Staff question safety practices in senior care facility

by Cameron Evans 

Four certified nursing assistants who have worked at a Missoula senior care facility that experienced the largest known coronavirus outbreak in Montana this fall said Village Health & Rehabilitation could have done more to protect its residents.

The one current and three former employees cited numerous issues including unclear communication about COVID-19 safety protocols, staffing shortages, and controversial directives from management.

The Goodman Group owns Village Health and two other senior care facilities in Missoula. In extensive responses to the Missoulian, Goodman Group spokesperson Amy Rotenberg disputed the employees’ claims that the facility fell short. Rather, Rotenberg said Village Health was "fully prepared when the spike in cases occurred both in terms of staffing and in terms of appropriate and safe protocol(s)." She counted an average staffing level at 106% above (more than double) the state's recommended minimum from Oct. 1 to Nov. 19.

The Missoula City-County Health Department investigated similar anonymous complaints against the facility, but did not issue any violation-based citations as a result. However, Village Health did not pass a state COVID-19 infection control audit in early November, according to the Montana Department of Public Health and Human Services and confirmed by Rotenberg.

Rotenberg said the facility passed a subsequent state inspection. Tuesday, Rotenberg said Village Health no longer had any active cases.

But neither state inspection document is yet available to the public. And the situation is complicated by the opaque way COVID-19 statistics are provided and updated by local, state and national agencies (see related story from Nov. 29).

As COVID-19 cases continue to rise in Missoula and across the nation, nursing homes and long-term care facilities have become ground zero for outbreaks. The older residents that nursing homes serve are considered most vulnerable to the effects of the coronavirus. And the number of cases can skyrocket quickly. 

The Village Health & Rehabilitation is the largest nursing home in Missoula, with 193 beds. In late September, Village Health reported a couple of positive cases among staff. By Nov. 15, 80 percent of its total residents had tested positive for COVID-19, according to a database from the Centers for Medicare and Medicaid Services (CMS), a federal agency that licenses skilled nursing homes. The most recent CMS data show 18 deaths due to COVID-19, or roughly half of the 42 deaths in Missoula County since the pandemic began.

Tabitha Power, a former CNA at Village Health, told the Missoulian that management increased attention to safety protocols as the facility experienced the first cluster of cases among staff this fall. Power said she left her job to care for her father. However, she and the three other CNAs also raised concerns that illustrate the challenges of keeping the virus at bay in such settings. The following issues are the ones CNAs each noted separately and were identified in the anonymous complaints to the local health department.

The Missoulian is not naming three CNAs. Two no longer work at Village Health and fear they may not get hired in Missoula as the Goodman Group manages two other nearby facilities. The third is a current employee.

Communicating safety protocols

Employees who spoke with the Missoulian said they received mixed messages about how to best keep residents and themselves safe from infection.

“I was told by a nurse that I was supposed to don and doff in every room," an anonymous employee said of wearing personal protective equipment. "I was told by another nurse that I'm supposed to reuse gowns." 

The Missoula City-County Health Department conducted a site visit at Village Health following an anonymous Oct. 2 complaint that stated Village Health was not taking proper precautions to protect employees and residents from COVID-19. The investigation found Village Health to be in "generally good compliance with the Health Officer’s Order, including employees wearing face coverings, no communal dining or group activities, and a visitor restriction policy."

The report summarizing the visit did not note any conversations with non-administrative staff, apart from an exchange with staff who confirmed that no group activities were taking place. During the visit, administrative staff at Village Health told the inspector that residents were required to wear cloth face coverings in the hallway but not in their rooms, which most residents share with another resident.

In response to claims that Village Health did not clearly communicate COVID-19 protocol with staff, Village Health said in a statement that staff were trained on an ongoing basis beginning in February and "again and again to reinforce and share new guidance in small groups, in person and in writing (ex. posters with policies). The training has included education on PPE requirements, donning and doffing, handwashing, cleaning equipment, and using shields and goggles. COVID specific information books and resources are available on all units at all times. National and regional support services are on the floor regularly supervising and are present to offer additional guidance and to clarify protocols. We regularly audit each facility for compliance and provide one-to-one or small group re-education."

Village Health fared well on its May 2019 annual health inspection, with any deficiencies listed as posing minimal harm. The facility also passed two COVID-19 focused infection control audits the state conducted for CMS. But Village Health did not pass an infection control audit on Nov. 4, Rotenberg confirmed in an email. 

Montana Department of Public Health and Human Services spokesperson Jon Ebelt said the state health department was issuing a Plan of Correction to Village Health citing any deficiencies, and said that document is not yet available to the public. Village Health confirmed in an email that it received the notice from the state.

"We are reviewing the findings now, which include some isolated incidents of employees not properly donning masks as instructed at the time of the survey and some missing documentation from a specific session of screening," Rotenberg said in an email. "... Any deviation from our rigorous protocols by any staff member is concerning to us and will promptly be addressed and corrections made that the dept of health has identified."

Prior to receiving the notice from the state, Village Health said that it was addressing COVID-19 with the "highest attention to staff safety and top-quality care for residents. Since the onset of the COVID-19 pandemic, state oversight bodies had found no violations of regulations and guidance, and independent sources provided Village Health with top ratings for safety and adherence to best practices in the industry."

Rotenberg said in an email Tuesday that the state conducted another infection control survey on Nov. 23 and Village Health was informed that it would be receiving zero citations. DPHHS has not issued any plans of corrections related to COVID-19 to the other three nursing homes in Missoula, according to the most recent information available on the state website.

Missoula City-County Health Department records show Village Health was the focus of 10 of 13 complaints pertaining to senior care facilities from the beginning of September to Nov. 5. The local health department issued no violation-based orders in response to the complaints.

Local health department officials have not issued any violation-based orders to long-term care facilities or nursing homes the two months prior to Nov. 5 when the Missoulian last requested any new complaints, according to Shannon Therriault, director of environmental health. The department ordered some businesses to close until they comply with COVID-19 restrictions, but it does not have authority to shutter federally regulated nursing homes.

