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CHRT report evaluates Michigan’s nursing home strategy and provides recommendations for future approaches

September 8, 2020
  • Findings support state’s initial strategy and identify additional approaches that can be taken now to increase safety and to support residents and staff

The Center for Health and Research Transformation (CHRT), an independent nonprofit health policy center at the University of Michigan, is releasing its summary analysis of the state of Michigan’s nursing home hub strategy along with evidence-based recommendations to help improve the care and safety of residents and staff in the state’s long term care system.

In the April 2020 COVID-19 surge in Michigan, the Michigan Department of Health and Human Services contracted with 21 nursing home “hubs” to help care for COVID-19 patients transferred from other nursing homes or discharged from hospitals and in need of nursing home-level care. The hubs were required to meet a number of quality and safety indicators and to have enough room to isolate and care for COVID-19 infected residents away from the general population.

CHRT found that, overall, Michigan’s hub strategy performed well. The percentage of deaths among nursing home residents with COVID-19 was considerably lower in Michigan’s nursing home hubs than in the state’s non-hub nursing homes: 17.4 percent in hubs compared to 26 percent in non-hubs. CHRT also found that Michigan’s nursing home residents constituted a smaller proportion of overall COVID-19 deaths than the U.S. average, with Michigan nursing home resident deaths making up 33.2 percent of all COVID-related mortalities in the state, versus 38.6 percent across the rest of the country.

Summary findings from CHRT’s analysis were posted on the Michigan Department of Health and Human Services website on September 1, 2020. Today’s report includes CHRT’s detailed recommendations—covering structural, process, access, and operational improvements—to help Michigan and other states prepare long-term care facilities, including nursing homes, for a potential resurgence.

“Since the April surge, we have more knowledge and experience with managing COVID-19 patients safely in nursing homes and long-term care facilities,” says Udow-Phillips. “That information will allow states all across the country to improve their strategies.”

Key recommendations from the Center for Health and Research Transformation report include:

  • Implement structural approaches that are flexible to allow for changes in case counts and regional capacity. At least at this time, a COVID-only facility is not needed and is likely counter-productive. States that began with that strategy are no longer pursuing that approach. COVID-19 and non-COVID-19 patients can both be safe in nursing homes with proper cohorting and safety protocols;
  • Maintain the hub strategy but with new criteria that incorporate lessons learned, including: the importance of and best approaches for cohorting; assurance of training and adequate tools to maintain patients safely, including staff capacity; and continuing care plans and collaborations with referring hospitals;
  • Increase technical assistance and onsite training for nursing homes and long term care facilities, to support their ability to implement the most effective safety measures;
  • Broaden current visitation policies to enable more outside visitation (weather permitting) and to reduce the negative effects of social isolation for nursing home residents;
  • Assure adequate support for nursing home residents and staff, including support for mental health and other needs;
  • Centralize and clarify COVID-19 guidance to all nursing homes and local public health departments, to ensure consistent messages and better knowledge of evolving national and state requirements; and
  • Improve data tracking and standardize reporting, to ensure prompt interventions and to help policymakers and practitioners focus on the most effective practices.

“We hope that these recommendations not only inform the current crisis related to the pandemic, but that they also lay the groundwork for rethinking our long term care system in the state and country,” says Marianne Udow-Phillips.

“Nursing homes are an important part of the continuum of care, but that continuum of care also includes other long term care facilities and home- and community-based services. We should all be thinking more broadly about how to better integrate and coordinate all of these systems now and into the future.”

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The Center for Health and Research Transformation (CHRT) is an independent nonprofit at the University of Michigan. CHRT works to inspire and enable evidence-informed policies and practices that improve the health of people and communities.

This evaluation was funded by the Michigan Health Endowment Fund, a foundation that works to improve the health and wellness of Michigan residents and to reduce the cost of healthcare, with a special focus on children and seniors.