US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Family members of residents at the Life Care Center home, in Kirkland, Washington, where some patients have died from Covid-19, at a press conference on 5 March. Photograph: Jason Redmond/AFP via Getty Images

The US nursing home industry is clamoring for legal immunity during the coronavirus pandemic, even as horror stories from hard-hit facilities enrage families, consumer advocates and the American public.

Healthcare organizations insist liability protections are essential for under-resourced nursing homes fighting against Covid-19, while an already staggering death toll continues to climb.

Tricia Neuman, senior vice-president of the Henry J Kaiser Family Foundation, said: “The liability issue is exposing a longstanding tension between consumer advocates, who want to see the standards enforced, and owners, who are worried about the financial implications of a lawsuit.”

The US “ground zero” for the virus was a nursing home outside of Seattle. Once the country became a global hotspot, elderly Americans suffered. In some states, nursing homes have accounted for a majority of Covid-19 deaths as facilities scrambled to adapt.

Critics say the virus has ravaged nursing homes “like a brushfire”, partly because of the industry’s disastrous track record with infection control, but also because of staffing and resource deficiencies that long predate Covid-19.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, said: “It’s a population at risk, but this industry has a lot of serious problems that led to these enormous outbreaks in nursing homes. So I don’t think they can just say: ‘It’s not our fault, we didn’t have equipment.’

“They were supposed to have that equipment. This isn’t new.”

Some nursing homes have also faced criticism for their responses to Covid-19 that have only fanned the outbreaks’ flames.

Mike Dark, a staff attorney at California Advocates for Nursing Home Reform, said: “Facilities mostly don’t want to flag that they have the virus even when it’s killing residents, because it’s such a publicity problem, it’s such a business problem, and they are for-profit enterprises.”

Cheyenne Pipkin (left) with her mother Loraine Franks visits her grandfather Jerry Hogan, a Vietnam veteran, at Lindsey Gardens in California. Photograph: Barcroft Media/via Getty Images

Nearly 70% of US nursing homes are for-profit, and the industry has a reputation for lackluster performance around infection control. In all longterm care facilities, which include nursing homes, somewhere between 1m and 3m serious infections are contracted annually, according to the Centers for Disease Control and Prevention.

Hundreds of thousands of people die from infections each year, even when not in the grip of a pandemic.

“Our members are working hard to do the right thing and are focused on their missions of providing care. They are on the front lines of fighting coronavirus and are full partners with hospitals and other providers,” Katie Smith Sloan, the president and CEO of LeadingAge, an association for nonprofits providing services to older people, said.

“Regulations about standards of care evolve and change rapidly; providers’ access to needed personal protective equipment and testing is limited and often insufficient.”

State officials have been quick to let nursing homes off the hook for decisions made in the midst of the public health emergency. Through a hodgepodge of laws and executive orders, at least 21 states have granted some form of civil immunity to healthcare providers, according to a tally sent to the Guardian by National Consumer Voice for Quality Long-Term Care – though in a few cases it is not clear if the immunity extends to nursing homes.

Smith Sloan wrote: “States recognize that providers require legal protection as a result of actions related to combating the Covid-19 pandemic. LeadingAge … is pursuing protections on the federal level with a coalition asking for uniform and consistent relief as well.”

Some states are including immunity from criminal liability, but policies do generally make exceptions for especially egregious treatment, including willful misconduct or gross negligence.

Richard Mollot, executive director of the Long Term Care Community Coalition, said: “To basically take away the one area of potential accountability when residents are most vulnerable to me is dumbfounding and dangerous.”

For some public health experts, however, the issue is not so cut and dried. They describe nursing homes as a sector in chronic need of reform that is nevertheless “the safety net of the safety net” for vulnerable people.

Experts acknowledge that the industry is filled with deficiencies, and is based upon a broken business model that struggles in the face of a pandemic. But they also say nursing homes have been under-prioritized by officials in a public health crisis that has disproportionately targeted their patient populations.

Michael L Barnett, a professor at the Harvard school of public health, said: “Putting a nursing home out of business because somebody died is really punishing at the wrong level, because certainly there are nursing homes that probably did not act responsibly, or they may have ignored the threat. But so did many government agencies.”

Instead of lawsuits, experts are advocating for immediate reinforcements in testing, personal protective equipment (PPE) and staff, followed by permanent fixes for longterm care. They suggest payment reform, so nursing homes are not dependent on fickle revenue streams to subsidize their Medicaid patients.

Mildred Solomon, president of the Hastings Center, warned against the “blitzkrieg of lawsuits” that these immunity measures mean to avoid.

