"First, they were telling nursing homes to take patients from hospitals, then they were telling us not to take patients, now there's conflicting guidance saying be prepared to take them," Wasserman said.
But Wasserman agrees with doctors who say nursing homes should not send residents to hospitals, even if they have COVID-19 symptoms, unless they are in dire need of care.
"We've got a whole strategy on how to deal with this in the skilled nursing facilities," he said. "If you think someone has it, you have to contain it there. We don't want to send someone to the hospital unless they really need the ICU."
Once a patient has gone to the hospital, he said, nursing homes have a moral duty to be sure they are not carrying the virus when they return, especially to a facility with no sign of contamination.
"If I knew someone was trying to send a COVID patient into my nursing home," Wasserman said, "I would stand in front of the door and say, 'Hell no, I'm not going to let you do this.'"
The nationwide shortage of tests, and long waits for results, are exacerbating the problem because it can be difficult to prove that a patient who has been in a hospital is completely free of the virus.
Officials at the Los Angeles County Department of Health Services, the second-largest municipal health system in the country, confirmed they are running into this problem.
"DHS has encountered resistance from some skilled nursing facilities in accepting patients who have not definitely tested negative for COVID-19," said Charmaine Dorsey, director of the department's Patient & Social Support Services. "This has complicated our efforts to reduce hospital census as we prepare for a surge in patients."
The health services department cares for more than 2 million people, many of them the poorest and most vulnerable in the county.
The situation is "particularly challenging for DHS as we have many patients with multiple medical and psycho-social comorbidities that make it difficult for us to place our patients in such facilities even in normal circumstances," Dorsey said.