Local health departments can prohibit new admissions and order other anti-contagion actions but "closing the doors and removing the residents falls under licensing authorities," according to Ellen Leahy, director and health officer for the Missoula City-County Health Department.

Appropriate staffing levels

Concerns about staffing shortages resulting in long and understaffed shifts appeared in interviews with the CNAs and in complaints to the local health department. CNAs told the Missoulian that as more staff had to quarantine, "8-hour shifts turned into 10- to 15-hour shifts" and said that upon showing up to a shift, it was not uncommon to find out that a coworker had called in sick. A CNA provided the Missoulian with text messages between her and a staff member who schedules shifts that stated on several days the facility was "desperate for coverage" and offered a bonus to work.

In response to complaints to the Missoula City-County Health Department citing staffing shortages, including one complaint that stated, "Staff are working with up to 24 residents at a time for one CNA and one nurse,” the department's infectious disease specialist Pam Whitney told the Missoulian the department explored finding more resources for staffing at long-term care facilities, including the National Guard.

In a statement to the Missoulian, Village Health denied "any report that there are severe staffing shortages" and said the facility has had "tremendous support from our staff, contractors and regional and corporate teams." Village Health added that staff regularly work 8- and 12- hour shifts, and are not scheduled to care for more than 20 residents without support. Village Health said in a statement that while "the total headcount of all care providers fluctuates daily based on census of residents," the facility averages 106% above the state minimum requirements for both licensed staff and aides.

Skilled nursing homes are not required to meet a specific staff-to-resident ratio, and are instead required to meet a minimum number of hours for registered nurses, licensed practical nurses and nursing aides, based on the time of day and the number of beds in the facility. According to state law, nursing homes in Montana with more than 100 beds will be given individual consideration, but a 100-bed facility would need to have at least 120 nursing aide hours in a 24-hour period, in addition to 32 registered nurse hours and 32 licensed practical nurse hours.

Whitney said in an email that short-handed facilities "eventually pulled other staff in." The health officials declined to name the facility with a severe shortage, but Leahy said it was "one of the larger ones." Village Health is the largest skilled nursing home in Missoula County. The second largest facility is Hillside Health & Rehabilitation, which has 95 beds and as of Nov. 15, reported its first resident COVID-19 case.

Work protocols

CNAs who tested positive for COVID-19 said they were asked to return to work at Village Health while still recovering, and a complaint to the Missoula City-County Health Department alleged an unsafe practice because an employee who tested positive was working with positive residents.

In an investigation of that complaint, the Missoula City-County Health Department found that Village Health had gotten approval from the state health department for two asymptomatic positive staff members to work with positive COVID patients.  

Leahy had previously denied that request. The state was unaware that Leahy had denied that request and agreed the decision was within the jurisdiction of the local health office, according to Whitney.

Leahy also confirmed that some facilities have been hit so hard by quarantines and isolations that they have implemented new protocols from the Centers for Disease Control and Prevention for how asymptomatic quarantined workers can go back to work on a “case by case basis.”

The emergency protocols the CDC released allow health care workers who have tested positive for COVID-19 to continue working with suspected or confirmed COVID-19 patients, pending approval from the appropriate state, local, territorial, and/or tribal health authorities, as a measure to mitigate staffing shortages.

Village Health said in a statement that staff are not allowed to return to work until they obtain approval from the Missoula City-County Health Department; "Any suggestion that there is pressure to return to work before authorized by health protocol is untrue."

A separate complaint submitted to the local health department on Oct. 21 stated that “Staff is working in both COVID and non-COVID halls on the same shift often," and a CNA stated that she would work in the COVID unit one day, and another hall without positive cases the next day.

In response to the complaint, the local health department again contacted Village Health and was told that "staff worked on one or the other area, and were not working both areas in one shift," Whitney told the Missoulian.

Village Health reiterated in its statement that it does not float staff from a COVID unit to a non-COVID unit in the same shift, and that "proper infection control is practiced in all units with appropriate PPE, and enhanced protocols are added when the staff enter a COVID unit." It added it is testing all staff and residents per CMS guidelines and has sufficient PPE.

Safety, prevention

Through its spokesperson, Village Health stressed its attention to keeping residents safe and healthy: “We remain focused on prevention, as the safety and well-being of residents and team members is our top priority.”

The CNAs the Missoulian spoke with also corroborated some of the practices outlined by Village Health in statements, such as surveillance testing, the use of PPE in the designated COVID-19 hall (although CNAs cited varying supplies of PPE and use requirements at the onset of the outbreak) and the notification of cases to residents' families and staff, which is mandated by CMS.

Village Health concluded its original statement to the Missoulian saying: "Our commitment to our residents and valued staff is and always has been steadfast. We greatly appreciate the daily commitment and dedication of our staff who care for our residents with utmost skill and compassion during this especially challenging time." 

Editor's note: Dee Strauss, executive director of Village Health, is married to Jim Strauss, publisher of the Missoulian. 

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Staff question safety practices in senior care facility

‘We can’t help her:’ Families of residents forced to leave Norwich nursing home in wake of coronavirus outbreak frustrated, worried

By Dave Altimari

 

Karen Kingston stands on her front porch for a portrait at her home Friday, Sept. 18, 2020, in Old Lyme. Kingston's 98-year-old mother lives at Three Rivers Healthcare nursing home in Norwich, which the state Department of Public Health moved to close this past Wednesday, Sept. 16, 2020, after several residents have died from COVID-19 and over two dozen others became infected with the virus. Kingston, whose mother tested negative for the virus, said all the residents have to be moved out in two weeks. (Kassi Jackson/The Hartford Courant)

The moment she learned about the first COVID-19 case in the Norwich nursing home where her mother lives, Karen Montanaro Kingston had been frantically trying to get the 98-year-old out of there.

