Minnesota Nursing Home Residents Have Been Endangered by State's Virus Response

In March, as nursing homes were beginning to limit visitors in order to slow the spread of COVID-19, the heartwarming story of a man visiting his father at a Minnesota nursing home every day, sitting outside his window while chatting with him on the phone, made its way into many social media feeds. The story offered encouragement and hope in the midst of uncertainty. Come what may, the most vulnerable members of our communities would be cared for and we would weather this storm together. Putting nursing homes in lockdown and keeping families away from loved ones may be difficult, but if it was keeping people safe, it must be worth it, right?

By late April things had shifted. It became clear that elderly populations might not be as safe in nursing homes as people had hoped, and by the third week of May, Alpha News reported that Minnesota had the highest percentage nursing-home related COVID-19 deaths nationwide. What happened? Minnesota had followed New York and other states in funneling COVID-19 patients out of hospitals and into nursing homes.

Last week the Washington Post reported that over 25,000 nursing home residents had died and 60,000 have been infected with COVID-19 as the virus has swept across the U.S., accounting for over 20% of the U.S. COVID-19 death toll. Throughout this time, New York state led the way in requiring nursing homes to accept COVID-positive patients in order to free up hospital beds, a move followed by California and New Jersey. All three states had instances of nursing homes failing to follow necessary safety measures due to poor staffing, lack of follow-through, or lack of necessary PPE, compromising the safety of staff as well as residents and increasing the likelihood of staff spreading the virus from one resident to the next. This failure on the part of the state, as well as nursing homes and hospitals, to protect at-risk individuals from infection is truly unacceptable made worse by the possibility that this was financially motivated. These policies were finally reconsidered when faced with public outcry.

In Minnesota, the state did not go so far as requiring nursing homes to accept COVID-positive residents, but Minnesota Department of Health guidelines encourage this practice. Emphasis on concerns of overcrowding hospitals created pressure to discharge COVID-19 patients as soon as possible, and many of those patients are discharged to long-term care facilities. Minnesota has 11 long-term care facilities that are designated “COVID support sites.” These facilities have been vetted by the state and deemed to be in accordance with state safety standards, but hospitals are allowed to arrange private agreements with other nursing homes that have not undergone this vetting process and discharge COVID-positive residents to these facilities.

Under threat of legislative subpoena, the Minnesota Department of Health finally released data on which long-term care facilities in Minnesota have COVID-19 outbreaks. The department has assured critics that none of these outbreaks began as a result of accepting a COVID-positive patient from a hospital, but Commissioner Jan Malcolm has acknowledged that the MDH has not compared infection rates in facilities that accepted COVID-positive patients and those that did not. It is true that not all of the nursing homes that have had COVID-19 outbreaks had accepted COVID-positive patients—of 863 facilities with outbreaks, 319 had accepted COVID-patients from hospitals. However, the widespread infection rates do indicate a failure to maintain protocols within nursing homes that would prevent the spread, especially considering that the MDH also released data revealing that 29% of long-term care facilities surveyed were not following infection prevention and control guidelines. These failures put residents’ lives on the line.

Age was identified as a risk factor for COVID-19 long before there were confirmed cases of the virus in Minnesota, which is why there were state-wide restrictions on outside visitors to nursing homes by the end of March. Why then did it take Governor Walz until May to release a “battle plan” for addressing the spread in long-term care facilities? Walz has insisted that discharging COVID patients to nursing homes was “not a mistake,” citing the statistic that hospital-acquired infections kill over 9,000 people per year. Commissioner Malcolm has used the same line of argument to defend MDH guidelines. Under normal circumstances it may be reasonable to discharge a patient from the hospital to a nursing home as soon as possible, but circumstances over the past three months have been anything but normal.

When dealing with a virus that is especially dangerous to older populations and can be spread by pre-symptomatic individuals for over a week before they show signs of infection, discharging patients to nursing homes is gambling with the lives of nursing home residents, especially when there is not proper oversight guaranteeing that long-term care facilities accepting said patients are in compliance with infection control guidelines. Furthermore, it is questionable if discharging COVID patients to nursing homes really does decrease the strain on hospitals, considering that patients are discharged to a setting where they are likely to infect other at-risk individuals, many of whom will require hospital care.  

Even after nursing homes had been identified as COVID-19 hotspots in Minnesota, long-term care facilities continued to accept COVID-positive patients, state officials continued to defend the practice, and no serious action was taken to ensure that facilities were following infection prevention and control guidelines. While families were denied access to their loved ones, there was a lack of proper oversight from the state ensuring that nursing home residents were being adequately protected from the virus. Many residents endured isolation from their families only to contract the virus from staff or other residents at their long-term care facility.

At the heart of this problem is a disregard for human life and dignity. No society that truly values life is willing to tolerate a low standard of care for its vulnerable members. With over 80% of Minnesota’s COVID-19 deaths occurring in nursing homes, far too little was done to protect residents. Throughout the COVID-19 pandemic, nursing home residents have faced loneliness and isolation in hopes of being protected from the virus only to find themselves in COVID-19 hotspots. The mishandling of the COVID-19 outbreak in Minnesota’s long-term care facilities reveals a dismissive attitude toward human life and dignity. For the families that have lost loved ones, the state’s response has been far too little and far too late.