Gov. Hogan enacts emergency order to protect nursing home residents, staff amid COVID-19 outbreaks

Concerns over equipment shortages continue
Posted at 2:41 PM, Apr 05, 2020
and last updated 2020-04-05 23:19:56-04

MARYLAND — Governor Larry Hogan enacted an emergency order to protect residents and staff at Maryland nursing home facilities, and bolster the state’s mitigation and suppression efforts amid outbreaks of COVID-19.

Effective immediately, new directives will require facilities to direct all staff who interact with residents to wear personal protective equipment and expedite all testing through the Maryland State Public Health Laboratory.

“As we have been saying for several weeks, older Marylanders and those with underlying health conditions are more vulnerable and at a significantly higher risk of contracting, getting more severely ill, and dying from this disease,” said Governor Hogan. “Of major concern is that we currently have cases or clusters of cases at 81 nursing homes and long-term care facilities across the state. Our highest priority is keeping Marylanders safe, and we will use every tool at our disposal to protect the most vulnerable among us.”

While the president of the Health Facilities Association of Maryland, which represents the majority of skilled nursing centers and assisted living campuses in the state, welcomes the orders, he said some may be nearly impossible with the current equipment shortages.

"These orders are important next steps but the requirement on PPE is going to be nearly impossible to meet under the current scenario without state and federal assistance and testing continues to be a problem," said Joe DeMattos. "Nursing homes have been literally tasking full-time employees for the last several weeks to scour the planet to identify PPE at whatever price is available."

Hogan also ordered facilities to create separate observation and isolation areas for residents, which DeMattos said has been in place for two weeks.

Governor Hogan’s order makes compliance with these directives mandatory. Anyone who knowingly and willfully violates this order is guilty of a misdemeanor and upon conviction is subject to imprisonment not exceeding one year, or a fine not exceeding $5,000—or both.

"I know that health care providers will do everything in their power to do the right thing. They will operate the best they can with what they have and I’m not worried about the penalties because I think were going to be focused all on the same objective," said DeMattos.

The enhanced protective measures include:

PERSONAL PROTECTIVE EQUIPMENT FOR STAFF. All personnel who are in close contact with residents of nursing homes shall wear personal protective equipment (PPE), including a face mask, appropriate eye protection, gloves, and gown. The PPE should be worn at all times while providing care to residents in the facility and personnel should follow CDC guidance for using personal protective equipment. Facilities must use the process established by MDH to request PPE from the state.

EXPEDITED TESTING FOR SYMPTOMATIC RESIDENTS. All facilities must use the most expeditious means available for testing. This includes using either a COVID-19 test kit provided by the state laboratory or another lab to send specimens to the state laboratory for expedited COVID-19 testing of residents and staff. Symptomatic residents of nursing homes and long-term care facilities are among the patient groups prioritized by the state laboratory, alongside hospitalized patients and symptomatic health care providers and first responders.

SEPARATE OBSERVATION AREAS. All facilities must designate a unit of staff who are assigned to care for known or suspected COVID-19 residents; designate a room, unit, or floor of the nursing home as a separate observation area where newly admitted and readmitted residents are kept for 14 days on contact and droplet precautions while being observed every shift for signs and symptoms of COVID-19; and designate a room, unit, or floor of the nursing home to care for residents with known or suspected COVID-19.

PLACEMENT OF DISCHARGED PATIENTS. MDH’s Office of Health Care Quality will assist acute care hospitals, if necessary, in discharging patients who require nursing-home level care. Facilities must cooperate with the Office of Health Care Quality and hospitals in the placement of discharged patients.

RIGHT OF RETURN FOR RESIDENTS. Nursing home residents admitted or seen at a hospital for COVID-19 must be allowed to return to the nursing home as long as the facility can follow the approved CDC recommendations for transmission-based precautions. If the residents must temporarily go to other facilities, every effort must be made by the receiving and original nursing homes to transfer the residents back to their original nursing homes as soon as possible.

In a statement, the Carroll County Health Department, which has seen outbreaks in two assisted living facilities, said they will be adopting these measures.