Florida picked nursing homes with spotty records for COVID isolation centers
John Pacenti , Holly Baltz | Palm Beach Post In the days before COVID-19 pounded…
| Palm Beach Post
In the days before COVID-19 pounded Florida with the power of Thor’s hammer, Gov. Ron DeSantis repeatedly bashed New York for sending elderly coronavirus patients from hospitals back to nursing homes.
DeSantis’ touted the state’s own solution back in May to relieve hospitals: Seniors who still tested positive for the novel coronavirus but were well on the road to recovery would be sent to a new and yet-to-open Jacksonville nursing home.
Florida ended up designating 23 isolation centers before DeSantis’ administration abruptly — and surprisingly — reversed course on Tuesday, announcing it was shutting down the project by stopping admissions at all the facilities by Oct. 1.
The isolation centers were DeSantis’ favorite talking point in protecting seniors in elder care facilities. They were also quite lucrative for the industry at taxpayers’ expense.
Yet, one-third of the isolation centers picked had spotty records on infection control or financial issues that could affect the care of the patients most vulnerable to the disease, a Palm Beach Post investigation found.
And a number of the isolation centers rank in the Top 20 in the state for the number of COVID deaths at facilities.
“You look at the overall ratings, they are not the best facilities in the world. You don’t see the five-star nursing homes going out to designate themselves to be COVID facilities,” said Brian Lee, director of the advocacy group Families for Better Care and who for seven years served as Florida’s ombudsman at the Department of Elder Affairs.
Lee said it seems as if the state just threw darts at a map of Florida to pick the isolation units without checking their own inspection reports. Some of these isolation centers were just dedicated wings at nursing homes while others were COVID only.
The Post investigation found:
- Violations at three centers involved the care of COVID patients and protecting others from the deadly virus.
- Seven of the isolation centers picked have been on the state’s watch list for not meeting minimum standards for nursing care or not correcting violations, COVID or not, in a timely manner.
- Two are part of a chain ordered to pay a $250 million fraud judgment that could put the chain out of business.
As a result, COVID-positive seniors were shuttled for the summer to isolation centers, some of which have struggled with even handling day-to-day care of residents pre-pandemic.
The state’s Agency for Health Care Administration, which regulates nursing homes in Florida, said it always rode herd on these isolation centers.
“The agency thoroughly reviews the regulatory history for nursing homes serving as COVID Isolation Centers, and COVID Isolation Centers receive enhanced oversight given the resident populations they serve,” the agency said in an email in August to The Post.
“Further, we are in daily communication with these providers regarding the status of admissions and discharges of residents.”
Ten of the isolation centers, though, failed quality assurance checks that verified COVID data submitted by the nursing homes to the Centers Disease Control and Prevention, The Post investigation found.
“That’s stunning,” Lee said. “How is it possible that nearly half of these facilities designated as isolation facilities are pushing invalid data? That begs the question, ‘What about the data these facilities are sharing with state officials?’ How is AHCA supposed to reimburse facilities properly if the counts are incorrect in so many cases?”
Just last month the isolation centers were going strong.
As of Aug. 26, AHCA reported 1,003 patients in about 1,600 beds in the 23 COVID isolation centers. The agency reported in August that 363 patients had been transferred from a nursing home or assisted living facility to a COVID isolation center and another 1,945 patients were transferred from hospitals.
Eighteen of the 23 have reported 242 deaths in total by Sept. 12.
Cashing in on COVID
Palm Beach County has four COVID isolation centers.
One, Avanté at Boca Raton, somehow missed for three weeks that a remote-control door opener had been pilfered, allowing a resident who had refused to follow contact precautions to escape. He was found across the street on a park bench hours after his flight, records show.
Avanté at Boca was on the state’s watch list in November. It has received an overall below-average Medicare rating and been fined more than $76,200 by federal officials for violations in the past three years. Still, an Avanté executive joined DeSantis at a Miami news conference on July 7 to tout the success of the isolation centers.
The three other isolation centers in Palm Beach County are Lake View Care Center in Delray Beach, Oasis Health and Rehabilitation Center in Lake Worth Beach and Consulate Health Care of West Palm Beach. They have not been cited for any infection control problems in the past year yet have a total of 41 COVID deaths between them.
All rank among long-term care facilities with the most COVID deaths in Palm Beach County, a Sept. 13 Department of Health report shows. Oasis has 17, Lake View has 14, Avanté has 12 and Consulate has 10.
Isolation centers were certainly money-makers for the elder care industry.
AHCA said Monday that elder care centers receive $325 per day for Medicaid patients needing COVID care in addition to the normal reimbursement rate, which averages $240 per day. That breaks down to about $17,000 a month for one COVID patient in an isolation center — all at taxpayers’ expense.
Nursing homes can get additional money from private insurance and Medicare, the agency noted. “That is a huge windfall for them,” Lee said.
The elder care industry has also reaped billions of dollars in federal assistance because of COVID, the advocate said. The pandemic plays right into a dynamic that has always benefited nursing homes and assisted living facilities.