But word of the outbreak at the Three Rivers Healthcare Center got out. Other homes shied away, she said, saying her mother was a “high risk” patient — even as Three Rivers staff assured her that her mother, Irene Montanaro, didn’t have the coronavirus.

Karen Kingston's mother, Irene Montanaro is 98 years old and lives at Three Rivers Healthcare in Norwich, Conn. She has tested negative for COVID-19. (Provided by Karen Kingston)

Kingston watched as the situation at Three Rivers worsened, an outbreak that would infect more than two dozen patients and staff and claim at least four lives. Montanaro’s former roommate at the facility died on Sept. 10 as the number of cases kept climbing.

“We would get these robocalls every Tuesday or Thursday and one time it said there were 10 new cases and that’s when I knew it was out of control and we needed to get her out of there,” Kingston said.

Now, with the state taking the dramatic step of ordering all patients out of the nursing home, Kingston and the family members of the other residents at Three Rivers are dealing with another disruption. The evacuation is the latest blow to families who had little contact with their loved ones because of the coronavirus lockdown and dealt with ongoing reports about the outbreak spreading and residents' dying. Now, their loved ones are being abruptly uprooted.

“We are kind of in limbo right now and don’t know what’s going to happen,” Kingston said. “Who is going to move my 98-year-old mother? We can’t go in there and help her pack. We can’t help her settle into a new place. She is going to have to go through this alone at 98-years-old.”

One tragedy after another

The decision to relocate all 53 residents was made quickly by state officials as they came to realize the depth of problems inside the Norwich facility.

Two inspections at the facility identified a range of infection control issues — many preventable errors in areas that received widespread attention as COVID-19 tore through nursing homes across the state, killing upwards of 2,500.

The problems cited by the health department included staff shortages, failure to properly cohort COVID positive and negative residents, having staff work with both COVID positive and negative residents on the same shift and lack of proper PPE. Among the issues that has generated widespread attention is the decision to work by a nurse who had vacationed with family members concerned they might be infected.

Now, in wake of the decision to move the residents out, state officials are scrambling to contact all of the families of residents to assure them their loved ones are OK and to get a sense of where they might want to go next. Some families haven’t been contacted, while other residents don’t have families to contact and are under the care of a conservator.

“We have not heard anything from anyone as to what is happening in there. We are completely in the dark,” Katelynn Gosselin said.

Katelynn Gosselin (left) is pictured with her grandmother Maryjane Jackson who is a resident of Three Rivers Healthcare in Norwich, Conn. (Provided by Katelynn Gosselin)

Gosselins’ 82-year-old grandmother, Maryjane Jackson, has been at Three Rivers since February. Jackson fell at home and was injured. She went to Three Rivers for rehabilitation, but needs 24-hour supervision now.

“I would like to get her out of there and home but that’s not possible,” Gosselin said. “I would hope they will move her somewhere close.”

Some families were told Friday by DPH officials that they plan to have everyone out of Three Rivers within two weeks. They will be moving four or five residents a day, starting with the COVID positive cases. Many of those, officials have said, are going to the Riverside Health and Rehabilitation Center in East Hartford.

Long-term Care Ombudswoman Mairead Painter said her office has been swamped with calls from family members since the announcement. She said the fast moving situation has left everyone with questions and family members worried about their loved ones.

“For some of them this has been their home for years and now they have to move somewhere new,” Painter said. “It’s been one tragedy after another for these families.”

“Mom was OK there”

When the first COVID case was announced in mid-August, Gosselin started a petition seeking to have any residents who were positive transferred out of Three Rivers before the virus spread. About 200 people signed it.

“We thought she was in a safe facility where they would take good care of her — and that didn’t happen,” Gosselin said.

Gosselin said she has no problem with the state moving patients out of Three Rivers.

“I have to say I see it as a good thing that they’re closing it because I don’t think the staff did a very good job of protecting people,” Gosselin said. “The fact a nurse was able to go to work while she was sick and not wear a mask and no one said anything to her is more than enough to close it down.”

Gosselin is referring to the actions of a supervising nurse who worked a double shift on July 24 after going on vacation in Rhode Island. She told several of her fellow employees that she wasn’t feeling well and that at least two members of her family had gotten COVID-19 tests, according to DPH investigators.

Three days later the nurse tested positive as well. Several employees told the DPH that the woman didn’t wear a mask as she worked the double shift.

DPH hasn’t identified the supervising nurse, but the Courant has learned her name is Mary Ciezynski, who was working as a part-time employee at Three Rivers. Among those infected was her mother, a patient at the facility who has since died, though not of COVID.

All told, 21 residents have tested positive as well as six staff and at least four residents have died. The outbreak spread beyond the walls of Three Rivers to nearby Backus Hospital where at least nine employees were infected by a Three Rivers resident who spent several days in the hospital in mid-August.

Norwich, CT - 9/16/20 - The Connecticut Department of Public Health announced Wednesday that Three Rivers Healthcare will be closing after several COVID-19 patient deaths and at least a number of other infections. Photo by Brad Horrigan | bhorrigan@courant.com (Brad Horrigan/The Hartford Courant)

The rapid outbreak was an abrupt turnaround. Up until the late July incident, Three Rivers had been relatively COVID-free with only a handful of cases and no deaths.

“My mom was OK there. It’s an old building but she liked the people taking care of her,” Kingston said.

While she didn’t like that she couldn’t visit her mother all of the time, Kingston was aware of how the virus was impacting other long-term care facilities across the state and knew the sacrifice was necessary.

Since Eastern Connecticut in general had very low case volumes she thought her mother was safe.

“They had done so well for so long but once they got one case it went down fast,” Kingston said.

Infection spread rapidly

The two DPH reports on Three Rivers revealed a litany of problems.

