What was NY thinking? - Printable Version
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What was NY thinking? - BostonCard - 05-14-2020
https://www.wsj.com/articles/new-york-sent-recovering-coronavirus-patients-to-nursing-homes-it-was-a-fatal-error-11589470773
This will be a scandal as bad or worse than the lack of testing. Howard Zucker (New York Health Commissioner) should be fired over this, and NY voters should hold Cuomo accountable for this ridiculously stupid decision.
I get that NY was trying to reduce the burden on hospitals, which were overburdened. But to send them to nursing homes without checking to ensure they were not infectious was indefensible.
BC
RE: What was NY thinking? - 2006alum - 05-14-2020
Absolutely appalling:
Quote:The day the policy was issued, Mr. Cuomo was closely focused on an expected brobdingnagian shortfall in hospital capacity amid surging coronavirus cases. He said in a press conference that day the state was looking at options such as hotels and former nursing homes.
Mr. Cuomo didn’t mention the nursing-home directive, which said patients referred from a hospital couldn’t be denied admission or readmission to a nursing home “based on a confirmed or suspected diagnosis of Covid-19,” and that nursing homes couldn’t require incoming patients to be tested.The governor over the following weeks defended the March 25 policy and said repeatedly that nursing homes shouldn’t accept patients if they believed they couldn’t care for them. The directive was meant to protect those infected with coronavirus from discrimination, a state official said.Nursing-home groups and physicians warned about the order’s potential effects. AMDA, the Society for Post-Acute and Long-Term Care Medicine, said that admitting infected patients represented a “clear and present danger” to nursing-home residents.
As I've said before and will continue to say again and again, in my experience as a New Yorker, New York politicians from top (Trump) to bottom (De Blasio) are much better at attracting press and taking credit (ok, maybe not De Blasio) than they are at carefully managing policy and governance. Cuomo is great in a press conference but his multi-year oversight (both meanings intended) of the MTA was disastrous and his and De Blasio's inability to work together at all is almost surely part of why the pandemic hit the greater NYC area so hard.
RE: What was NY thinking? - dabigv13 - 05-14-2020
I don't have a WSJ sub so I can't read the article, but do want to provide some perspective.
I'm certain that hospitals probably had a very real problem of nursing homes refusing to take back prior patients who had a covid diagnosis but were recovered. Nursing homes will refuse to take back their prior patients for a hundred reasons, but especially something like this. Now, ideally they are no longer infectious when they go back, but we still dont really know how long people are on average infectious for or what a positive PCR result 3 weeks out means in terms of still being infectious.
I have a friend in Washington who has had plenty of fully recovered nursing home patients sitting for days in the hospital, sometimes throwing a positive PCR a month out. Others even with negative PCR results will be rejected.
It's not an easy issue. Perhaps if there were dedicated nursing homes only for recovered covid patients, but that's not really how our system is set up obviously.
RE: What was NY thinking? - BostonCard - 05-14-2020
Based on my reading, it wasn't an issue of forcing nursing homes to take back former residents, but forcing them to take any recovering COVID-19 patient, where they had been a previous resident or not. Don't get me wrong, I was a medicine resident once, and I sympathize with the problem of trying to discharge a patient to a nursing home (thankfully I never had to do it in the midst of a pandemic).
Quote:Luxor Nursing & Rehabilitation had no confirmed coronavirus cases before the patients moved in, and can’t say if any arrived while still infectious, a spokesman said. But he added: Luxor “would not have accepted [the patients] without this directive.”
The issue is that no thought was put into this. By the time the crisis hit, it was well known that elderly patients were particularly susceptible to COVID-19. There had already been an outbreak in the nursing home in Washington. So, if you have to get recovering COVID patients to a SNF but you don't want to infect other residents, you basically have to make dedicated SNF's for COVID survivors who still need nursing care. There is just no way that infection control practices at nursing facilities are able to cope with COVID-19. This was an appalling directive by Zucker. Apparently New Jersey and California have a similar directive:
https://www.nytimes.com/2020/04/24/us/nursing-homes-coronavirus.html
(I think the NY Times has not paywalled its Corona coverage)
Quote:At the epicenter of the outbreak, New York issued a strict new rule last month: Nursing homes must readmit residents sent to hospitals with the coronavirus and accept new patients as long as they are deemed “medically stable.” California and New Jersey have also said that nursing homes should take in such patients. Homes are allowed to turn patients away if they claim they can’t care for them safely — but administrators say they worry that refusing patients could provoke regulatory scrutiny, and advocates say it could result in a loss of revenue.
In contrast to these states, Connecticut and Massachusetts designated certain facilities for Covid-19 patients alone — considered the safest way to free up hospital beds. The Washington Health Care Association, which represents long-term care facilities in Washington State, has asked officials to adopt a similar policy; so far, they have not.