“The worse the care the nursing home delivers the more they get paid. They get a higher reimbursement for pressure sores or urinary tract infections,” Lee explained. “So it’s an incentive for the homes to take COVID patients. That’s because it’s more money.”
This cash register rang loudest in the creation of a 150-bed Miami isolation center.
The Miami Herald reported in July that the state’s Department of Emergency Management forged a $1 million-a-month deal to turn a former hospital owned by Nicklaus Children’s Hospital into a 150-bed isolation center that would be run by Avanté Group.
Miami lawyer Alex Heckler coordinated an earlier deal for the hospital, now known as Miami Care Center, that fell through. Heckler was a friend of emergency management Director Jared Moskowitz and contributed to his campaign when he served as a state representative out of Parkland, The Post discovered.
Heckler registered as a lobbyist in May for Avanté Group.
The Miami Care Center stopped taking COVID transfers on Monday. What happens next for the 2½-month-old facility — such as operating as a for-profit nursing home — is unknown but the taxpayers forked out a fortune of $1 million a month either way.
Wendy Milam, corporate director for education at Avanté Group, said after Avanté was asked to run the Miami facility, it identified other communities with need and agreed to open up other facilities for COVID patients “to help decompress the hospitals.”
Besides Miami and Boca Raton, Avanté has isolation centers in Orlando and Melbourne.
“The opportunity to help the community during this pandemic fits perfectly with our mission to serve, care and heal,” Milam said.
The state was quite aware of past deficiencies and the corrective actions taken at its facilities, she said. “AHCA has been very supportive in our opening of these centers,” Milam added.
DeSantis is shutting down the isolation centers even as federal health officials — such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, predicted a conflation of COVID and the flu in the U.S. come the fall and winter.
The closing of the isolation centers comes after the state recently opened up visitation at elder care facilities. Florida is also reportedly eliminating every-other-week testing of staffers at long-term care facilities.
Lee said he thinks the state decided the isolation centers were just too expensive in the end.
Outbreak in Lauderhill
No isolation center has drawn more criticism than the one in Lauderhill in Broward County.
Before the state designated it an isolation center, an April state inspection found numerous problems with how Nspire Healthcare Lauderhill in Broward County handled COVID.
At least 18 residents were affected by poor practices in preventing the spread of COVID that put all 97 residents at risk, an inspection report said.
Residents, even roommates of COVID-positive residents, were found wandering the halls without masks and weren’t shuttled back to their rooms, a key practice required by Broward and others for controlling the disease.
Some staffers didn’t even know which residents had tested positive so they could isolate their roommates and don proper PPE when caring for them, inspection reports show.
By mid-May, 58 residents and 22 staffers were COVID positive, according to daily reports from the state Department of Health. In June, the facility was designated an isolation center.
“Instead of correcting what is wrong, the state turned it into COVID-19 only,” said Ken Thurston, mayor of Lauderhill, a bedroom community in Broward County.
Miriam Pastor, Nspire’s president, said in a June statement that the facility was picked because of “excellent care that is being provided.”
They reported 23 COVID deaths as of Sept. 12.
Jessica Bocanegra lost her grandmother to COVID at Nspire Lauderhill and said the facility had no business being an isolation center.
“Honestly, I think it’s ridiculous for that center to be a place where all the COVIDs go,” she said. “I don’t think they have good protocols. I don’t think they have good administration.”
Bocanegra’s main criticism of Nspire Lauderhill was that it was too corporate and unresponsive to families. Most of the isolation centers belong to companies with numerous facilities.
The city of Lauderhill remains unsatisfied.
Coronavirus cases in the city have tripled since early June from 92 on June 1 to 356 as of Thursday, DOH reports show.
Earlier in the pandemic, the city expressed its concern to the state about its rising number of COVID cases. The state sent in an epidemiological team to determine whether the virus was under control, Thurston said.
In response to a complaint in March, the state found no deficiencies. However, the next month, inspectors found quite a few problems, including COVID measures taken by the facility.
The facility is on the state watch list because it had failed to meet requirements for a working generator — an issue since 14 residents died at a nearby nursing home in stifling heat following Hurricane Irma in September 2017.
“We have asked the Department of Health for information on how they made the decision to select this particular nursing home. Why did you pick a failed nursing home and make it all COVID?” Thurston said.
“We have got no answers to the questions we’ve asked.”
Another Nspire facility, in Miami-Dade County had “repeated deficiencies related to infection control” four years in a row through 2018. It has recorded 24 deaths.
In November, Nspire Miami Lakes was cited for a break in infection control standards that had the potential for cross-contamination.
At other isolation centers, The Post found similar problems with infection control.
Seven staffers and the head of housekeeping at Hillcrest Rehabilitation and Healthcare in Hollywood had to be re-educated on COVID precautions after inspectors saw them doing several things, such as not wearing surgical masks, that could spread the highly contagious virus from their only COVID-positive patient and the person’s two roommates who were being isolated.