The facility, investigators found, was short-staffed. Eighteen of the 21 shifts that DPH reviewed between August 28-September 3 showed that one nurse worked alone in the A Wing, where patients with suspected COVID-19 were under observation.

Three Rivers also failed to properly test all of its employees as mandated by Gov. Lamont’s executive orders, the state found. A review of testing records showed that of the nursing homes' 55 employees, 16, or 29 percent, had missed weekly testing for COVID 19.

At least three patients were sent to the emergency room at William Backus Hospital without written documentation that the residents had COVID-19. DPH also cited Three Rivers for failing to cohort patients once the virus was detected and for having nurses working with both COVID positive and negative patients on the same shift.

Given the range of problems, the state late last week quietly appointed attorney Katharine Sacks as temporary manager of the facility, taking over all clinical decision-making from the owner, JACC Healthcare Inc.

But Sacks said it took her about 30 hours in the facility to realize that residents needed to be removed and that there was no way she could bring back into compliance by the state’s deadline of Sept. 30.

“I realized the building blocks of compliance weren’t here,” Sacks said, last week. She added she has been appointed a temporary manager of a long-term care facility about 30 times and had “never been in a facility she didn’t think could be brought up to compliance.”

Sacks said there was a severe staff shortage, lack of training for staff and no competent oversight of staff that was there.

In a statement, the nursing home owners, JACC Health Center of Norwich, said that it supported Gifford’s order to move all patients out of the facility. While Gifford’s executive order doesn’t actually close Three Rivers, it is unclear how it would operate without any residents.

“Since the initial COVID outbreak, we have been cooperating with the State Department of Public Health to bring our facility into full compliance with state and federal regulations, including the engagement of a Temporary Manager to oversee the facility,” the statement said. Following an initial assessment, the temporary manager concluded that bringing the facility back into substantial compliance within the timeframe mandated by regulatory bodies was not feasible due to a number of concerns, including the absence of critical staff."

Painter said given the depth of the issue at Three Rivers, she understands why DPH made such an unprecedented decision.

“It all comes down to poor management by a private, for-profit company,” Painter said. “This is opening people’s eyes about what no one sees inside a nursing home.”

The state’s plan is to first move the 17 residents identified as COVID positive and the seven residents under observation to the Riverside Health and Rehabilitation Center in East Hartford which still maintains a COVID-only wing. Riverside has had its own problems with COVID with more deaths than any facility in the state.

The 29 residents who have tested negative, including Irene Montanaro and Maryjane Jackson, will be placed in nursing homes within 15 miles of Norwich, if possible. While state officials have said there is capacity in nearby nursing homes to place Three Rivers residents, Painter believes it will not be easy or quick.

Just because a facility may have beds available doesn’t mean it’s the right fit for someone from Three Rivers. Painter said some people need 24-hour care, certain medications or a facility may not have the staff to handle more residents.

“Many families have been trying to get their loved ones out of there for weeks and can’t because other facilities don’t want people from a ‘high risk’ facility,” Painter said. “The state is going to have to make sure all the residents are tested and assure other facilities they aren’t exposing their residents to COVID.”

Kingston said she is hoping to get her mother moved closer to her Old Lyme home.

“I want to call somewhere and reserve a room but what if they can’t move her right away and we lose our spot?” Kingston said. “A 98-year-old woman shouldn’t have to go through this.”

 

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‘We can’t help her:’ Families of residents forced to leave Norwich nursing home in wake of coronavirus outbreak frustrated, worried

Coronavirus outbreaks ravage nursing homes again, even after Newsom safety measures

The Sundial Bridge in Redding. Coronavirus outbreaks have recently hit nursing homes in that Northern California city and also in Santa Cruz County.

(William Koplitz / Getty Images)

By Maura Dolan, Anita Chabria

After a steady slide in the statewide number of new coronavirus infections at skilled nursing homes, facilities in Santa Cruz and Shasta Counties are grappling with severe outbreaks, with several dozen people at both places testing positive and residents dying of COVID-19.

The outbreaks raise questions on whether a May directive by state health officials, requiring regular testing of nursing home residents and staff, is being comprehensively implemented. Some watchdogs fear another spike could be in the offing at facilities that care for some of California’s most frail and vulnerable.

“Something is terribly wrong because they shouldn’t be having deaths,” Charlene Harrington, a professor emeritus at UC San Francisco who studies skilled nursing facilities, said Thursday. “There is a breakdown.”

At the Watsonville-Post Acute Center in Santa Cruz County, 61 people, including nine staff members, have tested positive since mid-September. Nine residents, whose ages ranged from the low 70s to 90s, have died, county health spokeswoman Corinne Hyland said Tuesday.

The facility is licensed for 95 beds.

In Redding, the Windsor Redding Care Center, another skilled nursing home, also is coping with an outbreak. Sixty residents and 20 staff members have contracted the virus, and seven have died from COVID-19, said Shasta County Health and Human Services spokeswoman Kerri Schuette.

Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, said new California testing requirements imposed on nursing homes were being followed only sporadically and with little follow-up enforcement from the state.

In addition, rapid antigen tests the federal government has sent to nursing homes recently have been “absolutely useless,” she said. They produce too many false results.

State officials did not immediately respond to a request for comment.

State records show that about a half-dozen facilities across the state have significant outbreaks, and more have minor ones. Though the worst toll of the virus for elder care and skilled nursing facilities came early in the pandemic, infection numbers crept up again in August before once again declining in California.

In July and August, there were about 1,000 deaths a month in nursing homes and assisted living facilities, according to The Times’ coronavirus tracker. That number dipped to 562 in the month of September, according to the tracker. But danger persists. Over the last week, those facilities have averaged 142 new cases and 13.7 new deaths per day.

Hyland said the Watsonville facility had been following state guidelines for employee testing, which exposed the outbreak. The center reported an infected resident on Sept. 17. An outbreak at a nursing home is defined as an infection in one resident. Visitors have been barred during the pandemic, she said.