She said: “I think we have to hold our fire, not put our energy into finger-wagging and blaming. And put more emphasis on stronger regulations, with teeth.”

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US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Missouri governor mobilizes National Guard for virus fight

By JIM SALTER and HEATHER HOLLINGSWORTH

ST. LOUIS (AP) — Missouri braced for a surge of coronavirus patients as the number of deaths grew to nine, with the governor mobilizing the state's National Guard and a top St. Louis County official urging recently retired health care workers to return to work.

During a virtual press conference with the governor on Friday, Missouri National Guard Adjutant General Levon Cumpton said the Guard is "here to help you, not to control you.” He said missions might include setting up community-based testing centers and transporting medical equipment.

“I want to be perfectly clear: This is not about putting Missouri under martial law,” Gov. Mike Parson said.

St. Louis County Executive Sam Page, in a YouTube video released Thursday, asked that any recently retired doctors, nurses or other health care professional come back to work.

“In the coming weeks our medical institutions will face a heavy burden,” Page said. “We need your help to make sure everyone gets the treatment that they need.”

The number of confirmed cases increased Friday to 670, up 168 from Thursday, according to state health officials. They also reported nine deaths Friday before Springfield-Greene County health officials announced a fourth person had died at an assisted living home in Springfield.

The Springfield-Greene County Health Department said a woman in her 90s died at the Morningside East assisted-living center before three other women at the center died. The agency said the woman wasn't tested but it is considering her a COVID-19 victim due to her close contact with them. Four other people at the home have tested positive for the disease.

Lisa Cox, a spokeswoman for the Missouri health department, said Friday the state would not “at this time” count the Springfield woman's death as a coronavirus death.

Missouri Health and Senior Services Director Randall Williams on Friday said about 7,000 people have been tested for the virus in Missouri, putting the state's rate of positive cases among individuals tested for the COVID-19 virus at closer to 10%. The state health department is rationing tests and doesn't recommend testing people without symptoms.

For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But the virus can lead to pneumonia and even death for some people, especially older adults and those with existing health problems.

Missouri's Social Services Department on Saturday will start fielding phone calls about food stamps seven days a week to deal with the influx of requests for help. The agency on Friday also announced that the federal government approved its request to temporarily suspend phone interviews for food stamps.

Among the hard-hit places in Missouri is Life Care Center in St. Louis, a nursing home that has reported six cases. Sean Buckley, executive director of the Life Care Center in St. Louis, said in a written statement that four residents were hospitalized and two employees were directed to stay at home.

The St. Louis Post-Dispatch reported that the nursing home is owned by the same company that operates the Life Care Center of Kirkland, near Seattle, where 37 people died from COVID-19. Another Life Care facility in Kansas City was the site of Kansas’ first coronavirus death.

Stay-at-home orders are in place across much of the state, and on Friday the city of St. Louis cracked down further, closing all playgrounds. The St. Louis Department of Health said people had been gathering in large groups at playgrounds, increasing the risk of children either contracting or spreading the virus.

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Missouri governor mobilizes National Guard for virus fight

Nursing home staff spread coronavirus to other facilities, CDC investigation finds

Healthcare workers load a patient into an ambulance at Life Care Center in Kirkland, Wash. Six people in the state have died from the coronavirus. (Getty Images)

Staff members at the Seattle-area nursing home overrun by COVID-19 spread the coronavirus to other facilities where they worked, an investigation led by the U.S. Centers for Disease Control and Prevention has found.

The report published Wednesday said that as of March 9, the CDC confirmed 129 COVID-19 cases among people linked to Life Care Center of Kirkland. These comprise 81 residents, 34 staff members and 14 visitors.

Separately Wednesday, public health officials reported five more deaths associated with the facility, bringing the total number who have died to 35.

"Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread," the CDC report said.

The report urged other such facilities nationally to immediately work to prevent coronavirus outbreaks.

"Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members and visitors, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures," it said.

The advanced age of many long-term care facility residents, their underlying health conditions and their proximity to one another put them at risk for sickness and death, the report said.

"Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19," the report said.

Representatives of Life Care Center of Kirkland and its parent company, Life Care Centers of America, did not immediately respond to requests for comment.

The CDC conducted the investigation with the Seattle & King County Public Health agency and EvergreenHealth, the medical center that treated most of the patients hospitalized from the nursing home.

The investigation found that infected healthcare workers at the Kirkland, Wash., nursing home had a broad range of occupations: doctor, nurse, nursing assistant, physical therapist, occupational therapist assistant, environmental care worker, health information officer and case manager.

