The bad news has emerged in spurts. A seemingly isolated COVID-19 case at a Howard County nursing home. A risk of exposure at a senior living community in Rockville. Confirmation of dozens of positive coronavirus tests — and then deaths — at the Pleasant View Nursing Home in Carroll County, and nearly 200 cases at a FutureCare center in Baltimore.
But Maryland health officials have never provided a full list of the nursing homes where outbreaks of the infectious new contagion have been confirmed, even to the administrators and staff working to protect elderly and infirm residents. That is despite signs the virus is reaching vulnerable populations through unwitting staff members, many of whom work in multiple nursing homes.
The Baltimore Sun contacted health officials and nursing home administrators across Maryland in an effort to compile a list of COVID-19 outbreaks that have now been confirmed at more than two-thirds of the state’s 226 nursing home facilities.
A Maryland Department of Health spokesman told The Sun it was up to the local departments, and individual nursing homes, to release the information publicly.
But leaders of several large local health departments, including in Montgomery, Prince George’s and Harford counties, declined to name facilities with COVID-19 cases, saying they needed authorization from the state to share them publicly. In response to a public information request for the information, Baltimore officials said the information is not a matter of public record.
While many nursing homes have shared news of COVID-19 diagnoses with residents and their families, transparency has not been uniform. And that has contributed to confusion and fear, with residents and their loved ones left to worry and wonder as nursing homes remain hotbeds of coronavirus transmission in Maryland and across the country.
“We don’t know about [outbreaks] until they’re 30 people,” said Larry Ordet, who struggled to get information about his wife’s 103-year-old grandmother, who lives at a Baltimore nursing home. Five days after the facility issued an alert about a single diagnosis, he learned from a news article that the outbreak had grown, and turned deadly.
“It’s difficult to know that she’s safe — that she’s going to be safe,” the South Florida resident said.
The leader of one of the state’s largest nursing home industry groups said the scattered information makes it harder for administrators to track which staff members may have been exposed to the virus in other facilities. And, he said, it can contribute to speculation and alarm.
“I do think because it’s not available publicly, there’s misinformation that’s out there,” said Kevin Heffner, president of LifeSpan Network, which represents nearly 300 senior care providers in Maryland and the District of Columbia. “People fill in the blanks.”
While Maryland and Virginia are among many states refusing to identify which elder care facilities have confirmed cases of the coronavirus, some states are beginning to provide more data about nursing homes.
On Sunday, Florida released a seven-page list naming all 303 facilities that have had confirmed cases. California did, too, with a list of 258 sites. The Massachusetts Department of Health released its list of nursing homes with cases on Monday and New Jersey followed Tuesday with a detailed list of the 425 nursing homes that have confirmed cases.
More information could become available soon. A directive the federal Centers for Medicare and Medicaid Services issued Sunday night could lead to regulations requiring nursing homes across the country to notify residents and their families within 12 hours of confirming COVID-19 infections in their facilities, in addition to providing weekly updates on their efforts to monitor and contain the coronavirus.
Meanwhile, information about which nursing homes have confirmed outbreaks is becoming less relevant as the virus continues to spread, and as scientists learn more about the prevalence of asymptomatic infections.
“It’s probably a matter of when, not if, it’s in all nursing homes,” said Allison Ciborowski, CEO of Leading Age Maryland, another industry group. “Just relying on a list is not going to be entirely helpful.”
But Anna Palmisano, founder of Marylanders for Patient Rights, said she worries for residents who have weathered the pandemic in facilities that haven’t been as forthcoming or proactive. She said she worries in some cases that may be because administrators are concerned about their facilities’ reputations.
“We have to get beyond that. It has to be about what’s best for residents and their families,” she said. “Patients and residents need to know what’s going on so they can make informed decisions.”
Maryland has seen two of the largest known outbreaks of COVID-19 in nursing homes across the country. Twenty-six residents of Pleasant View nursing home in Mount Airy have died, among 82 residents and 39 staff members who have tested positive for the virus. And universal testing of residents and staff at FutureCare Lochearn in Baltimore by the facility’s operator revealed 170 coronavirus infections April 15.
Though the virus is infecting people of all ages, with most cases involving people 20 to 60 years old, it is most deadly for the elderly and people with underlying health conditions.
Information about how many of those infections and deaths are occurring in nursing homes has been coming out piecemeal, mostly from nursing home administrators and in some cases local health officials.
But when reached by The Sun, officials in many local health departments had the same response, saying they could not disclose lists of facilities “until we receive authorization from the Maryland Department of Health.” They noted that facilities “are required to inform their staff and residents (including their legal representatives) about positive COVID-19 cases.”
Only Cecil County officials provided the information in response: more than two dozen cases at a single nursing home, Calvert Manor Health Care Center in Rising Sun.
And Carroll County has provided near-daily updates on cases and deaths at Pleasant View, as well as in a smaller outbreak at Carroll Lutheran Village in Westminster. But on Tuesday, Carroll officials removed updated counts of cases and deaths at Pleasant View and Carroll Lutheran from a county health department website.
County health spokeswoman Maggie Kunz said the data had been posted “due to the scope of the containment and mitigation responses, which caused details to rapidly become public knowledge,” but going forward, the county would be “following state guidance that protects the confidentiality of outbreak reports in order to protect the privacy of individuals affected.”
Asked about state policy on releasing the information, Maryland health department spokesman Charlie Gischlar said local health departments “make their decisions about the information they release based on HIPAA policies, requirements, and state laws.”
The federal Health Insurance Portability and Accountability Act protects patients’ access to their health records as well as the privacy of individually identifiable health information.
Breaking News Alerts
The Sun asked health departments across the state for lists of nursing homes with COVID-19 cases through requests under the Maryland Public Information Act. Only Baltimore City and Kent County responded immediately, saying health surveillance information is not subject to the open records law.
Yet Hilary Ruley, the city’s chief solicitor, noted that state law does allow health officials to release aggregate surveillance data, including “nonindividually identifiable information about one or more cases of a condition or disease.”
On Tuesday, however, Baltimore officials did not respond to questions about the status of the largest known outbreak in city limits, at the FutureCare Lochearn nursing home, including whether there’s been a related death. Neither did Lochearn’s administrator, Franco Pastore, respond to a request for comment.
But at least one of the 129 residents reported to have tested positive for COVID-19 at the facility may have died: 78-year-old Minnie Saunders, her son Charles Culver told The Sun.
Information about nursing homes is eluding not only the general public and the media.
Joe DeMattos, CEO of the Health Facilities Association of Maryland, said his group requested lists of facilities with confirmed outbreaks April 2. He said the state told him that information could not be provided, even to the state’s largest association of nursing homes.
Baltimore Sun Media reporters Phil Davis, Nathan Ruiz, Edward Lee, Sameer Rao, Christina Tkacik, Jon Meoli and Mary Grace Keller contributed to this article.
This article has been updated to clarify that Centers for Medicare and Medicaid Services regulations on nursing home reporting on coronavirus cases are not yet in effect