“It spread pretty quickly,” Hyland said. “Unfortunately, this is a very vulnerable population.”

Dr. David Ghilarducci, deputy health officer for Santa Cruz County, said the county’s public health staff was working closely with the facility to control the outbreak.

Santa Cruz County health officials have been visiting the facility daily to review protocols on isolation, quarantine, testing and screening, and to respond to requests for more resources.

Officials from the California Department of Public Health also have made multiple visits to the facility to assess the situation and make recommendations, and the California National Guard is also providing help, the county said.

Because many nursing home employees work in more than one facility, the county immediately alerted other homes of the outbreak, Hyland said. She added that the county was tracing the contacts of the infected.

“This is really a large outbreak,” Hyland said. “We haven’t seen this sort of thing in our county until now.”

The Watsonville center’s website has reported previous infections in the past but in small numbers. The website indicates that past infections have been among employees.

Gerald E. Hunter, the facility’s administrator, said on the website that there were 23 residents and four staff members who were still positive for the virus on Oct. 5. He said the county’s numbers reflected the total infected since the outbreak started.

“Each day we evaluate all of our residents following CDPH and County of Santa Cruz guidelines to determine whom meets the criteria to be transferred out of the unit,” said Hunter on the website. He did not respond to a request for an interview.

Shasta County’s Schuette said the Windsor Redding Care Center was not accepting visitors when the outbreak occurred. The county and state public health teams, she said, were working with the facility to control the infections.

To date, nursing homes and senior facilities have accounted for 7% of California’s coronavirus cases, but 36% of its deaths, according to The Times’ coronavirus tracker.

On Sept. 29, Gov. Gavin Newsom signed a law requiring skilled nursing facilities in California to report disease-related deaths to health authorities within 24 hours during declared emergencies.

The law was written in response to concerns that health agencies were slow to respond to outbreaks because they did not receive timely information about the facilities.

Earlier, in May, California required testing of all residents and staff in nursing facilities to halt the spread of the coronavirus. The effect has varied.

“It depends on the place, it depends on the facility, and I am not sure there is a lot of follow-up,” said McGinnis, the nursing home reformer.

 

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Coronavirus outbreaks ravage nursing homes again, even after Newsom safety measures

Michigan nursing home prohibited employees from wearing masks amid coronavirus outbreak, reports say

The family of a woman who died while staying at a Michigan nursing home, and some former staffers, have accused bosses of refusing to allow employees to protect themselves from the coronavirus while at work, according to multiple reports.

Denny Williams’ mother, Wanda Parker, died from COVID-19 April 7, just days after she was taken to an area hospital from the Villages of Lapeer Nursing and Rehabilitation, where she had been staying, the Detroit Free Press reported.

Williams and his family, and a handful of employees from Villages of Lapeer Nursing and Rehabilitation have sued, alleging the facility prohibited workers from wearing masks.

Williams told the newspaper that workers – who he said didn’t appear to wear face coverings or other protective equipment when he visited his mother through a window – told him they “could not” wear it.

“All she kept saying was, 'please help me'. I still don’t sleep well because of that. I have nightmares about it,” Williams later told local news station WXYZ Detroit. “She was taken from us for no good reason.”

(iStock)

Taylor Minifield, who worked for the Villages as a certified nursing assistant, told WXYZ she tried wearing a mask at work to protect her mother, who had cancer, per doctors’ advice.

She said her boss “snatched it off my face and threw it in the trash.”

Minifield and Harden are now suing.

Another former CNA, Tasha Harden, told WXYZ their boss once sent two employees home, “both because they refused to take their masks off.”

According to the Detroit Free Press, nursing home managers also “refused to test residents or staff,” and would not let its workers stay home sick unless they had fevers.

Michigan’s Department of Health and Human Services reported that 19 people who lived at the 87-bed home died from COVID-19, according to the outlet. Meanwhile, 47 other patients, and 16 employees, contracted the virus, WXYZ reported.

As of July 31, more than 2,000, or 31%, of Michigan’s coronavirus-related deaths were linked to nursing homes.

In a statement provided to both outlets, the Villages of Lapeer said it was “not in a position to provide comment.”

“We can say that The Villages of Lapeer has been and will continue to cooperate with the involved parties,” the statement further reads. “Please be assured that The Villages of Lapeer is committed to continuing to provide high quality care and support to our residents and their families, as well as support for all of our staff during these challenging times.”

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Michigan nursing home prohibited employees from wearing masks amid coronavirus outbreak, reports say

Four MN nursing homes have more than 100 coronavirus cases as state looks to control outbreak

Saint Therese Senior Services in New Hope, Minn., on Thursday, April 30, 2020. A suburban Minneapolis nursing home said 47 residents have died from complications of COVID-19, the most at any long-term care facility in Minnesota. (Evan Frost/Minnesota Public Radio via AP)

By Katrina Pross

Four Minnesota nursing homes have more than 100 confirmed cases of the coronavirus. Three of those centers have at least 38 deaths.

The grim details of the state’s battle against the spread of the coronavirus in its assisted living centers were released this past Friday by the Minnesota Department of Health. In fact, the majority of deaths from the coronavirus in the state continues to be from long-term care or assisted living centers, making up 955 of the state’s 1,197 total deaths reported as of Monday.

The data’s release was in response to a request by Republican State Sen. Karin Housley of St. Mary’s Point, who has been critical of the state’s efforts to stem such cases.

“We are facing an unprecedented crisis at long-term care facilities in Minnesota,” Housley, who chairs the Senate’s Family Care and Aging Committee, said, pointing out that about 80 percent of the state’s coronavirus deaths have been in congregate-care facilities.

Housley had asked the Health Department for more details on how the virus was impacting nursing homes and at one point threatened to subpoena the agency. After receiving the data, Housley said in a statement that she would sponsor a bill requiring widespread testing at long-term care facilities.