Once the outbreak was discovered, investigators emailed about 100 long-term care facilities in King County to check for other clusters of the disease and visited nursing homes with suspected outbreaks to conduct emergency tests for the virus, the report said.

"As of March 9, at least eight other King County skilled nursing and assisted living facilities had reported one or more confirmed COVID-19 cases," the report said.

Several conditions probably made these facilities vulnerable, the investigation found.

Staff members worked in more than one facility. Staffers worked while symptomatic. Workers weren't familiar with standard precautions concerning droplets from patients, surface contacts and eye protection. Facilities had inadequate supplies of personal protective equipment and other items such as alcohol-based hand sanitizer. And supplies of test kits were limited.

"These findings demonstrate that outbreaks of COVID-19 in long-term care facilities can have critical impact on vulnerable older adults," the report said.

"The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members and visitors."

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Nursing home staff spread coronavirus to other facilities, CDC investigation finds

Five KCK firefighters isolated after taking man who died from coronavirus to hospital

by: Shannon O'Brien

KANSAS CITY, Kan. -- KCK firefighters fear their department hasn't prepared them properly for the coronavirus outbreak after five firefighters were put in isolation.

The firefighters found out two days after a call to Life Care Center in KCK that the cardiac patient they took to Providence Medical Center tested positive for COVID-19 after he died.

The news has left the local firefighters union concerned about crews' health and safety.

On Friday, Alvey declared a state of emergency in Kansas City, Kansas and Wyandotte County in response to coronavirus.

"What this will enable us to do is easily procure the necessary material and finance or resources to help the spread of the contagion," the mayor said.

KCK firefighters hope some of the resources made available will be used to provide equipment and training to better with the virus.

"I'm not so sure that we have access and have been provided all the resources we need this time for the individual apparatus," said J.J. Simma, president of IAFF Local 64.

Other than the same guidelines about personal care put out to the public, Simma said it wasn't until Friday afternoon -- after those five firefighters were ordered to isolate -- that crews received a memo from top brass at KCKFD with specific guidelines on how to approach their job.

Last week, KCMO Fire Chief Donna Maize put a full-protection approach in place, including extra gear to protect firefighters and a disinfectant fogger to clean ambulances.

"But I think I would in our membership would feel much more comfortable if we were taking steps in that manner even if they were above and beyond," Simma said, "because what where I believe doing as of right now it's available to us is. Possibly some masks if we have them, possibly some gowns, which are not in camps related they don't come for all of your skin body and basic safety glasses and gloves like we always wear."

Alvey said he believes the KCK fire department is equipped right now to handle the COVID-19 outbreak.

"It is like any other any other public health crisis," he said. "You could come into a house with somebody who has tuberculosis. You can come into a house with someone who has hepatitis. The same kinds of measures are brought into there."

Alvey encouraged firefighters who feel like they are not protected to protected to report it.

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Five KCK firefighters isolated after taking man who died from coronavirus to hospital

Owner of KCK facility tied to Kansas’ first coronavirus death also runs Washington home

WICHITA, Kan. — The nursing home resident who become Kansas’ first coronavirus-related death was infected at the Life Care Center of Kansas City, which is owned by the same company that runs the facility in Washington state linked to 22 fatalities, state health officials said Friday.

Dr. Lee Norman, the Kansas Department of Health secretary, said officials will be focusing on whether there has been any personnel sharing between the nursing homes in Kirkland, Washington, and the one in Kansas. Life Care has skilled nursing facilities across the country.

Health officials haven’t found “any particular source of infection for this person. He was bed-bound so the infection came to him,” Norman said.

No other residents of the Wyandotte County nursing home have been reported to be showing symptoms, although the investigation is still in its early stages, he said.

Life Care Center of Kansas City referred all calls to another phone number whose voicemail box was full.

For most people, the coronavirus causes only mild or moderate symptoms, such as a fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

The vast majority of people recover from the new virus. According to the World Health Organization, people with mild illness recover in about two weeks, while those with more severe illness may take three to six weeks to recover.

President Donald Trump on Friday declared a national emergency as part of federal efforts to curb the pandemic. Gov. Laura Kelly has already declared a state of emergency in Kansas to make it easier to mobilize resources.

The number of coronavirus cases in Kansas grew to six on Friday. A 72-year-old Butler County man developed symptoms days after returning from a Caribbean cruise, and health officials said the man is in isolation in a Wichita hospital.

Four other COVID-19 cases have been reported in Johnson County. All of them become infected while traveling out of state.

