Amid arcane COVID-19 transfer rules, a prominent Cuban exile ping-ponged between homes
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Antonio Veciana was scheduled to move back to Casa Marisa, an elder-care facility in Miami-Dade County, after a brief rehabilitation stint at Riviera Health Resort. Casa Marisa, however, refused to take him.
The reason: Riviera did not test him to ensure he did not carry the coronavirus before initiating the transfer.
As a result, the frail 91-year-old ended up stuck on a bus while two facilities debated what to do with him.
The ordeal left his daughter, Ana Veciana-Suarez, fuming.
“I feel like I’m in some dystopian comedy,” she said.
The limbo endured by Veciana is one of the unintended consequences as Florida and other states wrestle with a complicated issue: how best to handle transfers of nursing home and adult living facility patients at a time when COVID-19 is rampaging through long-term care homes.
Nursing homes and ALFs have been incubators of the virus, and their residents — many with serious underlying medical conditions — are particularly vulnerable. Sometimes residents have to be transferred to other facilities, to be treated for COVID-19 or for other healthcare needs. Before they come back to an environment filled with other elders, shouldn’t they be tested to ensure they are coronavirus free?
On May 5, Gov. Ron DeSantis decided the answer was yes. He issued an emergency rule that elder-care facilities can accept individuals discharged from hospitals only after they’ve tested negative for COVID-19. The rule mandates that the tests be conducted by the discharging hospitals.
“Putting somebody who’s COVID-positive back into a nursing facility that’s not equipped to isolate ... is a major, major hazard to the health, safety and wellness of those residents,” DeSantis said.
The rule applies to general acute care hospitals, long-term care hospitals and comprehensive medical rehabilitation hospitals. It does not apply to discharges from other nursing homes and ALFs, from rehab centers like Riviera, and hospital-to-hospital transfers — exceptions that can prove fatal not just for the patient but for others he or she encounters at the receiving home.
Complicating matters, patients with the virus can take more than a week before they show symptoms. And getting back negative test results can take days if not weeks.
Veciana is a well-known figure in Miami’s Cuban exile community. He founded and formerly headed the anti-Castro organization Alpha 66. Now in his 10th decade, he is beset with episodes of dementia.
He was sent to Baptist Hospital from Casa Marisa weeks ago when he showed symptoms of contracting the coronavirus. His children, who monitor his well-being closely, were concerned.
After it was determined he did not have the virus, Veciana was transferred to Riviera as an interim step. Early last week, Veciana-Suarez was told Riviera intended to transfer him back to Casa Marisa.
Casa Marisa told Veciana-Suarez it wouldn’t take her father back unless he was certified COVID-19 negative, a policy Veciana-Suarez happens to agree with.
Instead, Riviera had a note from a doctor certifying he had no symptoms.
Veciana-Suarez is an author and former Miami Herald columnist who still writes some for the news organization. For a while, she covered elder affairs and she knows her way around government bureaucracy. She and her siblings sprang into action, trying to get help for their father.
Knowing that the lack of test results would be an issue, Veciana-Suarez offered to get her father tested by a private physician known to the family.
Last Thursday, still with no test undertaken, Riviera attempted to execute the transfer. It did not go well. Veciana-Suarez said her father was stuck in a bus — possibly for as long as two hours — while representatives of the two facilities argued over which should take responsibility for him.
Veciana ended up going back to Riviera, which would subsequently agree to get him tested for COVID-19. He tested negative.
Jackson Health, one of South Florida’s largest hospitals, has dealt with this problem in a unique way. Jackson secured permission from Florida’s Agency for Health Care Administration to use a phased-out facility as a nursing home for when Jackson patients no longer need hospital treatment but have yet to be certified coronavirus negative via a test.
While nursing homes have sought to isolate those either infected or exposed to the virus, it has been difficult at a time when personal protective equipment and staffing have been in short supply. Over the past two weeks, at least two Florida nursing homes have had new admissions barred by the state over sloppy anti-COVID-19 procedures.
ALFs, which can be significantly smaller than nursing homes, don’t always have the room to isolate anybody.
Multiple figures with the administration at Riviera told Veciana-Suarez that Riviera’s “policy was to release patients with a simple doctor’s affidavit saying the patient had no symptoms.”
“I find it flabbergasting that they’re moving elderly patients around with no real proof that they’re not infected,” she said.
Matt Gawne, chief operating officer of Riviera, told the Miami Herald: “We have stringent infection control protocols in place, are restricting all non-essential visitors and are screening our staff daily, including taking their temperatures,”
He added: “We continue to actively monitor our residents daily, our team wears masks at all times and disinfects the building daily to ensure everyone is protected.”
None of that is a guarantee that a resident will be COVID-free at the time he or she is transferred out.
Troubles elsewhere
Despite approximately 900 deaths from COVID-19 at long-term care centers, the toll at Florida’s elder-care facilities is actually less extreme than in some other states, particularly in the Northeast.
The state with the largest overall outbreak, New York, initially required that nursing homes and ALFs take residents back when hospitals were ready to discharge them. The idea was to keep hospital beds free for those with the most dire need. That policy, since reversed because it could stoke the spread of the virus in nursing homes, resulted in sharp criticism for Gov. Andrew Cuomo, whose handling of the pandemic has otherwise earned high marks.
The DeSantis administration’s handling of the virus in elder-care homes has come under fire for other reasons, having more to do with transparency. Initially, the state’s health department would not release any data on which facilities had positive cases. When the Miami Herald drafted a lawsuit demanding release of the records and filed notice with the state, the governor’s legal counsel attempted to quash the lawsuit by applying pressure through a shared law firm.
In Florida, the percentage of deaths from COVID-19 occurring in nursing homes and ALFs has steadily surged. That portion rose from 32 percent on May 1 to 45 percent on Monday, May 18. It is still a lower percentage than in states like Pennsylvania and Massachusetts, though the percentage is higher than in several other states.
Selina Tran, an administrator at Cresthaven, an elder-care facility in Palm Beach that has had one resident and three staffers test positive, said that even now it is completely the receiving facility’s responsibility to demand documentation showing that an incoming patient from a hospital or nursing home has negative COVID-19 tests.
“They can’t just send somebody back without any proof,” she said.
Veciana-Suarez said she was only able to get her father’s situation resolved through persistence and knowledge of the system.
“How about people in homes who don’t have children living in the area, or who don’t know their way around?” she asked.
She said she has been led to believe that her father, finally, would be returned to his ALF — and accepted — on Tuesday.
Epilogue: It didn’t work out that way. Because Antonio Veciana can’t stand or walk at this time, he can’t be in an ALF, his daughter said later Tuesday afteroon. The family is trying to figure out what to do next.
This article has been updated to correct the day Antonio Veciana took the bus ride.
This story was originally published May 19, 2020 at 12:49 PM with the headline "Amid arcane COVID-19 transfer rules, a prominent Cuban exile ping-ponged between homes."