WHICH CENTERS HIT HARDEST?

• North Ridge Health and Rehab in New Hope: 221 resident cases, 74 staff members infected, 57 resident deaths
• St. Therese of New Hope: 155 resident cases, 43 staff members infected, 67 resident deaths
• Southview Acres Healthcare Center in West St. Paul: 120 resident cases, 33 staff members infected, 38 resident deaths
• Lyngblomsten Care Center in St. Paul: 81 resident cases, 50 staff members infected, 16 resident deaths
• Augustana Chapel View Care Center in Hopkins: 68 resident cases, 22 staff members infected, 29 resident deaths.

MDH Commissioner Jan Malcolm said at a media briefing Monday afternoon that the numbers and data can be misleading without proper context, such as how the state compares with others. The MDH is also trying to take a balanced approach between trying to protect patient privacy and disclosing the names of facilities that have had more than 10 cases, Malcolm added.

“I certainly understand the public interest in knowing more detail about what’s going on in these long-term care facilities,” Malcolm said.

Of the 289 care centers listed with a confirmed case of coronavirus, more than half (146) had four cases or fewer; and 30 percent (86) had just one case.

Efforts to reach officials with the top few centers for comment were unsuccessful.

HOW DOES MINNESOTA COMPARE?

The outbreak in the United States is believed to have first taken a hold in a Seattle-area nursing home, prompting facilities across the country and Minnesota to limit visitors and interaction between staff and residents.

When looking at the numbers of cases in skilled nursing homes, Minnesota has 49.7 cases per 1,000 residents, Forum News Service reported. That ranks as the 26th highest state in the country and puts Minnesota below the national average of 62 cases per 1,000 residents.

The national average for deaths per 1,000 nursing home residents is 27.5 deaths. Minnesota is at 12.1 deaths per 1,000 nursing home residents, which is the 29th highest state.

Minnesota has stepped up its “battle plan” to address infections in long-term care centers with efforts such as expanding testing, helping staff get personal protective equipment when needed and looking to boost staffing.

Housley said in an email to the Pioneer Press that while the commissioner’s response did provide some useful information, she has several takeaways, including that she thinks some centers need more personal protection equipment and testing. She also said patients in these facilities should be allowed visitors again, and that Minnesota should a consider a similar approach to Colorado, which is looking at allowing outside visits.

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Four MN nursing homes have more than 100 coronavirus cases as state looks to control outbreak

What’s Behind the Nursing Home Horror

After decades of mistreatment, older Americans are bearing the worst of the pandemic.

By Charles C. Camosy
Dr. Camosy teaches bioethics and moral theology at Fordham University.

Emergency medical technicians transporting a patient from a nursing home to an emergency room bed at St. Joseph's Hospital in Yonkers, N.Y., on April 20th.Credit...John Minchillo/Associated Press

We knew it from the beginning. A nursing home in Washington State was the center of the first known coronavirus outbreak in the United States. We knew that institutions caring for the elderly and disabled in close quarters would be particularly vulnerable during the pandemic.

But we did not act. Personal protective equipment, special training and extra staff went almost exclusively to our critical care facilities. Nursing homes got virtually nothing. Well, that’s not entirely true. In New York and other places we gave them patients, and even nurses, infected with the virus.

The result has been a raging wildfire of infection and death. We don’t have full reporting of anywhere close to all the deaths at this point, but the best estimates right now are that about half of those who have died from Covid-19 have been nursing home residents. In some places, it’s much more: Connecticut reported that nearly 90 percent of its Covid-related deaths between April 22 and April 29 occurred in nursing homes.

We tend to see this as a public health failure, but it is also a moral failure. That fact hit me recently, after I went on Fox News’s “Tucker Carlson Tonight” to talk about the plight of nursing homes.

Even before the pandemic, these were places where what I call “throwaway culture” was thriving. The staff aren’t paid a living wage, often have poor training and are hopelessly overworked. The residents face elder abuse, and large percentages of them are desperately lonely. A good number get no visitors at all, which pushes rates of dementia among residents to unbelievable levels.

I suggested to Mr. Carlson’s audience that it was no surprise that throwaway culture kicked into hyperdrive in nursing homes during our current moment. I was excited to be able to make my case to a national audience; afterward, I was exhausted. All I wanted to do was help my wife get our 2-year-old to bed and go to sleep myself.

But that’s when the messages started coming in. Email. Facebook messenger. LinkedIn. Twitter. One after the other after the other. And they were horrifying.

It is one thing for a professor of bioethics to cite abstract numbers and trends and offer a theoretical explanation for them. It is another thing to get message after message detailing the human toll of what you had just discussed.

One of the most moving — and frightening — was from a nursing home staffer. She said she was given inadequate P.P.E. and training, and had likely been exposed to the virus. Her communications with management were ignored. Staff members at her facility were not being tested. She decided to quit her job rather than risk infecting her residents. “I don’t know if you can help me,” she said. “I feel that what you said is true; the elderly need a voice by someone that cares.”

Another correspondent, who had worked in health care administration, said that she was “not surprised in the least that the hospitals were trying to discharge their Covid-19 infected patients” back to long-term-care facilities because, in her experience, this has “been happening for quite some time.” It got worse: Agreeing with me about the radical understaffing of nursing homes, she said that it is “increasingly common is to discharge high cost and difficult patients to homeless shelters … Yep, you heard me right … HOMELESS SHELTERS.”

Not every story was coronavirus-specific. One man told me the story of the fatal neglect of his father — after which the nursing home falsified his father’s records and hid behind state laws that nursing home lobbyists had written.

A former director of nursing at a long-term-care facility said that given her terrible professional experiences, she had refused to put her 78-year-old husband, who was suffering from dementia, anywhere outside her own home. Another clearly frightened woman explained that she had just had a horrible experience with her mother in a nursing home; she even gave me, a complete stranger, her phone number, in the desperate hope that I could raise the alarm about how bad things were.

