Megan O’Brien would have moved her mother from her nursing home if she had known there was a COVID-19 outbreak at the facility. It’s too late now; 101-year-old Jean O’Brien tested positive for the coronavirus this week.

“If we’d known, we would have rallied to make a plan to keep her safe,” O’Brien said. “We didn’t get an opportunity. They didn’t communicate with us.”

Gov. Gretchen Whitmer issued an executive order Monday, requiring long-term care facilities to submit daily reports on all cases of COVID-19, an infectious respiratory disease, which poses a particularly dire threat to older residents, especially those with pre-existing conditions. Sixty-six percent of Michigan residents killed by the virus are 70 or older.

Nursing homes have become a hotbed for the coronavirus, producing many confirmed cases in Southeast Michigan’s hardest-hit communities as well as rural counties where fewer cases have been detected.

“Nursing homes are the next frontier,” said Dr. Nirav Shah, a senior scholar at Stanford University’s Clinical Excellence Research Center. "The answer for nursing homes is the same as the answer for the rest of the economy opening up: widespread testing, contact tracing and isolation.”

County health departments across Michigan are working to test staff and elderly residents who remain isolated from families. Whitmer’s order includes provisions to separate the sick from the healthy and use telemedicine where possible to reduce the risk of exposure.

Chief Medical Officer Dr. Joneigh Khaldun said $3.8 million will go to local health departments to help COVID-19 testing, contract tracing and prevention at nursing homes. MDHHS will also begin setting up regional hubs to treat people with COVID-19 from congregate care settings who don’t require hospitalization.

“We have to protect our most vulnerable and especially those who are elderly or living in our nursing facilities across the state,” Khaldun said Wednesday.

The Michigan Department of Health and Human Services said it will release data about the number of COVID-19 cases and deaths, capacity and bed availability and personal protective equipment inventory at nursing homes. The state previously compiled reports of respiratory outbreaks at various types of congregate care facilities but did not track data on cases at nursing homes.

MDHHS reported 243 congregate care facilities with a respiratory outbreak as of April 15 -- which includes adult foster care, group homes, homeless shelters, prisons other similar facilities. The number rose to 340 by Thursday.

Khaldun said Friday that 2,218 confirmed cases have been found at 331 nursing homes across the state. Specific facilities were not named, but Khaldun said more detail will be released on Friday.

Some local health departments also declined to identify specific nursing homes with an outbreak, citing privacy concerns.

Kevin Lingell, a spokesperson for the Service Employees International Union, said a lack of transparency has made it extremely difficult to assess the situation in nursing homes. He said Whitmer’s order for reporting and standardized protections at nursing homes is a good step, but comes too late for those who already died.

"I wish it would have happened a month ago honestly," Lingell said. "COVID-19 is really widespread through probably a majority of the homes that we represent now. A lot of this damage is done. We do need to know where the virus is and who it's impacting, but now it's like we're checking for pulses rather than trying to prevent it. Unfortunately, it's taken a long time to get to this point."

Families who spoke with MLive said they would have acted differently if they’d had more information.

Tracie Fryz said her mother Loretta, 76, was a resident at Four Chaplains Nursing Care Center in Westland. Loretta suffered from advanced kidney failure and was moved outside the facility three times a week for dialysis treatments.

Fryz said her mother was transported without any personal protection equipment. Staff told her there were no COVID-19 cases at the facility.

Loretta tested positive for the coronavirus on April 1. She died two days later.

“I’m not blaming them for my mother’s death. I’m more so saying they’re at fault for not telling anybody, I feel they infected too many other people by not telling their own staff members,” Fryz said. “I would have thought ‘Should I get my mom out of there? Should I do something different for her? Should I take her home until this all goes away?’”

O’Brien said her mother was also a resident at Four Chaplains. She said staff lied when asked whether COVID-19 patients were being treated at the home and downplayed the risk of cross-contamination. Meanwhile, cases and deaths rose exponentially in the surrounding Wayne County.

O’Brien said she and her eight siblings spent weeks on the phone seeking answers from the governor’s office and officials at Four Chaplains and its owner, NexCare Health Systems. The family resolved to get Jean tested and move her immediately, but now she’s infected and can’t be transferred.

"If you know there's a fire in your house don't you try to get people out to safety?" O'Brien said. "There was a fire in their house and they shut and locked the doors."

Four Chaplains and NexCare Health Systems did not respond to a request for comment.

Jean was born in 1918, in the middle of the Spanish Flu outbreak that killed 675,000 Americans. O'Brien is hopeful her mother will see her next birthday on Sept. 3, but said the situation looks grim.

Teleconferencing software and a window in Jean’s room provide the only contact she’s had with the outside world. O’Brien said her mother is despondent and refuses to eat.

"The spark of my mom is just not there," O'Brien said.

Families with loved ones in nursing homes fear Michigan will be ravaged by lethal outbreaks reported at facilities in New Jersey and New York. Their uncertainty is made worse by emergency measures to suspend visitations.

Linda Pritchard’s 99-year-old mother Bette is living at a nursing home in Ingham County with six confirmed COVID-19 cases. Pritchard hasn’t been able to visit her mother for six weeks and worries it’s only a matter of time before Bette is infected.

"She feels abandoned by her family, even though we're not abandoning her," Pritchard said. "My worst fear is she will die alone. I think that’s many of our fears for our parents these days."

COVID-19 has already killed hundreds of nursing home residents in Michigan. Local health departments across the state said nursing homes face shortages of staff, equipment and testing needed to contain the virus.

