Marin County health officials are working closely with the county’s nursing homes to prepare for a possible surge of coronavirus patients that could surpass the bed capacity of the county’s three hospitals.

Health officials are seeking to minimize the number of Marin nursing-home residents who will need to be hospitalized if they contract COVID-19, thus keeping as many hospital beds available as possible.

MarinHealth Medical Center, the county’s largest hospital, is licensed for 235 beds, with about 170 in use, according to hospital officials. Novato Community Hospital is a 47-bed facility, according to data compiled by the California Department of Public Health.

Preparation is also underway for the possibility that skilled-nursing facilities may need to be used to house coronavirus patients if hospitals become overwhelmed. Marin’s 13 skilled nursing facilities are licensed for about 1,026 beds, state data shows.

“Our first priority right now is working with skilled nursing facilities to increase their capacity to care for patients with COVID-19 within their facility,” said Dr. Lisa Santora, Marin County’s Deputy Public Health Officer. “A key to preventing a surge is to make sure patients from those skilled-nursing facilities don’t transfer to the hospital until necessary.”

Santora said Marin’s skilled-nursing facilities are licensed to provide medical services while its more than 70 assisted-living facilities are not.

Five residents at Marin assisted-living facilities have tested positive for coronavirus. Four are in Novato – three at Atria Tamalpais Creek and one at Young at Heart. Santora declined to say where the fifth resides.

“We’ve been doubling down on our efforts with the assisted-living facilities,” Santora said.

She said public health workers have made site visits to ensure that staff at the facilities are following infection control procedures to prevent outbreaks.

Marin County also has been working with Kaiser Permanente, which has some members in these facilities, to educate residents and their families about COVID-19 and to update residents’ advanced directives. Kaiser’s medical center in Terra Linda is licensed for 116 beds, according to state data.

Santora said since not all of the assisted-living facilities are equipped to care for residents if they contract COVID-19, the county is seeking to identify potential alternate care sites. These might include other assisted living facilities, hotel rooms or county facilities, such as the Marin Center.

The California Department of Public Health has told skilled-nursing facilities to prepare to receive and care for suspected or confirmed COVID-19 patients while preventing the spread of the virus within their facilities.

“California is experiencing increasing numbers of COVID-19 cases and hospitalizations, and there is an urgent need to ensure hospital capacity to be able to meet the demand for patients with COVID-19 requiring acute care,” according to a letter from the department sent to all facilities April 1. “Patients hospitalized with COVID-19 can be discharged to a skilled nursing facility when clinically indicated.”

The approach has drawn a negative response from the Society for Post-Acute and Long-Term Care and the American Health Care Association.

“Multiple states are considering adopting an order similar to what was issued in New York that requires every nursing home to admit hospital patients who have not been tested for Covid-19 and to admit patients who have tested positive,” the association’s CEO Mark Parkinson and chief medical officer Dr. David Gifford wrote in a joint statement.

“This approach will introduce the highly contagious virus into more nursing homes,” they wrote. “There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths.”

The AHCA officials said it is imperative that hospital patients be discharged only to nursing homes that can create segregated COVID-19 units and that have adequate personal protective equipment.

They said public health officials should consider asking nursing homes to move residents from one nursing home to another to create dedicated COVID-19 facilities to accept hospital discharges. This has been done in Connecticut where state officials are reopening shuttered facilities to house residents who are COVID-19 positive.

Santora said Marin County has been seeking to identify which local skilled-nursing facilities would be “ready, willing and able” to accept COVID-19 patients if hospitals become overwhelmed. She said Kentfield Hospital, a long-term acute care provider, has said it is willing to do so. Kentfield is licensed for 60 beds, according to the state.

Hunter Moore, CEO of the Redwoods in Mill Valley, said his facility, which has about 52 skilled-nursing beds, has rooms where it could isolate and care for patients who might have COVID-19.

Moore said the Redwoods has an adequate supply of personal protective equipment at the moment.

“If we get a flood of people we would be concerned about our supplies,” he said, “and are working closely with various agencies and groups to try to enhance those supplies.”

David Berman, the medical director at Villa Marin in San Rafael, which has a 31-bed skilled-nursing facility, said, “All facilities are having to deal with this; we will do our best to comply.”

Kevin Hogan, administrator at Marin Convalescent and Rehabilitation Hospital, a 56-bed skilled-nursing facility in Tiburon, said, “There is uneasiness at different levels because of the unknowns, but there is a willingness to move forward and do what is right for the hospitals and individuals who are impacted by this the greatest.

“One just has to look to New York,” he said.