Minnesota’s Border Battles: COVID-19 edition
Last year, we released a report titled ‘Minnesota’s Border Battles‘ in which we compared the economic outcomes in Minnesota counties bordering other states with the outcomes in the border counties…
On Wednesday, I had an op ed in the Star Tribune titled ‘Minnesota’s long-term care homes are dangerous‘. I noted how, when it comes to Covid-19, outside long-term care facilities, Minnesota is safer than average. Inside them, it is more dangerous. As of Wednesday, for example, Florida had seen 15 deaths per 1,000 care home residents compared to Minnesota’s figure of 30. The question is: why?
Florida had its first confirmed case of Covid-19 on March 1st. At that time it was already well known that the elderly and sick are most at risk. Gov. Ron DeSantis noticed this, commenting that “that not all age groups were equally at risk for coronavirus” and that the fatalities were occurring in “folks 65 and up”. Recognizing the particular danger this posed in Florida – he described the state as “ground zero for the nursing home, we’re God’s waiting room” – he acted accordingly. While he drew much criticism for not closing Florida’s beaches, he allowed Florida nursing homes to reject hospital referrals who were still infected. More recently, Florida started sending infected residents in the opposite direction, from nursing homes to hospitals. “Our goal is to keep the virus out of our facilities,” one Florida nursing-home CEO told the Sun-Sentinel. “Hospitals are more concerned about their beds.”
Gov. Walz took a very different approach. Minnesota’s first confirmed case of Covid-19 came on March 6th, so, in crafting his policy response, he had access to the same science on at risk populations as Gov. DeSantis. He even had warning on the specific vulnerability of care homes. On March 8th, Dr. Thomas Frieden, former head of the federal Centers for Disease Control and Prevention, told CNN that “nursing homes and other long-term care facilities are ground zero.” On March 18th, in a study of the nation’s first large outbreak, in a nursing home in Kirkland, Wash., the CDC told health officials, “Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19.”
But despite frequent claims to being ‘guided by the science’, Gov. Walz did not act on this. The Star Tribune reports that:
Early in the pandemic, the Minnesota Department of Health turned to nursing homes and other long-term care facilities to relieve the burden on hospitals that were at risk of being overwhelmed by COVID-19 patients. Minnesota hospitals have since discharged dozens of infected patients to nursing homes, including facilities that have undergone large and deadly outbreaks of the disease, state records show.
Officials at the Department of Health and the care homes insist that they are taking precautions against the spread of Covid-19, but there is only so much they can do. As another Star Tribune report says:
Many of the state’s 370 nursing homes are laid out like hospitals, with residents doubled up and as many as four people sharing a single bathroom. Some nursing facilities have shower areas shared by dozens of residents on entire floors. This institutional design was meant to be cost-efficient, but it has contributed to the rapid spread of the virus from one vulnerable resident to the next and the stunning death toll within Minnesota’s nursing homes, say public health experts.
These dangers have been compounded by that fact that, as the Star Tribune reports: “Currently, even poorly rated nursing homes with large and deadly clusters of coronavirus cases have been allowed to admit COVID-19 patients from hospitals.” One of these is North Ridge Health and Rehab in New Hope. The Star Tribune reports that:
Government health records show that North Ridge has struggled in recent years to adhere to basic standards of patient care. The facility has been fined $117,000 by federal regulators and cited for dozens of health and safety violations over the last three years. The nursing home earned just two stars (“below average”) on the federal government’s five-star rating system for overall care. The facility was also listed among the most-troubled nursing homes in the nation.
Even so, North Ridge:
…has accepted 42 patients from hospitals and other long-term care facilities since mid-April even as the coronavirus has raged through its 320-bed nursing home, killing 48 of its patients and infecting scores more.
Another Star Tribune report notes how four Minnesota nursing homes with COVID-19 outbreaks have bee cited for serious infection-control violations:
A troubled nursing home in Moorhead transported a coronavirus patient to a dialysis center without notifying staff at the center or the driver of the patient’s infection, potentially exposing at least nine people to the deadly virus.
At a nursing home in west-central Minnesota, a resident with symptoms of the virus was allowed to attend communal meals and group bingo games, endangering 17 other residents of the facility.
And in Winona, a nursing home with a major coronavirus outbreak moved a patient who appeared sickened with the COVID-19 respiratory illness to a room with someone who was healthy. Staff also wandered about the facility without removing contaminated protective gear.
On May 7th, Gov. Walz outlined a five-point plan to protect residents of long-term care facilities. The plan includes expanded testing, more support for infection prevention, providing more personal protective equipment, and ensuring adequate staffing levels at Minnesota facilities. Since then, 380 of Minnesota’s 459 Covid-19 deaths were in care homes: 83%.
Neither Gov. Walz nor Health Commissioner Malcolm are reconsidering their policies in the light of their actual outcomes. Gov. Walz defended the policy on Wednesday. Commissioner Malcolm said that moving recovered COVID-19 patients from hospitals to long-term care facilities has been an “affirmative” part of their plan for managing hospitalizations. She said they are “revisiting” that policy, but that it is still happening. Yesterday, she acknowledged that deaths in long-term care continue to grow and said it’s a “valid concern,” but also that the state’s nursing home “battle plan” is making progress in other areas and metrics. What these other areas and metrics are remains unclear.
In my Wednesday op ed I noted that “if our state’s long-term care facilities had suffered this lower, median death rate, 323 fewer residents of Minnesota’s care homes would have died.” That is about three times the number of homicides in our state annually. On that metric, we continue to do very badly indeed.
John Phelan is an economist at the Center of the American Experiment.