Legislature, News, public health

Can a pandemic push North Carolina to finally expand Medicaid? These House members hope so.

Seven House Democrats took part in a conference call Wednesday to urge lawmakers to pass House Bill 1040, Healthcare for Working North Carolinians.

On the day when North Carolina surpassed 10,000 COVID-19 cases, a group of House Democrats gathered by teleconference to make the case for Medicaid expansion.

Rep. Sydney Batch, a Wake County Democrat, told reporters that the newly filed Healthcare for Working North Carolinians Act (HB 1040) would help thousands of residents who are either uninsured or underinsured.

“Not only will this bill help frontline workers who have supported us through this crisis, it will also help many North Carolinians who have unfortunately lost their jobs because of this crisis and are now in the coverage gap,” explained Rep. Batch.

Rep. Sydney Batch

Batch estimated that Medicaid expansion would return $4.5 billion in federal tax money to North Carolina’s overwhelmed health care system, allowing state tax dollars to be used for economic recovery initiatives.

Mecklenburg County Rep. Christy Clark, a cancer survivor, believes the latest bill could provide health coverage to as many as 500,000 North Carolians who are working but can’t cover the cost of insurance.

“Those are the very people who are keeping the state running during this unprecedented pandemic,” explained Clark. “People deserve quality healthcare at a cost that will not break their bank or prevent them from seeking care at all.”

Twenty-seven percent of adults in North Carolina have unpaid medical debt, according to Clark.

Rep. James Gailliard

Rep. James Gailliard, a Nash County pastor, noted that expansion was especially critical for rural North Carolina where food deserts and a lack of broadband further compound negative health outcomes.

“What we have done in our unwillingness to give people access to healthcare is we have participated in creating a public health crisis. We see it playing out right in front of us with the pandemic.”

Click below to hear Rep. Gailliard discuss the impact expansion would have for his regional hospital:

Rep. Verla Insko (Orange County-D.) believes the issue of expansion is finding more support among voters as COVID-19 changes life around us, but she acknowledged that Senate Republicans will need to stand-up to that chamber’s leadership for the measure to ultimately pass.

A Cone Health Foundation report released last summer estimates Medicaid expansion would create 37,200 more jobs in North Carolina by 2022.

The legislation, filed on the opening day of the session, has been referred to the House Rules Committee.

Read HB 1040 here.

COVID-19, News, public health

Gaston County bucks Gov. Cooper’s stay-at-home order, allowing all businesses to re-open today

Gaston Co. Chairman Tracy Philbeck

[This post has been updated to include the Governor’s response.]

The Gaston County Board of Commissioners has decided all local businesses will be allowed to re-open after 5 p.m. today.

Chairman Tracy Philbeck says the one-size-fits-all approach to the COVID-19 crisis is creating more harm than good for Gaston County residents.

“Our goal was to make sure our hospital system was not overwhelmed,” Philbeck said. “We’ve done that. Why punish us for being successful in flattening the curve when a strict Stay at Home order no longer makes sense for our county?”

Governor Cooper had extended the state’s stay-at-home measure through May 8th, saying the state still needed to keep a careful watch on the daily trends and adjust accordingly.

The Republican-led board says they are not in lock-step with the Cooper administration, but will continue to promote social distancing and disinfection recommendations.

Here’s more from the so-called ‘Gaston Promise‘ released on Wednesday:

….we support putting our citizens back to work and allowing them to worship corporately, both of which are their constitutional rights. In fact, we are reminded by Article I, Section 13 of our North Carolina Constitution, that “all persons have a natural and inalienable right to worship Almighty God according to the dictates of their own consciences, and no human authority shall, in any case whatever, control or interfere with the rights of conscience.”Worship –whether by oneself or corporately –is an inalienable right of the people.

Furthermore, it is no coincidence that our State’s founders listed the following atop all the rights guaranteed to North Carolinians in our Constitution’s Declaration of Rights: “We hold it to be self-evident that all persons are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, the enjoyment of the fruits of their own labor, and the pursuit of happiness.”Work –whether at home or at one’s business –is also an inalienable right of the people.

Health and Human Services Secretary Mandy Cohen has rejected a county-by-county approach on lifting restrictions, noting that the virus does not respect county boundaries.

As of Wednesday, Gaston County had recorded 137 positive cases of COVID-19 and three deaths. North Carolina has surpassed 10,000 positive cases.

