- Deborah Kassel's 81-year-old father, a retired physician, tested positive for
COVID-19 in March following a hospital stay after spinal surgery. - After only four days in a rehab facility, Kassel's father was told he was being discharged and sent home, despite still testing positive for the
coronavirus and requiring 24-hour care. - Kassel's father is not alone: Thousands of patients across the US are being prematurely sent home, while still potentially infectious, due to insurance companies refusing to reimburse hospitals for extended stays.
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There is a loophole in the treatment of COVID-19 and my father, a 81-year-old retired physician, has fallen through it. Countless others are sure to follow.
His experience as a patient being summarily discharged from a medical facility two days after retesting positive for coronavirus exposes a tragic flaw in our current health system. It highlights the hypocritically, hyped-up lip service being paid to the illusion of protective safety practices. The mandating of masks, six-foot distances, and handwashing means nothing if positive patients potentially able to transmit the virus are being released into the general population.
My octogenarian father is the poster child for this absurd pandemic-perpetuating phenomenon.
In complete disregard for both logic and ethics, my father — a Vietnam veteran and gastroenterologist who has cared for countless patients over a 50-year practice — is slated to be discharged from an acute rehabilitation center in New Jersey against our family's wishes. He'll be deposited in his New York City apartment — still short of breath, still unable to care for himself, and still positive for COVID-19.
It seems that the formal appeal to extend his treatment will not prevail — for the simple yet nonsensical reason that the facility is holding to the letter of the law, which in this case is the ever-changing and tragically enabling guidelines of the
My father's fight for his life began in mid-March, just before New York city schools, restaurants, and life as we know it began to shut down.
Following spinal surgery at Hospital for Special Surgery (HSS) in New York City, my father was transferred to Mount Sinai's in-patient rehabilitation unit — but then discharged along with the other virus-free patients to make room for the exploding number of coronavirus cases, including two on the floor above.
Given the imminent peeking of cases in New York, my sister's home in New Jersey seemed like the safer place to recuperate. But seven days into his stay, his temperature spiked, and a visit to CityMD in East Hanover, NJ led to an emergency admission to St. Barnabas for pneumonia and coronavirus.
Within two weeks, thanks to courageous health care workers in hazmat suits, my father was weaned from his external oxygen supply and transferred to a rehabilitation facility to resume his post-surgical, therapeutic recovery program.
However, after a mere four days into his treatment, the case worker informed me that he would be discharged the next day. After much pleading, I was able to convince the attending physician that my father should be retested. The results came back within 72 hours and confirmed that he is still positive for COVID-19 and therefore still actively infectious.
In addition to his inability to walk without assistance, shortness of breath, and unsteady balance, my father's impaired memory puts him at risk of unwittingly spreading the virus through close contact with others.
The hospital justifies their decision, asserting that the CDC grants them the discretion to send my father home, despite the retest administered two days ago confirming that he is still positive for COVID-19. While conceding that no nursing service — private or public — will provide at-home treatment and risk contaminating their staff, they also admit that my father cannot survive without 24-hour care.
What do they — the rehab facility, Governor Cuomo, the CDC — think will happen once my 81-year old COVID-19-positive father is deposited into the home he shares with hundreds of building residents, accompanied by me — his sole, yet full-time-job-holding caretaker with a daughter of my own?
A medical director at the CDC who acknowledged the unsafe nature of the discharge, pointed to a long-festering reality: the fact that "our healthcare system is managed like a business." Insurance companies are limiting their reimbursement to medical facilities, who in turn deny covering the costs of positive patients beyond a restricted period, forcing the premature releasing of vulnerable and still contagious patients.
In a March 25 JAMA article, "Post-acute Care Preparedness for COVID-19," Dr. David Grabowski and Dr. Karen Maddox posit this same conundrum. "Where will patients who have begun to recover from COVID-19 receive post-acute care? There is still uncertainty around how long patients remain contagious after clinical recovery. Using generic clinical guidelines without retesting will result in a significant percentage of discharged patients into the community who are still infectious."
The bottom line is this: Thousands of people like my father are being discharged while still definitively or potentially infectious.
Home-care services for an active infectious case are lacking or virtual. Training and provision of PPE for the family members targeted for providing care are non-existent.
Without medical and administrative intervention, a resurgence of infection is inevitable.
How can my father and I not dwell on this devastating eventuality — as we all dutifully shelter in place?
Editor's note: At the time of publication of this op-ed, Kassel's father is still not home. He is still positive for COVID-19.
Deborah Kassel, PhD is an educator and writer who teaches English and cinema studies in