California’s public health department on Thursday told the state’s nursing homes to prepare to accept patients with coronavirus, even though many facilities are ill-equipped to prevent the spread of infection among residents at elevated risk of dying from the disease.

“We don’t want hospitals transferring anybody who is COVID-19 positive,” said Craig Cornett, CEO and president of California Association of Health Facilities. “We couldn’t take care of them right now even if we had the personal protective equipment — the special masks, the gowns, all the things you’ve been hearing about there being a national shortage of.”

In response to MarketWatch questions about whether facilities were in a position to prepare for accepting these patients, or whether the state would compel them to do so, a California Department of Public Health spokesman responded only with a statement saying the state is “providing technical assistance and guidance to all facilities in the health-care delivery system. Our mission is to protect the health-care system in order to maintain access to care throughout the duration of this pandemic.”

On Thursday night, California Gov. Gavin Newsom ordered the state’s 40 million residents to stay at home and avoid non-essential travel in an effort to slow the spread of the coronavirus, which threatens to overwhelm the state’s health facilities.

California nursing homes already had problems with infection prevention before the aggressive “shelter-in-place” response to the coronavirus pandemic, which has kept some staff and family members away from vulnerable nursing-home patients, while putting an extra burden on remaining staff to provide care and prevent infection, said Eric Carlson, an attorney with the advocacy group Justice in Aging.

“Inspection results show that many facilities already have a record of deficiencies relating to infection prevention and staffing,” Carlson said. “Also, few facilities provide ventilator care, which likely will be needed by many residents with COVID-19.”

Facilities statewide are shorthanded, said Leza Coleman, executive director of the Long Term Care Ombudsman Association, representing government nursing-home watchdogs in California counties.

“If I’m a facility administrator and you’re going to send me a COVID-19-infected person into the building, I would probably push back,” she said.

California’s public health department on Thursday sent a letter to skilled nursing facilities that strongly recommended preparation for COVID-19, which included advice on preventing infection among patients and staff.

The letter also predicted that hospitals will discharge patients with mild COVID-19 symptoms who will still require nursing care.

Facilities “should prepare to accept such residents and institute the appropriate precautions to prevent spread of infection to (health care personnel) and other patients,” the letter said.

Following reports that 35 nursing-home patients died from the virus at a Kirkland, Wash., facility, more cases have been identified at nursing homes around the country in states such as Illinois, Oregon and Wyoming. Risk factors for COVID-19 include old age as well as ailments commonly found in nursing-home patients, such as pulmonary disease, hypertension, strokes and diabetes.

Thursday’s letter from California health regulators also urged nursing care facilities to keep their staffs home from work “if they are symptomatic with fever or respiratory symptoms.”

But in keeping with a nationwide testing shortage, the letter did not include information about detecting infection among potentially infected staff who do not present symptoms.

“I wish there were more testing for people not presenting symptoms,” said Benson Nadell, program director of the long-term care ombudsman program in San Francisco.

The California Department of Public Health licenses, certifies and regulates nursing homes. But advocates said that despite Thursday’s directive, the state has little leverage to compel nursing homes to adequately prepare for infected patients, or to accept them once they’re discharged from hospitals.

“Some nursing homes may be prepared for this role but many are not. Sending persons who are infected with COVID-19 to nursing homes that are understaffed, unprepared and mostly unmonitored would be a grave risk for all involved, including existing facility residents,” said Michael Connors of California Advocates for Nursing Home Reform. “Telling nursing homes to prepare does not mean that they will.”