We need to listen to people like this and act on what they are saying. The pandemic doesn’t have many silver linings, but as the number of nursing-home deaths piles up, the news media is being forced to cover a world many of us would prefer to ignore.

It is understandable that we would. Part of the price we pay for living in a death-denying, consumerist, throwaway culture is that we must push these kinds of grim realities to unseen places that afford us plausible deniability. The pandemic forces us to look. If we want to understand the current phase of the coronavirus pandemic, we can no longer look away.

After receiving this waterfall of messages, I expected to fall into despair. But while I do have my bad days, I also have hope. Times like this have produced major cultural changes in our past. If we do take a hard look, we may change more than just the way we treat older Americans. We may, along the way, find a way to push against throwaway culture in all its forms.

Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us? To honor the moral and social equality of every human being, regardless of their mental or physical status?

Why not? Many of us are staying home and practicing physical distancing, not primarily for ourselves but for the benefit of our elders and others who find themselves at risk. Let us build on that good and decent impulse by challenging a throwaway culture that, right up until this very moment, has marginalized these populations and made the nursing-home crisis a tragic inevitability.

Charles C. Camosy (@ccamosy) is an associate professor of theological and social ethics at Fordham University. His most recent book is “Resisting Throwaway Culture.”

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What’s Behind the Nursing Home Horror

Some Florida seniors isolated with Alzheimer's and dementia due to the pandemic are getting robotic therapy pets

These robotic therapy pets will be provided for Florida seniors and older adults with Alzheimer's and dementia.

(CNN)Since the coronavirus outbreak, strict visitation rules and social distancing guidelines imposed at nursing homes in Florida have left some seniors feeling isolated.

In order to help them cope during the pandemic, the Florida Department of Elder Affairs is providing them with some furry new friends. 

 

The agency announced on Monday that it's providing 375 therapeutic robotic pets to socially isolated seniors and adults living with Alzheimer's Disease and Dementia, according to a news release issued by the agency.

 

Robotic therapy pets can provide an alternative to traditional pet therapy.

 

"We know social isolation disproportionately affects older adults, and COVID-19 has required people with dementia and their caregivers to remain alone for extended periods of time," the release states.

 

The state's Department of Elder Affairs hopes the pets can help the seniors combat social isolation and depression by improving their overall mood and quality of life. 

 

An alternative to traditional pet therapy, research shows that the robotic pets have similar positive effects and is highly successful in decreasing social isolation for older adults, according to the agency's news release.

 

"We know social isolation disproportionately affects older adults, and COVID-19 has required people with dementia and their caregivers to remain alone for extended periods of time," Department of Elder Affairs secretary Richard Produm said in a statement. "We look forward to delivering these therapeutic robotic pets to those who will benefit from their companionship."

 

The robotic pets were created by Ageless Innovation, a company that is devoted to developing fun and engaging products geared toward older adults.

 

The company has also partnered with the Association on Aging in New York to distribute up to 1,1100 robotic pets to those who are at the most risk for social isolation.

 

CNN's Rosa Flores and Sara Weisfeldt contributed to this report.

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Some Florida seniors isolated with Alzheimer's and dementia due to the pandemic are getting robotic therapy pets

Nursing home presuming all 800 patients, staff have COVID-19

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Beaver County, Pennsylvania — A Beaver County nursing home is operating under the presumption that all of its 800 patients and staff members have COVID-19, reports CBS Pittsburgh. The Brighton Rehabilitation & Wellness Center, northwest of the city, said they'll all be treated as such.

Over the weekend, a union representative from the nursing home reported at least 42 of the 450 patients living there had tested positive and three had died.

The union said 10 of the more than 300 workers have tested positive.

Last night, the nursing home spoke with the Department of Health and it was decided test results would no longer be considered. Instead, anyone showing symptoms will be isolated and aggressively treated. It's thought that will better protect others from asymptomatic cases.

Staffers are using N-95 masks and other protective equipment to try to stay safe.

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Nursing home presuming all 800 patients, staff have COVID-19

Coronavirus outbreaks like 'wildfire' at US nursing homes under lockdowns

Pat Herrick holds a photo of her mom Elaine Herrick, 89, a resident of Life Care Center who died at the nursing home in Kirkland, Washington, on 5 March. Photograph: Jason Redmond/AFP via Getty Images

Nursing homes across the US have been in lockdown for weeks under federal orders to protect their frail, elderly residents from coronavirus, but a wave of deadly outbreaks nearly every day since suggests that the measures including a ban on visits and daily health screenings of staffers either came too late or were not rigorous enough.

Recent outbreaks in Tennessee, New Jersey, Ohio, West Virginia, Massachusetts and Maryland have pushed the death toll at the nation’s nursing homes to at least 450 and highlight the biggest gap: screenings of doctors, nurses, aides and other workers do not involve actual testing but the taking of temperatures or asking health questions that still allow infected, asymptomatic people to slip through.

“It’s still been like Swiss cheese with people coming in and out of there, and thus you’ve got these explosions in senior facilities,” said John BaRoss of Long Valley, New Jersey, who recently pulled his 85-year-old mother out of an assisted-living center out of fear of infection.

After an outbreak of 100 infections and four deaths at the Gallatin Center for Rehabilitation and Healing outside Nashville, Tennessee – where the National Guard was called in to help evacuate the facility – Sumner county mayor Anthony Holt blamed staff members who came to work despite showing symptoms for Covid-19 and “exposed a lot of patients”.

“Things got out of hand,” Holt told the Associated Press. “Once employees became symptomatic, they should have asked them to go home immediately and called the health department. I don’t think that occurred.”

After an outbreak near Dayton, Ohio, killed six people and infected nearly 50 at a pair of nursing homes less than 10 miles apart, health officials began scrutinizing medical specialists such as phlebotomists and respiratory therapists who work in multiple facilities a day. One such health worker who visited both homes tested positive for Covid-19.