Hillcrest has recorded 25 COVID deaths, tied for the most of any isolation center.
Another isolation center, Oakbridge Health Care Center in Lakeland, is operating on a conditional license after it was shut down in December 2017.
Medicare and Medicaid stopped payments after a litany of negligence complaints, recorded in inspections and in lawsuits. It has been on the state’s watch list since 2017 for not correcting a variety of violations.
Oakbridge had deficiencies that included harm to a patient who became unresponsive for at least two days, according to an ACHA complaint, and didn’t get appropriate care because the nurse was tending to more than 50 patients. The patient didn’t go to the hospital until family members called 911 and ended up in intensive care.
Oakbridge has not reported any COVID deaths to the state.
An appeals court in July upheld a quarter-billion-dollar fraud judgment against Oakbridge’s owner, Consulate Health Care, the largest nursing home chain in Florida. Company leaders said paying the fine could lead to “immediate economic extinction.”
A Consulate home in Palm Harbor, Countryside Rehab and Healthcare Center, was cited in June — as it was caring for COVID-19 patients — for poor use of personal protective gear. Inspectors found at least three nurses wearing masks that had been pulled down. Countryside also had been cited for minor hand-washing problems in August 2019.
Like Hillcrest, it has recorded 25 deaths.
Consulate did not respond to questions for this story.
And finally, a resident at Clear Choice Conway Lakes Rehabilitation and Health Center in Orlando, which has experienced only one COVID death, had an infection that could cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.
Despite signs warning that PPE must be worn because the patient was in isolation, a nurse in late July was found in the resident’s room chatting without wearing any protective gear. The nurse also didn’t wash his hands. Another staffer didn’t wash her hands when she left the room and wore her PPE in the hallway, which was against the rules.
DeSantis’ numerous victory laps back in May almost always had him taking digs at New York for allowing hospitals to send seniors with COVID-19 back to elder care facilities.
The idea in New York was to free up beds but a state directive there ordering hospitals to send these seniors back to facilities was akin to pouring gasoline on the fire.
More than 6,600 New Yorkers in elder care facilities lost their lives to COVID as of early May. The number of deaths is believed to have nearly doubled since.
Florida has tallied 5,350 deaths in elder care facilities.
DeSantis touted in May that an AHCA order forbidding hospitals from discharging positive seniors back to elder care facilities spared Florida a similar fate even though the order had come down only a few days earlier.
Dr. Larry Bush, an infectious disease specialist at Wellington Regional Medical Center, said the isolation centers were a godsend for the hospitals, which had basically become custodians for these seniors who tested positive but were otherwise just a little sick or asymptomatic.
“It frees up the hospital to take care of other people,” Bush said. “It just lightened the load.”
It became apparent to the state over the summer that a handful of isolation centers were inadequate when cases in Florida surged dramatically.
As hospitals filled up, the state scrambled to add more isolation centers.
The Lauderhill mayor says that a facility in nearby Tamarac became an isolation center because, as he understands it, all of the beds at Nspire were filled with COVID-19 patients.
Florida went from one on April 14 to five in May. By the end of June the state was up to 23.
This whole idea of isolation centers for COVID-19 seniors came to fruition after Duval County nursing home operator, Dolphin Pointe Health Care Center’s co-owner Geoff Fraser, pitched the idea.
At first, the state balked, floating the idea that Dolphin Pointe could take just overflow patients from hospitals, but eventually it came around to Fraser’s approach, he said.
Dolphin Pointe took residents from Central Florida, the Tampa area and the Panhandle and has had 220 patients successfully go back to their elder care centers, he said. It has recorded three deaths.
Fraser said setting up these isolation centers isn’t as easy as just housing COVID residents together. He said there have to be rigid PPE protocols, extra staffing and extra infection control.
Seven of the facilities are like Dolphin Pointe — nursing homes that had yet to open but became isolation centers.
But then AHCA said other facilities pitched themselves as isolation centers.
The agency said that staff who care for COVID patients do not provide care for non-COVID residents. “There should be no crossover of staff or residents and no shared spaces,” the agency said.
AARP says the most serious cases are still centered at elder care facilities, not isolation centers, and the crisis remains. The industry remains ill-prepared to corral the coronavirus and the organization is not surprised that isolation centers have problems.
“Four of 10 five-star facilities in the U.S. have been cited for infection-control problems,” said Dave Bruns, AARP’s spokesman in Florida. “So infection-control problems are endemic and have been endemic in elder care facilities for decades.”
He stressed AARP understands that the Department of Health, AHCA and DeSantis have tried with these isolation centers to address the problem, but that nursing homes, both residents and staff, represent 2 percent of Florida’s population but more than 40 percent of all cases and deaths.
“They have put in tremendous efforts and done what needed to be done on many occasions, but it hasn’t worked. There are too many deaths, too many cases,” Bruns said.
“This pandemic has cruelly exposed all of the long-standing problems in long-term care in Florida and in America.”
Post researcher Melanie Mena contributed to this story.