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Owner of KCK facility tied to Kansas’ first coronavirus death also runs Washington home

This nursing home is at the center of Washington's coronavirus. Here's what one first responder saw there

By Jake Tapper

(CNN)When first responders reported last week to a hard-hit nursing home in Washington state, the epicenter of the nation's coronavirus outbreak, they found an understaffed facility with inadequate gear attempting to serve dozens of patients vulnerable to catching the virus.

Just three staff members reported to Life Care Center in Kirkland, Washington, between Tuesday night and Wednesday morning to serve about 90 residents, a first responder familiar with the situation told CNN. Still, neither the King County Health Department nor the Centers for Disease Control and Prevention sent personnel Thursday to provide assistance -- though they have since. 

 

First responders were concerned that staff members were not wearing appropriate personal protective equipment to handle the high number of patients with probable coronavirus. They also arrived to the facility to find employees using positive pressure bag valve masks to ventilate potential coronavirus patients -- even though firefighters have been told not to use such masks, as they can disperse more particulate into the air, the responder said.

 

The children and other relatives of patients in the facility have been attempting to sound the alarm about conditions in the facility for weeks. 

 

A spokeswoman for the city of Kirkland told CNN that "our firefighters are taking direction from King County Emergency Medical Services regarding the personal protective equipment. At this time we have been told to continue providing respiratory support including positive pressure bag valve masks."

 

CNN has reached out to the county medical services officials, Public Health Seattle-King County, the Washington state Department of Health and the CDC for reaction.

 

Life Care spokesman Timothy Killian told CNN Monday that the first responder "did not see the full extent of what was happening within the facility in the middle of the night." 

 

"A large number of our employees would have been in rooms treating and taking care of patients and they wouldn't have been immediately visible to anybody who walks in," Killian said.

 

A spokesperson for the Life Care Center said during a news conference Saturday that the CDC has now provided it with extra nurses, practitioners and doctors. 

 

State governments are working to contain the spread of the novel coronavirus in the US, as federal officials say more testing for the illness will likely see the number of known cases increase. As of Saturday night, there were at least 19 deaths in the United States -- at least 14 of them tied to the Life Care Center in Kirkland alone, according to a Seattle and King County Public Health news release.

 

Two new coronavirus deaths out of 16 total recorded in the state are linked to the facility, according to the release. A man in his 70s, who was a resident at the care home, died on March 2, while a woman in her 80s, who was also a Life Care resident, died on March 5, officials said.

 

While staff are caring for patients to the best of their ability, "we cannot make any promise that exposure, further exposure, within the facility is not happening," said Tim Killian, a spokesman for Life Care Center of Kirkland.

 

Some Life Care Center residents have gone from no symptoms to acute symptoms within an hour, Killian said.

 

"We've had patients die relatively quickly under those circumstances," he said. 

 

Killian told reporters during a Saturday briefing that 70 employees are showing coronavirus symptoms. Those employees have been asked not to return to work.

 

As of February 19, the facility employed 180 staff members and housed 120 residents. Fifty-four residents have since been transferred to various hospitals, Killian said, and all residents at the facility are confined to their rooms.

 

On Thursday, the facility received 45 coronavirus tests, the results of which are still pending, he said.

 

Life Care Center of Kirkland said in a statement later Saturday that they had received additional testing kits from the Washington State Department of Health and are now able to test all remaining residents in their facility. The tests are currently being administered, according to the facility's statement.

 

While the Trump administration -- through a response effort led by Vice President Mike Pence and a White House task force -- has sought to assure the American public, officials have still not explained why the federal government has been so slow to distribute testing kits in bulk and has dragged its feet on removing restrictions for who can conduct diagnosis. 

 

Health officials briefing the media at the White House Saturday afternoon could not say exactly how many people had been tested related to using the 5,861 tests conducted by the CDC and public health labs across the country. Various factors impact the number of people who can be tested, including the fact that most people receive at least two tests -- swabs for the nose and the throat.

 

FDA Commissioner Dr. Stephen Hahn said Saturday that 1,583 patients have been tested by the CDC but that the government doesn't know how many patients received tests from the 2,361 specimens collected by state and local labs.

 

Each day the number of tests is rising, and the numbers are soon expected to dramatically jump, he said. 

 

Federal officials say 2.1 million tests will be shipped out by Monday, with a further goal of 4 million tests to be shipped by the end of next week.

 

CNN's Steve Almasy, Melissa Alonso, Dakin Andone, Greg Clary, Cat Gloria, Kay Jones, Christina Maxouris and Hollie Silverman contributed to this story.

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This nursing home is at the center of Washington's coronavirus. Here's what one first responder saw there