Health Secretary Rachel Levine’s removal of mom from care home amid epidemic draws scrutiny

Health Secretary Rachel Levine said Tuesday that she had removed her 95-year-old mother from a personal care home amid a statewide coronavirus outbreak that has been particularly devastating to facilities that house elderly populations.

“My mother requested and my sister and I as her children comply to move her to another location,” Levine said at a press conference, responding to a question from ABC27. “During the COVID-19 outbreak. My mother is 95 years old. She is very intelligent and more than competent to make her own decisions.”

Department of Health spokeswoman April Hutcheson declined to name the facility but said the elder Levine and her children were notified of residents who tested positive and lived nearby within the personal care home.

Levine was careful to note that her mother was in a personal care home, not a nursing home, and that the facility in question fell under the jurisdiction of the state Department of Human Services, not her own agency.

In Pennsylvania, a personal care home is legally differentiated from a nursing home or assisted living facility. All three are licensed by the state with the key difference being the level of care. According to the Department of Human Services, which regulates personal care homes, the facilities offer assistance for people who need help with daily tasks — such as bathing and doing laundry — but do not need medical care. They’re designed to allow residents to live with greater autonomy for long periods of time before eventually transitioning to more advanced care.

Nonetheless, all three types of facilities are vulnerable to outbreaks of COVID-19.

According to state data, as of Thursday there were 12,677 resident cases of COVID-19 in addition to 1,922 cases among employees for a total of 14,599 cases at 549 individual locations across 44 counties.

Such facilities accounted for more than two-thirds of all deaths — 2,896 out of 4,218 — statewide.

Levine’s removal of her mother from the personal care home, which was revealed as she announced a plan to ramp up coronavirus testing in nursing homes, drew criticism from lawmakers such as York County Republican state Rep. Seth Grove that she’s done what many families are unable to do for financial or logistical reasons.

The state’s top health official, however, said she “remain[s] committed to protecting residents in Pennsylvania, wherever they live.”

Most public health officials advise against removing family members from elder care facilities because many residents require a level of care that may not be feasible outside those settings. Similarly, if the individual is moved into a multi-generational household, they could be at greater risk of exposure than if they remained confined to a room at a nursing facility with fewer contacts.

“Moving an older adult from a long-term care center is risky and could have long-lasting impacts,” geriatrician David Gifford, chief medical officer of the American Health Care Association and the National Center for Assisted Living, told AARP.

There are a number of new restrictions on such facilities when it comes to admissions, readmissions, activities, dining, screening and visitation. A resident can choose to leave a facility but they may have a difficult time being readmitted after their discharge. Hutcheson said discharge and readmittance decisions vary from facility to facility.

On Tuesday, Levine announced plans to begin testing every nursing home resident and staff member, a massive undertaking designed to address growing numbers of infections and deaths at such facilities.

“By testing every resident and every staff member in every nursing home, we will be able to pinpoint exactly who has COVID-19, who has been exposed but has no symptoms, and cohort positive cases to prevent further spread,” she said.

Cohorting refers to the process of grouping together patients who are confirmed to have COVID-19, were exposed but aren’t exhibiting symptoms or who were not exposed. Pennsylvania has offered guidance to nursing homes on how to cohort their residents but it’s not a requirement. In some cases, if the outbreak has already spread quickly across a given unit, cohorting may have limited benefits.

This factor gave rise to some criticism that the state was “forcing” positive and non-positive cases together when, at least in practice, nursing homes have a great deal of discretion about how and when to separate residents who are positive for the disease, who are negative or who have not been tested.

The testing process itself will be a massive undertaking.

According to state data, in 2019 the industry employed 116,000 full- and part-time employees staffing 88,000 resident beds. For context, a total of 303,000 coronavirus tests have been conducted statewide since the beginning of March.