The Detroit Health Department launched an initiative to deploy 15-minute tests at all 26 nursing homes in the city. The effort revealed 357 cases and 129 deaths at 21 nursing homes as of Wednesday, with an infection rate of 26%.

Health officials said every Detroit nursing home has at least one COVID-19 case. The city partnered with the CDC and Abbot Laboratories to keep up periodic testing at other long-term care facilities, including adult foster care homes and mental health facilities.

“Within communal or congregate settings, we’re finding that COVID-19 is spreading so rapidly,” said Denise Fair, chief public health officer at the Detroit Health Department.

Fair said Detroit will unveil detailed information about the number of cases and deaths in specific nursing homes on Monday. Fair said the city is the first in Michigan to release information about outbreaks in long-term care facilities.

"My goal is to be extremely transparent," Fair said. "I think people need this information."

Wayne County, home to the largest concentration of COVID-19 cases and deaths, was unable to provide details on outbreaks in nursing homes. A spokesperson for the county health department was unable to track the number of cases and deaths connected to nursing homes or identify specific nursing homes with an outbreak.

Most cases from nursing homes are attributed to the resident’s home address instead of the nursing facility. Additional investigation is needed by health officials to track those cases, the spokesperson said.

There are 157 senior facilities impacted by the coronavirus in Oakland County. Bill Mullen, the county’s communication and media officer, said 1,276 cases and 211 deaths have been found at nursing homes, which represents 20% of the cases found in Oakland County.

Mullen declined to name specific nursing homes where outbreaks were discovered.

"There isn't any public health need for identifying the particular location that has had an exposure, because we've been able to reach out to all of the close contacts for that exposure," Mullen said.

"Whether you have someone in a nursing home or whether you have just a loved one staying at home with you, the reality is COVID is everywhere in the community."

Shah said a “blanket release” of data isn’t always the best approach, but nursing homes need to communicate with families. That includes sharing information with nursing home staff, who are among the lowest-paid health care workers.

Lingell, the union representative, said nursing homes are short-staffed and face shortages of masks and other personal protection equipment. Nursing home staff are working longer hours at multiple different facilities and are sometimes forced to reuse masks and PPE.

“We’ve heard from many of our workers who are frustrated, they’re upset, they’re scared,” Lingell said. “They say that they’ve been exposed, but the (nursing home) administration is not being upfront that there are cases in the home. They’re afraid for their own health and their family’s health.”

Local health departments have taken varying stances on identifying specific nursing homes where COVID-19 has been found.

The Marquette County Health Department reported three nursing homes are connected to 28 of the county’s 35 confirmed cases but declined to identify them.

The Hillsdale County Medical Care Facility reported 51 positive cases of COVID-19 between its patients and employees. More than half of Hillsdale County’s 97 coronavirus cases have come from the same elderly care facility, officials said.

The District 10 Health Department, which covers 10 counties in northern Michigan, reported 27 of the 35 positive cases and both fatalities reported in Crawford County come from people who died in nursing homes.

The health department reported five staff members and five residents tested positive at the Munson Healthcare Crawford Continuing Care Center. Grayling Nursing & Rehabilitation Community, also in Crawford County, reported 10 staff members and seven residents are infected with COVID-19.

Jeannie Taylor, public information officer for the District 10 Health Department, said nursing homes represent a large share of the positive cases and deaths in rural parts of Michigan. Testing for COVID-19 remains a widespread problem across the state, but Taylor said it’s particularly hard for rural counties with few confirmed cases.

"The governor has opened criteria to allow for more people to be tested, but what we're finding in our rural communities in northern Michigan is that we still don't have enough kits to be able to perform that testing," Taylor said.

In West Michigan, the Muskegon County Health Department reported outbreaks at two assisted living facilities.

Four residents of Seminole Shores Assisted Living Center died from COVID-19 and one resident of DaySpring Assisted Living has died, according to a news release. Health officials did not say how many positive coronavirus cases have been identified at either facility.

Park Village Pines, an assisted living facility in Kalamazoo County, reported 10 cases of coronavirus and two deaths. Four congregate care facilities in the county have reported respiratory outbreaks, according to MDHHS.

The Genessee County Health Department reported three positive cases and four deaths at the Regency at Grand Blanc. Maple Woods Manor reported 17 residents have died of the virus and another 24 residents tested positive at its facility in Clio, also in Genesse County.

There are 12 congregate care facilities with reported outbreaks in Genessee county, according to MDHHS.

Ingham County Medical Care Facility on Dobie Road reported one positive COVID-19 case on April 17. That number rose to six confirmed cases by Wednesday -- two residents and four staff.

The facility has released information to the community as new cases are discovered. Wednesday's press release includes details about protocols to limit the risk of community spread.

Michigan is reporting a flattening of the curve among the general population, but nursing homes are expected to face a high risk of outbreaks until a vaccine for the coronavirus is created. Fair, the Detroit public health official, said it’s important to keep a close watch on senior citizens.

“You can’t take your loved ones’ care for granted, not one single day,” O’Brien said. “You have to be a part of their care, and my family was until they went into quarantine and we got locked out. When we got locked out, they got to do whatever they wanted and that’s why my mom tested positive.”

COVID-19 PREVENTION TIPS

In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.

Health officials say you should be staying at least 6 feet away from others and working from home, if possible.

Carry hand sanitizer with you, and use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and when you go into places like stores.

Read more Michigan coronavirus coverage here

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