TED SMITH & BILL HOOVER: Are officials labeling care facilities fairly?

There is no debate that we are in the midst of an unparalleled public health crisis. Given the nature of COVID-19, it is not surprising that a significant percentage of the deaths are centered in nursing homes, where those most vulnerable to this disease congregate. It must be noted that the overwhelming majority of the 15,600 senior care facilities nationwide are doing their job of protecting those in their care.  Yes, there are some facilities that rightfully should be identified and admonished for their lack of preparation and poor management.  But we should be very careful to not paint the entire profession with the same brush.

Here in Durham, North Carolina there is a wide range of how skilled nursing facilities (SNF’s) have so far managed the pandemic. Ultimately, all will be judged accordingly by public opinion and regulatory agencies that govern our profession.  But right now there are crucial life and death issues to deal with.  For example, our Durham facility, Hillcrest Convalescent Center, is associated with one death which was subsequently reported by the state Department of Health and Human Services.  That patient with chronic conditions was transferred by the hospital to us; after three nights in our admission triage unit, the patient was not showing improvement and was returned to the hospital where they died the following day.  The hospital’s last rapid (not laboratory) test indicated positive for the virus.  The short time while at our facility, this patient was isolated in a private room and cared for by staff with full personal protective equipment, so cross-contamination to patients through our caregivers is highly unlikely.  In fact, all staff and all patients were tested; all the test results returned are negative.

Another post-acute, short-term rehab patient from our admission triage unit had returned to the hospital two days earlier and tested positive, so now our SNF is labeled an “outbreak” facility with two positive COVID-19 tests and one death. Thus, a cascade of doubt was immediately cast on our Durham facility and all of its patients and residents.

Not to mention hundreds of hours spent by our anxious staff collecting test samples, completing rosters and sitting in on virtual meetings reiterating everything we are already doing correctly, because of our “outbreak.” Several days were lost that should have been used to provide and continue to protect our patients and staff.  Our staff have worked diligently to follow all federal, state and local guidelines and were successful in preventing an outbreak; their reward was to be branded as failures by the powers that be.

In North Carolina, when a SNF has two cases (and any associated death) of COVID-19 tied to it, regardless of any other mitigating facts, the facility and its essential health care workers are publicly shamed, to warn others the facility is a danger to be avoided. The health department definition and public reporting of two cases being a disease “outbreak” is draconian in this type of circumstance.

This thinking, seemingly prudent on its surface, is strikingly reminiscent of the conundrum at the heart of “The Scarlet Letter,” Nathaniel Hawthorne’s classic novel of life and values in the Massachusetts Colonies during the 17th century. There are competing needs and conflicting values always present in societies, and we must be on guard to avoid simplistic labeling and crude solutions that can distort the truth and be harmful.

It is our sincere hope that time will allow for more appropriate remedies that support all congregate facilities and their essential workers. We must quickly develop better systems and more efficient ways of working together, especially in times of crisis. The public reporting support system should be part of the solution, not the problem.