In May, the nursing home told patients and their families that the residents were being relocated to other facilities to prevent them from catching the coronavirus. According to news reports and a union leader, at least eight patients and eight nurses at the nursing home had caught the virus when the hospital temporarily closed the nursing home wing.
It wasn’t until the end of June that the board of the Not-for-Profit Hospital Corp., which runs the hospital in the city’s poorest ward, voted to keep the nursing home closed for good.
The ombudsman charged with overseeing the care of the elderly in the District says if the hospital knew from the start that the closure could be permanent, it would have been required to follow federal and local laws for how to wind down operations that are designed to protect patients.
The rules allow for family input and patient appeals to ensure the move still allows loved ones to visit and minimizes what experts call “transfer trauma.”
“If they had known they were going to close … that’s very troublesome,” said Mark Miller, the D.C. long-term-care ombudsman. “I don’t know if they did. But if anybody did, then they intentionally issued invalid, illegal notices and misled people. … That seems to me that calls for an investigation.”
Toya Carmichael, a vice president of the Not-for-Profit Hospital Corp., said the hospital’s leaders knew when they first relocated residents that there was “always a possibility” the nursing home would never reopen. She said they followed procedures for a short-term emergency shutdown, not a permanent closure, because the board had not yet voted to shut the facility.
Carmichael noted that United Medical Center’s hospital will close in 2023, and the replacement hospital planned for the nearby St. Elizabeths campus — also in Ward 8 — will not include a nursing home.
“The board thought it made the most sense to go ahead and decide to close the [nursing home] now,” Carmichael said. “Just imagine we transfer our patients back to our facility in 2021, and then in 2022 we have to transfer them back out again. It really doesn’t make for a good continuum.”
Asked about the decision by The Washington Post, council member Vincent C. Gray (D-Ward 7), who chairs the council’s health committee, said he would hold an oversight hearing on whether the nursing home followed D.C. law on moving residents out.
“Why was it such a short period of time that was extended to the people who were moving from there?” he asked. “That relocation anxiety can oftentimes lead to severe consequences for people, and we certainly don’t want that to happen.”
However, Gray also said the United Medical Center facility had a history of poor performance, and suggested its former residents might be better off elsewhere. “I think ultimately this is going to be an improvement for the people who have been at the nursing home,” Gray said.
Advocates say the nursing home, despite struggles including a troubling patient death in 2017, offered what many families needed. Within a mile of the Southern Avenue Metro station and close to many bus lines, the hospital was a place that poor families without access to a car could come to visit their loved ones.
The District has 18 other nursing homes, including three in Ward 8. The city already had a shortage of beds when the UMC facility was shuttered. Miller said more than 500 D.C. residents whose care is paid for by Medicaid are housed in Maryland nursing homes because there isn’t space for them in the District.
Nineteen UMC patients stayed in Ward 8 by moving to BridgePoint Subacute and Rehab National Harbor. Four were moved to Ingleside at Rock Creek, a facility 13 miles away in upper Northwest Washington that is not near a Metro station.
Fourteen went to Layhill Center for Nursing and Rehabilitation in Montgomery County, an hour’s drive from United Medical Center. Others who were transferred between 10 and 25 miles from United Medical Center include 15 patients moved to Silver Spring, seven moved to Clinton, one moved to Hyattsville and one moved to Adelphi.
To permanently close the facility, United Medical Center would have been required to submit a closure plan to the D.C. health department and give notice to each resident far enough in advance that they could perhaps tour other facilities to choose where they want to move.
Even temporarily transferring residents normally requires 30 days’ notice, during which a resident can submit an appeal and not be moved until the appeal is decided. But those rules for transfers were waived by the Centers for Medicare and Medicaid Services during the pandemic.
The Post reviewed the transfer notices that some residents received. On one form, the nursing home wrote, “You voluntarily waive your 30 day advance notice of transfer,” and said the patient would be moved to BridgePoint that very day. The form noted that the patient was incapable of signing their own name to accept the decision.
Miller said the ombudsman’s office worked with families, patients and the nursing home to try to make sure each patient was transferred to a location that was acceptable to the person and their family. One man, for example, had read news reports of surging coronavirus cases in the Maryland suburbs and was fearful of leaving the District.
“He kept saying that he did not want to die. He really was adamant that we help him not have to go to a Maryland facility,” Miller said. The nursing home found him a bed in the District.
Still, the process was tumultuous. Some residents had concerns about getting their belongings moved on very short notice. Many were expecting federal stimulus checks to arrive in the mail, and worried the money wouldn’t make its way to their new addresses.
“You just can’t move people like plants. You have to look at everybody’s situation individually and what their preferences are, if they could express it,” Miller said.
He said some families may have consented to a temporary move to a farther home, thinking they couldn’t visit their loved ones while nursing homes are closed to outsiders during the pandemic anyway, but would never have agreed if they had known the move was permanent.
Now, however, they may be reluctant to move fragile patients a second time. “Transfer trauma is a real thing,” Miller said. “Think of having to move on short notice. It’s very disruptive. And then think about being health compromised, maybe cognitively impaired somehow: very traumatic. People die from transfer trauma.”
Families who do want to move their relatives, now that the nursing home is closing for good, should call the ombudsman’s office at 202-434-2190, Miller said.
Nursing home employees were also caught off guard by the decision to close permanently, said Wala Blegay, an attorney for the nursing home’s nurses’ union.
Employees were told they could either transfer temporarily to other parts of the hospital, or opt to stop working until the nursing home reopened, Blegay said. She said that seven employees, none of them members of the nursing union, exercised the option to return when the nursing home returns — leaving them unsure now whether they still have a job.
The 27 nurses she represents are all working in the medical and surgical unit of the hospital right now, work very different from the jobs they trained for, caring for elderly and ill nursing home residents.
Carmichael, the Not-for-Profit Hospital Corp. vice president, said the company is offering them additional training and hopes to keep all of the nursing home workers employed at the hospital, but is still negotiating with employee unions.