In Maryland, Governor Larry Hogan said an outbreak that spread like “wildfire” at a Mount Airy nursing home, killing five and infecting 77, apparently began with an asymptomatic health worker who made it past a temperature check screening and “infected the population”.

Some relatives of those at the Sundale nursing home in Morgantown, West Virginia, where 29 residents and staff have tested positive, say more should have been done to keep coronavirus out before the federal restrictions took hold in mid-March.

“The day before the shutdown, we just walked in wherever. There was no sign-in. There was nothing,’ said Courtney Templeton about her last visit to her 69-year-old mother.

Templeton also faults the home for not testing residents fast enough and not keeping healthy ones separate from those just back from a nearby hospital showing Covid-19 symptoms, including her mother’s roommate.

“She came back coughing and had a fever,” Templeton said of a visit two weeks ago, after which she began begging the home to protect her mother. “Can’t you keep the incoming patients separate? Can’t you keep them quarantined for 14 days?”

Last week, Templeton got word both the roommate and her mom had the virus.

Though the federal government has not been releasing a count of its own, an AP tally from media reports and state health departments indicate at least 450 deaths and nearly 2,000 infections have been linked to coronavirus outbreaks in nursing homes and long-term care facilities nationwide.

And for the nation’s more than 15,000 such facilities and the 1 million people who live in them, experts say the situation could get worse before it gets better.

They say the crisis has only deepened a chronic staffing shortage at nursing homes because more workers are self-quarantining or staying home with their children.

There is still not widespread testing of staff or patients, and shortages of masks and other protective gear persist.

“It’s an emergency situation, and it’s just been totally neglected in all the national policy,” said Charlene Harrington, a professor emerita at the University of California San Francisco and former state health official. “They’re not focusing on the fact that these are the most vulnerable of people in the whole country.”

And overcrowding in hospitals has some states seeking to force nursing homes to take patients who are recovering from Covid-19, raising fears they could spread it to residents inside.

New York issued a statewide advisory last week forbidding nursing homes from denying residents admission “solely based on a confirmed or suspected diagnosis of Covid-19,” California told its nursing homes to make similar preparations.

Massachusetts announced plans to designate specific nursing homes as care centers for Covid-19 patients – a move that has set it apart from other states

“Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept Covid-19 patients is a recipe for disaster,” said Mark Parkinson, president of the American Health Care Association.

Federal directives on nursing home coronavirus prevention followed the nation’s biggest outbreak in one place, the deaths of 40 at the Life Care Center nursing home near Seattle. A government inspection found infections at the home and others nearby were likely caused in part by employees working while sick.

A 13 March order from the Centers for Medicare and Medicaid Services says nursing homes should immediately halt visitors and non-essential workers, cancel communal dining and group activities, and actively screen residents and staff for fever and respiratory symptoms.

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Coronavirus outbreaks like 'wildfire' at US nursing homes under lockdowns

Woman helped elderly couple get food when they were too scared to go shopping during coronavirus outbreak

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By Caitlin O'Kane

As the coronavirus outbreak continues to spread throughout the globe, older Americans are among the most vulnerable. This poses a conundrum: Do they avoid crowded grocery stores or do they stock up on food?

One elderly couple from Oregon had recently driven to a Safeway in Bend, Oregon, but they were too scared to get out of their car.

After 45 minutes, the wife cracked her window and shouted out to a young woman, professional runner Rebecca Mehra. "She cracked her window open a bit more, and explained to me nearly in tears that they are afraid to go in the store," Mehra wrote on Twitter.

I went to the grocery store this afternoon. As I was walking in I heard a woman yell to me from her car. I walked over and found an elderly woman and her husband. She cracked her window open a bit more, and explained to me nearly in tears that they are afraid to go in the store.

— Rebecca Mehra (@rebecca_mehra) March 12, 2020

The couple is in their 80s and heard the coronavirus was disproportionately affecting older people, Mehra wrote. They told her they don't have family nearby that could help them. "Through the crack in the window she handed me a $100 bill and a grocery list, and asked if I would be willing to buy her groceries," Mehra wrote in a series of tweets.

"I bought the groceries and placed them in her trunk, and gave her back the change," she continued. "I know it's a time of hysteria and nerves, but offer to help anyone you can. Not everyone has people to turn to."

After her story went viral, Rebecca Mehra spoke to CBS affiliate KBNZ. "It was the first time I thought about how much this is really affecting my community," she said of the elderly couple who asked her to help them get groceries. KBNZ

Mehra's Twitter thread resonated. "Overwhelmed by the positive response to my tweet yesterday," Mehra wrote on Thursday, one day after posting the initial story. "Over 11 million of you have seen my story and counting. Thank you to everyone who has shared it."

"Frankly most people I know would have done the same thing I did. I was just in the right place at the right time," Mehra wrote.

She spoke to CBS affiliate KBNZ after her story gained widespread attention online.

"It was the first time I thought about how much this is really affecting my community," Mehra said, adding that she was just at the right place at right time and wishes she had gotten the couple's names.

"It just felt like a no brainer thing to do in the moment," she said. "It seems like it's inspired thousands of people hopefully to check in on their neighbors, check in on their grandparents, and their parents."

Many elderly Americans, as well as those with serious chronic medical conditions such as heart disease, diabetes or lung disease, are at a higher risk of contracting coronavirus – and some of them might not have the help they need.

High-risk individuals should make sure they have a supply of their regular medications on hand in case there's an outbreak that forces them to stay home, according to the CDC. They should also consider a mail-order service for medications.

The CDC also recommended stocking up on over-the-counter medicines, including those that relieve fevers, as well as medical supplies and household items, such as tissues. Food supply is also important.

All Americans should also be practicing social distancing and proper hand washing to help prevent the spread of the virus.

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Woman helped elderly couple get food when they were too scared to go shopping during coronavirus outbreak