for various infractions in 2019.
Florida has been a hot spot for the virus in recent weeks, averaging more than 3,000 new positive cases a day, though the figure has been falling since a peak last month. More than 4,000 of the state’s 10,500 coronavirus-related deaths have occurred at long-term care facilities.
As the outbreak worsened, Florida Gov. Ron De Santis adopted a different approach to nursing homes infections than the one used by New York Gov. Andrew Cuomo, who has faced criticism for directing nursing homes in the state to let residents return after being hospitalized for COVID-19. New York has reported more than 6,600 deaths at long-term care facilities, out of a total of 32,000 fatalities.
In Florida, DeSantis called for the establishment of special COVID-19 isolation centers to serve people in need of long-term care services who have contracted the virus. Some isolation centers have been set apart in dedicated wings within a larger facility, while others are now in standalone facilities. All are supposed to provide clinical monitoring and isolation to patients from hospitals, long-term care facilities or local communities until they can safely return to their assisted living facility and nursing home.
Kristen Knapp, a spokesperson for the Florida Health Care Association, which has partnered with Florida's ACHA, the government agency that oversees the centers, said that facilities receive a reimbursement for serving as an isolation center, but she did not specify the amount.
“These dedicated recovery buildings and units are a proven model that Florida has pioneered across our state,” said Patrick Manderfield, Florida ACHA's Deputy Communications Director. “These facilities serve to protect our elderly and most vulnerable in our state’s emergency response.”
Dr. John Brownstein, an epidemiologist at Boston Children's Hospital, said that conceptually the idea of isolation centers makes sense.
“We need to ensure the virus doesn’t spread through vulnerable populations,” said Brownstein, also an ABC News contributor. “Nursing homes and assisted living facilities represent some of the most concerning environments for disease transmission so isolated infected individuals is a key part of that. However, clearly there needs to be a standard of care and transparency around infection control procedures.”
Manderfield dismissed concerns about the use of facilities that had subpar ratings, saying the state carefully vetted isolation locations and made certain all were “in full compliance” with state and federal nursing home regulations. He said the state reviewed every facility “to ensure they are capable of maintaining safe and separate spaces for COVID-positive patients.”
When asked if the three facilities the Avante group owns that are on the AHCA watch list and have scored below average ratings are qualified to serve as COVID-19 isolation centers, Biegasiewicz said the company responded with strict infection control policies "to ensure that our residents are getting the most up-to-date and most important infection control practices provided to them."
“We really felt that it was an opportunity to assist the state of Florida and definitely assist our most vulnerable populations, which we know is our elderly population,” Biegasiewicz said.
Biegasiewicz said the state agency did not outline any specific requirements for the isolation facilities.
Brian Pollet is the administrator of the Ybor City Center for Rehabilitation, another one of the state’s 23 isolation centers and one rated above average by Medicare. He said the Florida Department of Health made multiple visits to the facility before being asked to serve as a landing spot for infected patients. It now has 24 beds dedicated to the effort.
“I guess the agencies were impressed by the way we engineered our units,” Pollet said.
Currently, nursing homes that fail to test residents and staff for coronavirus after hints of an infection could face fines under new measures by the federal Centers for Disease Control and Prevention. But advocates for the elderly said they would like to see Florida and other states establish clear standards specifically for COVID-19 isolation facilities, beyond the usual standards for long-term care facilities.
Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, a nonprofit that provides legal assistance for the elderly, told ABC News that isolation centers should have a full time infection preventionist on top of the federal regulations that are required for all nursing homes.
“There are currently no federal standards,” Edelman said of the COVID-19 isolation facilities.
Edelman added that he believed “facilities with poor records in staffing and infection prevention should not be eligible for designation as COVID-only facilities.”
Eric Carlson, a long-term care expert with the advocacy group Justice in Aging, said facilities may be motivated to serve as a COVID-19 isolation center because of the “higher Medicaid rates paid by the state for COVID-specific care, or simply by a desire to fill empty rooms.”
Carlson said that the lack of COVID-specific standards puts residents at coronavirus isolation facilities in danger.
The lack of specific standards, he said, “leaves the door open for mediocre or bad facilities to put themselves out for COVID-specific care, in an effort to bring in more residents, in situations where the residents may have few options.”
Editor's Note: This story has been updated to correct the name of the organization that maintains the watch list referenced. It is Florida's Agency for Health Care Administration.