Yeah Connecticut and Massachusetts. Boo NY, NJ, CA, and WA.
BC
RE: What was NY thinking? - 82 Card - 05-15-2020
California may not have sent new coronavirus patients to nursing homes but leaving coronavirus patients in nursing homes was done. For example, a Contra Costa County Health Services press release says:
Quote:CCHS tested all patients and staff Thursday. While results continue to return, 24 residents and three staff members have tested positive so far. Two residents who tested positive are receiving care at local hospitals.
The other 22 were left in the nursing home.
RE: What was NY thinking? - OutsiderFan - 05-15-2020
Connecticut designated Covid-only nursing homes this week, so let's not throw a parade for it just yet.
My nurse friend's facility was forced to accept untested new patients starting at the end of April. Hospitals wanted them out of their care and they had nowhere else to go. The testing capacity didn't exist, nor did the facility plans, to get anything right on this front. There is plenty of blame to go around at all levels.
New Jersey talked about Covid-only places but the logistics were insane.
RE: What was NY thinking? - BostonCard - 05-15-2020
New York set up field hospitals in Central Park. The state should have realized that it needed to prepare for what to do with patients when they no longer needed to be hospitalized but still couldn't go home. Yes, the logistics of having COVID-only SNF's were insane, but sending patients recovering from COVID-19 to nursing homes with non-COVID patients was more insane.
BC
RE: What was NY thinking? - akiddoc - 05-16-2020
California has been doing the same thing.
RE: What was NY thinking? - BostonCard - 05-16-2020
Yeah, as mentioned in the NY Times article, and it is a mistake. You will get a few patients discharged faster, at the cost of having to admit a lot more patients with COVID-19 later, when the virus spreads in the SNF.
BC
RE: What was NY thinking? - OutsiderFan - 05-17-2020
A lengthy Pro Public story outlining the differences between San Francisco and New York City pandemic responses:
https://www.propublica.org/article/two-coasts-one-virus-how-new-york-suffered-nearly-10-times-the-number-of-deaths-as-california
One thing I will say is this reporting does a great job making a case (unintentionally) that partisan politics are not the reason for S.F's success and NYC's failure, because both cities have D Mayors with D Governors. To me it demonstrates the importance of leadership talent. Based on this piece, London Breed is better qualified to lead than Cuomo or de Blasio. It's also pretty cool to know S.F. is the #2 most densely populated city in America after NYC, so the density argument for NYC vs. SF doesn't hold water.
RE: What was NY thinking? - Griffins78 - 05-17-2020
From the beginning I couldn't understand why everyone was praising Cuomo for his leadership. I couldn't stand listening to him and my friends reassured me it might be because Cuomo talked like a typical New Yorker.
My take was that because NYC was the biggest hot spot and the global media and financial center - they all paid attention to Cuomo. Their lives and livelihoods were dependent upon what was happening in NYC and he was much better than Trump. CNBC follows the markets most of the day and reported on or cut away for Cuomo's daily briefings. Oh and DeBlasio was generally being made out to be a failure and Cuomo the savior.
Very little was being talked about Newsom nationally. But I felt so fortunate we had him, our County Health Directors and city/county leaders not only monitoring and responding to the early warnings but working cooperatively across agencies. The article puts emphasis on sheltering in place but what wasn't elaborated on was the mobilizing and organizing that happened behind the scenes, not only to coordinate agencies but to put in place a stunning number of initiatives, programs, and activities to deal with the crisis. Here is a list of CA Actions.
Reading the article provided greater insight into the political machinations in NY and paints a very different, negative picture of Cuomo, in many ways, not very different from Trump. Credit and blame are central and lack of sound compassionate leadership and decision making. Credit taking for the heroic efforts of others. New Rochelle was considered the center of the COVID-19 fight but the Bay Area and Seattle had earlier cases and reacted differently and better. In reality, both Trump and Cuomo are interdependent upon each other in this crisis. Trumps failures impacted NYC and put the spotlight on Cuomo but Cuomo's failure impacted the U.S. and put the spotlight on Trump.
Glad to be in the SF Bay Area.
RE: What was NY thinking? - OutsiderFan - 05-17-2020
There is no more trustworthy source of journalism than Pro Publica for me, so when it report facts that make Cuomo look bad, I don't for even a millisecond think there is some biased attack against him going on. Cuomo has done some good things, but clearly his preparation and initial response was really poor. After realizing the scope of the problem, which was only as a result of not responding fast enough, he's been better. He's really good in front of the media, which colors the totality of his performance and how people judge him. Talking a good game is not the same as performing well in one, however, and most people weren't watching the game. Pro Publica covered it for those who didn't.
It makes sense that if you see the dismal U.S. numbers and conclude the federal government failed miserably, New York's numbers suggest a similar degree of failure with its government.