On a blustery afternoon in late March, a man who is blind and suffers from depression was kicked out of a Twin Cities nursing home. With nowhere to go, he spent the night in the building’s lobby before being transported to another facility.
The reason for his eviction: He was caught leaving the nursing home to have a friend read his mail to him in the facility’s parking lot.
Just days earlier, a woman with paraplegia and anemia was evicted from the same nursing home, North Ridge Health and Rehab of New Hope, after she left the building in her wheelchair to give a relative a basket of laundry in the parking lot. Without a ride or place to go, she called a taxi to take her to a hospital.
These abrupt evictions, detailed in recently released state Health Department surveys, highlight the extreme measures being taken by many of Minnesota’s nursing homes to curb the spread of the novel coronavirus, which has killed 1,143 residents of long-term care facilities statewide and sickened thousands more, state health data show.
Since the pandemic began, complaints about involuntary discharges and transfers from senior care homes statewide have risen nearly 30% over the same four-month period a year ago, according to the state Office of Ombudsman for Long-Term Care, the state’s official advocate for senior care residents. They are the top reported grievance to the ombudsman’s office, with 150 complaints lodged between March 1 and the end of June, records show.
“This is no way to treat people who live in our communities,” said Cheryl Hennen, Minnesota’s long-term care ombudsman. “Eviction is not a viable option during a state of emergency when a discharge could impact the health of the resident as well as the community. This is a public health issue for all of us.”
Minnesota’s 1,700 long-term care communities have been under extraordinary strain during the COVID-19 pandemic. Many struggle with shortages of staff, protective equipment and space to quarantine infected residents. They also face intense pressure from family members to ensure their loved ones’ safety, knowing that with a virus so contagious even one breach could have widespread and fatal consequences.
“The pressure to keep this virus out is immense,” said Dustin Lee, president of Prairie Senior Cottages, which operates seven assisted-living and memory care homes statewide. “It’s like we are operating in a crisis environment all the time.”
State health authorities have also turned to nursing homes to help relieve the burden on hospital systems at risk of being overwhelmed by COVID-19 patients and to help provide space for those who need to be isolated.
Yet the safety measures have sown some confusion and anxiety. Some residents with advanced dementia may not understand why they cannot have loved ones visit them, creating additional stress and trauma, Hennen said. Others are told they can no longer do regular errands in the community such as getting their hair cut or doing their laundry.
The new rules have created such profound isolation that some people will “risk almost everything” to see their loved ones, even arranging clandestine visits with relatives, Hennen said. In extreme cases, Hennen said, residents have reported repercussions, including eviction notices.
“Care homes have essentially created the conditions for a vulnerable adult to fail or to be angry, and then punished the person when he or she reacts,” said Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota’s School of Nursing.
North Ridge Health and Rehab, the state’s largest nursing home with 320 beds, said it strongly discourages residents to leave the facility for nonessential reasons, or against medical advice. Those who do risk their health and that of others in the community and are not allowed to return. At that point, they are considered officially discharged and must obtain a doctor’s order and be evaluated again before they can be readmitted, said Austin Billie, the nursing home’s vice president of operations.
North Ridge, which has a history of regulatory problems, has reported 69 deaths from COVID-19 — the most of any nursing home in the state. One reason for the large death toll is that hospitals and other nursing homes have been transferring COVID-19 patients to North Ridge because the facility has the space and ability to care for them, Billie said.
“The safety and well-being of our residents is our top priority,” Billie said.
In two April surveys, the state Department of Health determined that North Ridge violated federal rules designed to protect residents from unsafe and arbitrary evictions. These rules require nursing homes to discharge residents to safe locations and provide them with at least 30 days’ notice before they are discharged. Nursing homes are also required to notify residents of the reason for a discharge and their appeal rights.
One resident’s eviction appears to have stemmed from his desire to have someone read his unread mail, according to a state survey.
The resident, who is not identified by name or age, said a volunteer would normally read him his mail because he is blind and because the staff did not have the time to do so. But the volunteer could no longer visit because of COVID-19, causing four or five months of unread mail to accumulate, he said.
The man turned to a friend, who read him his mail from a car in the facility’s front parking lot. The friend was told by a staffer at the front desk that it was OK if he did not go beyond the property, the state report said. But when the resident returned to the building, he was told he was being discharged immediately. His belongings were already on a dolly.
“I had to sit in the chairs, in the front entrance,” the man said, according to the state report. “I sat there all night, into the next morning.”
Finally, at 10 a.m., about 17 hours after he was evicted, the man contacted Metro Mobility, the public transportation service for people with disabilities, and was taken to a Salvation Army facility. Two weeks later, the man was living in a Holiday Inn hotel, the report said.
The resident had underlying health problems, including major depressive disorder, lower back pain and diabetes, in addition to vision loss. Yet he told state investigators that he was not given his medications upon discharge from North Ridge. A nurse disputed this account, though the state’s review of medical records found no evidence that he was given his drugs, the state report said.
“Based on interview and document review, the facility failed to ensure a proper discharge process,” the state Health Department concluded in its survey.
Another resident, who also is not identified, faced a similar outcome over attempts to get her clothes washed.
The woman said she left North Ridge on March 21 to drop off a basket of laundry to a family member waiting outside the building, and then was told upon returning that she would not be allowed back into the facility. The resident “called a cab due to not having a ride and/or a place to go,” the state report said.
The nursing home’s administrator said the woman had been told of the facility’s policy of not allowing residents who left without approval to return, the state report said.
State investigators again concluded that federal rules were violated, because the resident was not informed of where she was being discharged and her appeal rights.
Billie, the North Ridge vice president, said the nursing home has re-educated staff on processes — particularly to ensure the correct paperwork is used in discharges resulting from residents leaving against medical advice.
In late April, he said, the state Department of Health approved North Ridge’s plan to correct the violations. The facility has since been in compliance.
Staff writer Matt DeLong contributed to this report.
To get help
Contact the Office of Ombudsman for Long-Term Care if you are concerned or have questions about transfer or discharge from an assisted-living facility or nursing home. Call: 651-431-2553 (metro) or 1-800-657-3591 or e-mail: MBA.OOLTC@state.mn.us.
The ombudsman’s office provides free, confidential advocacy services.