Two new units designed for COVID-19 patients who have recently been discharged from hospitals have opened at nursing homes operated by Novi, Mich.-based Optalis Healthcare, according to CEO Raj Patel.
The hospital step-down units, called subacute-care units, are located at Evergreen Health and Rehabilitation in Beverly Hills and the Shelby Health and Rehabilitation in Shelby Township.
"We were starting to see our surge" of coronavirus-positive patients last week, Patel said. "The past week or two we are seeing more patients discharged from hospitals or needing additional care (from nursing facilities)."
Nationally and in Michigan, hospitals began clearing beds in early March to care for the influx of coronavirus patients.
But now, as hospitals begin to discharge somewhat recovered patients, doctors have been looking for facilities to transfer the patients, many of whom still require round-the-clock care. Some have been sent to the TCF Center in Detroit, which has been converted into a field hospital for patients with coronavirus.
The Health Care Association of Michigan, which represents nursing homes and assisted-living enters, said it is not aware of any other nursing homes that have opened subacute-care units. Several have applied for approval.
Optalis' 44-bed Evergreen assisted-living unit was lightly occupied before it was converted, Patel said. It is connected to Optalis' long-term-care facility, which is 2 ½ miles from Beaumont Hospital Royal Oak, a hospital hard-hit with admissions of COVID-19 patients.
"Hospitals were looking for places to discharge patients to as a step-down unit," Patel said. "We are proud we are able to convert space from residential to a high-tech subacute unit with complete medical equipment: oxygen tanks, personal protective equipment, high-resolution cameras into patient rooms and limits in and out of rooms."
To help staff the units, Patel said Optalis uses its own staff, but it also teamed up with Madonna University and nursing school Dean Judith McKenna to use faculty and fourth-year nursing students.
About 25 students and faculty are working on the units, Patel said. They are getting paid while getting externship hour credits toward graduation, he said.
The students include four-year bachelor's degree nursing students, who are graduating in May, and also nursing students graduating in August 2020 as part of Madonna's accelerated bachelor's degree program.
Patel said Optalis is reporting the number of COVID-19 patients it has at its 13 nursing, rehabilitation and assisted-living facilities to the Michigan Department of Health and Human Services. He declined to provide the nursing home chain's numbers to Crain's.
A spokesperson for the department said the state hopes to begin reporting data from nursing homes this week.
Last week, CMS ordered nursing homes to report residents testing positive for COVID-19 to the Centers for Disease Control and Prevention. Nursing homes already were required to report those numbers to state health officials.
Michigan has about 440 nursing homes in the state. Nationally, there are about 15,600 with 1.3 million residents, according to the Centers for Disease Control and Prevention.
State allows hospitals, nursing homes to expand to fight coronavirus
On March 20, Optalis applied for emergency certificate-of-need to expand its two facilities. It applied two days after Gov. Gretchen Whitmer issued executive order 2020-13. The governor's order permitted building of temporary enhancement and expansions of healthcare facilities and relaxing credentialing requirements of healthcare workers to fight against the coronavirus pandemic, which has claimed more than 2,200 lives in Michigan.
Patel said Evergreen was one of the first in the state to receive a CON that allowed it to convert an existing 44-bed assisted-living unit to a closed and isolated COVID-19 unit. A second 28-bed COVID-19 unit was created at Shelby Health and Rehabilitation in Macomb County, he said.
"The patients (admitted) are far more stabilized and have been weaned off ventilators," Patel said. "They are typical sub-acute patients, in recovery mode. They have survived but we test them before they come in and we have clinical nurses reviewing admissions. There are cases we can't take. We look at the patient's condition and oxygen level requirements."
At Evergreen, assisted-living patients were moved to an alternate location to create a closed COVID unit, Patel said. "We have separated it from the rest of building with its own exterior doors," he said.
Patel said the units were remodeled to accommodate the isolation needs of patients and for staff safety.
"New procedural items were developed to reroute laundry and dietary to avoid contact with the non-COVID areas of the building," said Patel, adding that laundry and dietary procedures were established to minimize exposure to the other parts of the building.
"A separate entrance was designated for staff to come and go from the unit," he said. "A changing room was made for staff to utilize agency scrubs that are laundered in house reducing the risk of outside contamination. A separate break room within the area of the COVID unit was set up."
All beds are now fully electric and cameras were installed to limit exposure into rooms for monitoring patient safety, an Optalis official said.
A large screen at the nursing station allows nurses to see patients while their room doors stay closed.
"Staff from this unit only takes care of patients on this unit and does not cross over to non-COVID patients," Patel said.
But Patel said he is unable to give the number of total patients in the two units.
"Patients are generally from local hospitals, but we are unable to give you specifics by hospital to avoid appearance of preference," Patel said. "Several patients have been discharged to either home back to the non-COVID unit" back in the nursing home.
Most patients are 65 and older and covered under Medicaid and Medicare, he said.
Patel said healthcare workers are receiving 15% to 20% hazard pay on top of their normal hourly wages.
"Staffing levels change daily with census but in general, the COVID units require double or more staffing ratios than the average subacute unit. It is very labor-intensive," Patel said.
Optalis' COVID-19 units are staffing a nurse-patient ratio of 1 to 6 or 8 patients compared with a 1-to-12 ratio, he said.
"Taking care of patients in subacute settings is very expensive," Patel said. "We could really use (state and federal) help with funding. This is not a profitable situation, but we are not worrying about going broke. We care about our patients and will do whatever we need to do to care for them."