A “Heroes Work Here” banner is erected along Lafranier Road in Traverse City in front of Medilodge GTC.

TRAVERSE CITY — Michigan health officials have renamed, redesigned and relaunched a previously controversial system that allows nursing homes to become designated care facilities for recovering, but still contagious COVID-19 patients.

MediLodge GTC, a nursing home on Lafranier Road decommissioned in July as a regional hub for recovering COVID-19 patients, has been approved as a COVID-19 care and recovery center, the Record-Eagle has learned.

Michigan Department of Health and Human Services spokesperson Lynn Sutfin confirmed the status of MediLodge in an email Friday, and said the facility is one of 6 such facilities approved in recent days.

Bill Gray, spokesperson for Prestige Administrative Services, which manages 80 long term care facilities in seven states including MediLodge GTC, did not return a call seeking comment.

CRC’s are designed to replace Gov. Gretchen Whitmer’s hub strategy and require more stringent staffing and facility standards than hubs did, said Sen. Curt Vanderwall, a member of the state’s Nursing Homes COVID-19 Preparedness Task Force.

“The biggest change is, they have to have designated staff in specific areas where these patients will remain, so there isn’t a way to have cross contamination,” Vanderwall said. “It is considerably harder for a normal nursing facility to be able to provide that basis of care.”

The task force released its recommendations in September; replacing hubs with CRCs was on the list, documents show.

On Oct. 9, the MDHHS identified facilities meeting CRC criteria and invited them to apply, Sutfin said. Approval requires a site visit by staff with the state’s Department of Licensing and Regulatory Affairs — Medilodge GTC’s visit was Thursday, Sutfin said.

CRCs vs. hubs

CRCs must dedicate staff to care for COVID-19 patients and only COVID-19 patients, staff must have additional training and there must be someone assigned to serve as an “Infection Preventionist” and have completed required coursework from the Centers for Disease Control and Prevention; hubs did not have these requirements.

CRCs must have separate wings to care for COVID-19 patients, with separate entrances and exits, their own nursing station and supply rooms for linen storage; hubs were strongly encouraged, but not required, to have these protocols in place.

Trash needs to be collected more frequently and meal delivery needs to be handled separately from the rest of the facility, documents show. Personal protection equipment supplies will be prioritized by MDHHS for CRCs and the department encourages the use of the CDC’s ”burn calculator” for estimating need.

CRCs must also have a satisfactory visit by Licensing and Regulatory Affairs officials; initially, hubs did not as previously reported.

Labeling CRCs “second generation of regional hubs,” Sutfin called attention to MDHHS Director Robert Gordon’s statement, as previously reported by the Record-Eagle, that the initial hub strategy was put into place quickly to meet an immediate need.

“With more time to prepare and more research on best practices and key elements needed for safety available, the state will now employ new criteria and procedures to approve facilities as CRCs,” Sutfin said.

As of Friday, there were no positive cases of the virus in residents or staff at Medilodge GTC, their website shows. The facility reports a total of 25 cases among residents and staff since May 8 with 18 residents recovered and discharged.

Hub history

Regional hubs were part of Gov. Gretchen Whitmer’s early COVID-19 strategy designed to take the pressure off hospitals by caring for two types of patients: those discharged from a hospital still positive for the virus but no longer needing hospitalization; and residents of nursing homes who tested positive but the facility caring for them could not safely isolate them from other residents.

MediLodge GTC was one of the first three nursing homes to be approved as a hub, and initially at least, the names and locations of the facilities were intentionally kept from the public by MDHHS, as previously reported by the Record-Eagle.

Following months of criticism from legislators, healthcare professionals and family members of nursing home residents, hubs were decommissioned and a Nursing Home Task Force was assigned to come up with an alternative.

CRC’s are the result.

An internal MDHHS Guidance and Protocols document states CRCs will care for the same two types of patients but first must meet the following conditions:

The facility has a rating of 3 or higher in the staffing category of the CMS Nursing Home Compare

The facility is not operating under a Denial of Payment for New Admissions (DPNA) restriction. The facility is not designated by CMS in Nursing Home Compare as a “red hand” facility, which denotes citations for abuse.

Online ratings & state monitoring

Nursing Home Compare, which itself will be decommissioned Dec. 1 and transitioned to another site called “Care Compare” is a website that gathers data from 15,000 long term care facilities in the U.S. and makes health inspections, fire safety inspections, staffing, quality of resident care and citations publicly available.

Medilodge GTC rates three out of a possible five stars overall, for each of the above categories, the Nursing Home Compare website shows, and has had no Medicare payment denials in the past three years.

A January 2019 health inspection gave the facility two stars following medication administering deficiencies; a deficiency in monitoring the nutrition of one wheelchair-bound resident with memory care requirements, who lost 15 percent of her body weight in two and a half months; and twice failing to notice another resident’s supplemental oxygen supply tank gauge read zero.

Increased monitoring of CRCs by the state would pick up deficiencies like these and others, Vanderwall said.

Sutfin said MDHHS will make weekly calls to CRC facilities to monitor what is happening on the ground within facilities and to provide technical assistance when needed.

The calls will be supplemented with a specific data reporting structure for CRCs that will provide insight into PPE levels, staffing and bed occupancy, Sutfin said.

“The criteria set out by the task force in our recommendations has to be met,” Vanderwall said. “The last thing that we want to do is to have somebody in one of these places go back to their nursing home and cause an outbreak. We need to be firm and we need to stand tall on the inspections.”

The future of CRCs

MediLodge was approved Thursday, information provided the Record-Eagle shows, and is the only such approval in northern Michigan.

The other facilities approved as CRCs are MediLodge of Frankemuth, The Lodge at Taylor, Regency at Chene in Detroit, SKLD Plymouth, St. Ann’s Home in Grand Rapids.

MediLodge of Frankenmuth, The Lodge at Taylor and SKLD Plymouth had also been regional hubs and were decommissioned about the same time as Medilodge GTC, MDHHS information shows.

Other approvals are soon expected to follow.

“It is a top priority to provide a sufficient number of safe CRCs so that people have someplace to go that will limit potential COVID-19 exposure to residents and staff,” Sutfin said. “We are working to stand up CRCs as quickly and safely as possible.”

Nursing homes that are not designated as CRCs are currently able to accept COVID-positive residents at their discretion, an MDHHS policy document shows.

A sampling of calls to nursing home administrators and clinical directors in northern Michigan shows area facilities are not necessarily willing to do so.

For example, two county-owned nursing homes, Grand Traverse Pavilions in Traverse City and Meadow Brook in Bellaire, require negative COVID-19 tests for admissions and re-admissions, then a 14 day quarantine.

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