This afternoon, Gov. Cooper’s office issued the following response to the Gaston County action:

“This order’s only effect is to create confusion during a public health emergency, which is dangerous. The Gaston County order itself says that the statewide Stay At Home order remains in effect, and state leaders urge people to continue following it.”

COVID-19, public health

Family member says aunt died at Citadel of COVID-19 but he found out from the funeral home

Notes from recently court documents filed against Accordius Health, which owns the Citadel in Salisbury. A new lawsuit includes sworn affidavits of dire conditions, short-staffing and substandard care for the residents.

This story was updated at 5:15 p.m. with comment from Accordius, which owns the Citadel.

In early April, the Citadel, a poorly rated nursing facility in Salisbury, called Ronald Barber to inform him that a resident had tested positive for the new coronavirus and had been sent to Rowan Novant hospital.

It wasn’t his 98-year-old Aunt Dot who was ill, but the facility staff wanted him to know there had been a case of COVID-19.

It was “the last call I ever received from Citadel,” he said.

The next one came from a funeral home.

In a sworn affidavit filed with the court, Barber said that roughly two weeks later, on the morning of April 15, he received a call from James Alexander, director of the Noble & Kelsey funeral home in Salisbury.

“I had no idea why he was calling,” said Barber, who was also his aunt’s power of attorney. Alexander then told him that his Aunt Dot had passed away the day before and the Citadel had sent her body to them.

“I was in shock,” Barber said. “They assumed I knew, but I didn’t … I never received a call from the Citadel to even alert me of any dire condition, much less to tell me that she had passed away. They simply had the funeral home take her away without my knowledge.”

Barber’s sworn affidavit is one of 12 — including several from certified nursing assistants who work or have worked there — alleging rampant substandard care at the Citadel contributed to the deaths of several residents with COVID-19. One CNA said in an affidavit that the facility continued accepting patients after residents had tested positive for the virus; others said they learned of an outbreak from the media.

There were inadequate supplies, too few staff and “the problem of the facility knowing individuals were not going to come in but doing nothing about it,” the CNA said.

A one-star facility, it has also been cited for abuse by the Centers for Medicare and Medicaid Services. The affidavits were taken by two law firms, Wallace & Graham and Gugenheim Law, who are suing Accordius Health “seeking a comprehensive view of the facility’s policies” to prevent further neglect. The firms and their clients are not asking for monetary damages.

Accoridius spokeswoman Kim Morrow said the company had not see the complaint and could not comment on the allegations.

“It is unfortunate that there has been so much misinformation put out by a source clearly not familiar with the facts of what has been going inside this building,” she wrote in an email. “The negative press this law firm is trying to create for the sake of building their own reputation, only hurts the patients and staff they claim they are trying to protect. I only wish that those individuals responsible for such reckless and selfish behavior would put those efforts to helping our facility care for our residents as so many people from the community already have, rather than trying to capitalize on this pandemic for personal gain and recognition.”

The Salisbury Center has reported 144 positive cases of COVID-19 and 10 deaths, according to the most recent figures from the NC Department of Health and Human Services.

It’s unclear whether those numbers include another resident Marjorie Galvin, 96, who died last night.

A CNA, whose name is redacted in court documents because they are afraid of retaliation from the company, stopped working at the Citadel two weeks ago. “I could not continue to work under the direction of the Citadel management. It was heartbreaking for me to make the decision that I would not return to the facility because of my love and concerns for the residents there,” they said.

Many of the residents who had tested positive were sharing bathrooms with residents that were tested and came back negative,” the CNA said, and the same thermometers were used throughout the facility.

On April 7, the CNA said, “I witnessed an event that disturbed me greatly.” Two staff employees transported a resident who had developed a high fever from his room to the quarantine hall. “He was wheeled outside of the rooms of the entire hall of residents and past the nurses’ station but he was not wearing a mask. I admonished them for this reckless behavior,” they said.

They immediately called Ardith Peacock the director of nursing, the CNA said. “She replied that she didn’t know what else to do, she had provided them in-service training.”

In the weeks leading to the CNA’s departure, they said, “the condition at the facility had become dire. Residents were ill with the virus, the staff members were sick and not reporting to work, and we had no meetings whatsoever advising us of what was occurring and how to deal with the epidemic.”

Morrow, the Accordius spokeswoman, said the Citadel has been doing “everything we can in lockstep with the CDC guidelines, the local department of health and local hospitals, and have been working around the clock to protect the safety of our residents and the staff during this unprecedented, worldwide pandemic,” Morrow said in an email. “The Citadel Salisbury had an emergency preparedness plan in place and also implemented a COVID-19 pandemic plan even before Gov. Cooper’s Emergency Declaration on March 10, 2020, and more than a month before the first confirmed case at the Citadel Salisbury on April 7, 2020.

“These plans have been reviewed daily and revised as needed with input from Department of Health and our local hospitals.  In fact, the N.C. Department of Health completed a COVID-19-Focused Infection Control inspection of the Citadel Salisbury on April 17, 2020, and found the facility to be in full compliance with the applicable regulations, including in the area of infection control.”

Another CNA, who’s name is also redacted, said they and another employee “cornered” a supervisor and asked “why on earth” Citadel was “accepting new admissions during the coronavirus outbreak.”

The CNA said they became ill the week of April 20th with chest congestion, coughing, loss of taste and smell, and diarrhea. They remain in 14-day quarantine, but others have continued working at the Citadel despite having tested positive, they said.

The CNA said that they were told by a Citadel administrative employee to take off a mask that they had put on while handling a newly admitted patient. “Earlier in the outbreak the staff was told not to wear masks because it frightened the patients.”

“My hall received two new patients and both are dead now,” they said.

COVID-19, public health

Among nursing homes, lowest-rated facilities account for most COVID-19 cases, deaths

PruittHealth-Carolina Point, one of the nursing homes with the largest COVID-19 outbreaks (Photo: Lisa Sorg)

Three nursing homes rated as “much below average” by federal regulators have the largest number of COVID-19 cases, according to data released yesterday afternoon by the NC Department of Health and Human Services.

These one-star facilities also are in the top five for reported deaths in North Carolina from the coronavirus.

The Citadel at Salisbury, also known as the Salisbury Center, leads the state with 144 cases; 10 residents have died.

PruittHealth-Carolina Point in Orange County has reported 108 cases and 11 deaths.

At the Durham Nursing & Rehabilitation Center, 95 cases have been confirmed, and seven deaths.

All three nursing homes have also been cited for abuse in the past, according to the Centers for Medicare and Medicaid Services.

As of yesterday, there were 1,380 reported positive cases of COVID-19 in North Carolina nursing homes, and 126 deaths. More than two-thirds of the cases and 70% of the deaths in these facilities occurred in those with 1-star or 2-star ratings — much below average or below average.

NC DHHS released the data after more than 20 media outlets, including NC Policy Watch, threaten to sue the agency under the Public Records Act. Previously, DHHS had refused to disclose the names of the facilities citing privacy laws.

Further analysis of the data shows that the nursing homes accounting for 83% of the positive cases also scored low in staffing benchmarks. In fact, inadequate staffing is common among most facilities in North Carolina; 31 of 47, rated by the Centers for Medicare and Medicaid Services received either “below average” or “much below average” marks.

Only six nursing homes were “above average” or “much above average” for staffing.

Even several of the highest-rated homes, though, reported positive cases, but the numbers were lower than their lesser-rated counterparts. The lowest percentage of cases that resulted in or contributed to death were in five-star facilities.

However, several factors besides the facilities ratings could influence the outcomes, such as the overall health of the resident. For example, some facilities house more people who are medically fragile.

According to DHHS data, there also have been 22 positive cases in “other congregate living facilities,” and 1 person has died.

In residential care facilities, which include assisted living homes for senior citizens and people with disabilities, 220 positive cases have been reported. Of those, 17 people have died.

These figures often change. Within the last 12 hours Durham County added to its total: 111 at the Durham Nursing and Rehabilitation Center, 47 at Treyburn Rehabilitation Center, five at the Durham Recovery Response Center, 4 at Durham VA Healthcare System Community Nursing Home and two at Hillcrest Convalescent Center. These are not included in the tables below. Sources: NC DHHS, Centers for Medicare and Medicaid Services

Overall rating (1 worst to 5 best)Total nursing homes in NC, by ratingNumber of facilities with outbreaksTotal number of reported positive casesTotal number of reported deathsPercentage of cases that resulted in or contributed to death   
1 star9710614437
2 star88103374613.6
3 star7814234229.4
4 star877127129.4
5 star7656534.6
*Durham VA Community Care Center had 3 cases; they were not in the Medicare database
FacilityCountyLab-Confirmed CasesDeathsOverall rating medicare.govHealth InspectionsStaffingQuality Measures
The Citadel at SalisburyRowan144101112
Pruitt Health-Carolina PointOrange108111122
Durham Nursing & Rehabilitation CenterDurham9571221
Five Oaks Manor RehabCabarrus7462224
The Laurels Of ChathamChatham6751122
Springbrook Nursing and RehabJohnston6572224
Pinehurst HealthCare & RehabMoore6531121
Louisburg Healthcare and Rehab CenterFranklin62142222
Grace Heights Health and RehabBurke5964434
Autumn Care - CorneliusMecklenburg53102224
Signature HealthCAREOrange5221113
Wellington Rehab and HealthcareWake4963323
Universal Health LillingtonHarnett4211111
Alston BrookDavidson4123333
Monroe Rehab CenterUnion3533323
Treyburn Rehab & NursingDurham3331124
Mount Olive CenterWayne3142224
LongLeaf Neuro-Medical Treatment CenterWilson3015355
Brian Center Health & Rehab/HendersonvilleHenderson3043332
Pavilion Health Center at BrightmoreMecklenburg2634423
Sunnybrook Rehabilitation CenterWake2614325
The Laurels of HendersonvilleHenderson2405435
Premier Living & Rehab CenterColumbus2232222
Village Green Health & RehabCumberland2022314
Carrington Place, MatthewsMecklenburg1813323
NC State Veterans Home - SalisburyRowan1633254
Cleveland PinesCleveland1213322
Liberty Commons Nursing & Rehabilitation Center of Columbus CountyColumbus1213324
Pelican Health HendersonVance1013323
Peak Resources-Outer BanksDare614431
Clapps Nursing CenterGuilford604325
Camden Health & RehabGuilford602222
Autumn Care - DrexelBurke515534
NC State Veterans Home - KinstonLenoir415452
Rich Square Nursing and RehabilitationNorthampton411133
Hunter Woods Nursing & RehabMecklenburg401214
Three Rivers Health & RehabilitationBertie303323
Durham VA Community Living CenterDurham30N/A
The Lodge at Mills RiverHenderson205435
Hillcrest Convalescent CenterDurham214443
White Oak Manor TryonPolk204444
Huntersville OaksMecklenburg203243
Village Care of KingStokes203333
Autumn Care - MarshvilleUnion203333
Autumn Care - SaludaPolk203322
Autumn Care - StatesvilleIredell202224
Liberty Commons SalisburyRowan202115


COVID-19, News, public health

Health care bills take shape as General Assembly prepares to return next week

State House members unveiled two draft bills Thursday that would put more than $600 million into COVID-19 research and treatment, support for rural hospitals and distribution of personal protective equipment for medical personnel.

The draft bill dealing with funding,  includes:

* $100 million for “vaccine development, community testing and other COVID -19 research” through the medical schools of UNC-Chapel Hill, Duke University, Wake Forest University and East Carolina University. The schools would each receive $25 million.

* $75 million in funding to the North Carolina Healthcare Foundation for rural hospitals across the state.

* $50 million to purchase and stockpile personal protective equipment or PPE for medical professional.

* $25 million for COVID-19 testing, trend analysis and contact tracing

* $10 million for Campbell University to develop a “community and rural-focused primary care workforce response.”

* A 5% increase in Medicaid provider payments, or about $68.4 million in non-federal funds.

* $2.25 million for supplemental payment for foster care, or $100 for each child getting foster care assistance from April through June.

Lawmakers discussed the bills in Thursday’s Health Care work group of the House Select Committee on COVID-19, which has been preparing bills for quick passage once the General Assembly returns April 28. The committee members emphasized that these bills will just be the first phase of relief efforts.

Significantly, one of the bills would authorize the state Department of Health and Human Services to provide Medicaid coverage for COVID-19 testing for the uninsured during under the Families First Coronavirus Response Act for the length of the pandemic. The coverage would be retroactive, to the extent that is allowed, for those who have tested positive for the virus. If the federal government approves, the bill would fund testing and treatment for those living at 200 percent of the federal poverty level, which equates to about $50,200 for a family of four.

Rep. Donny Lambeth (R-Forsyth), co-chair of the committee, said the work of House members on these bills has been exhaustive but the work of state lawmakers on pandemic relief has truly just begun.

“The package is a robust plan based on what we have heard in the last several weeks from our communities from the mountains to the ocean,” Lambeth said. “But this is a package I would consider to be phase one. We will continue to monitor the situation and we will address the next phase at some point in our future.”

“It has been historical, it has been stressful, it has been scary and dangerous to an extreme,” Lambeth said of the pandemic. “Just as Carolinians have done time and time again, during major hurricanes, floods and wildfires and now this virus, we have responded.”