‘A catastrophic outbreak’: How Oregon failed to slow coronavirus before death overtook nursing home

By Fedor Zarkhin

Oregon’s top nursing home regulators received repeated warnings and even acknowledged privately that the coronavirus could decimate a Southeast Portland care facility but failed to take fast and aggressive action before the first 10 residents died, an investigation by The Oregonian/OregonLive has found.

State officials were told as early as March 25, about a month after Oregon’s first case, that Healthcare at Foster Creek was struggling to protect its residents from coronavirus, records obtained by the newsroom show.

A caregiver who worked in the facility filed a complaint that day, warning the Oregon Department of Human Services of inadequate safeguards and impending death.

“We have residents who I believe will not survive and I’m fearful for them,” the caregiver wrote.

A top state regulator, Jack Honey, expressed alarm over other alleged problems at the facility. “And just between you and me,” Honey later wrote to a colleague, “I am so worried about this erupting into a devastating outbreak.”

That anxiety was prophetic.

Coronavirus cases linked to Healthcare at Foster Creek quickly ballooned, eventually infecting 120 people and killing 34 Oregonians. By the time the last resident was evacuated May 5, the facility accounted for about one out of every four deaths statewide, and it remains Oregon’s deadliest outbreak.

The newsroom’s investigation found that despite warning signs state officials took days and in some cases weeks to act, losing critical time to help slow spread inside the nursing home.

Blaming a lack of protective equipment for state regulators, authorities waited nine days to inspect the facility after the March 25 complaint but inexplicably found no violations during their 47-minute visit – only to return one week later to uncover a slew of problems, including some outlined in the initial and subsequent complaints.

Among them: caregivers wearing the same masks for entire shifts, employees not washing hands between interactions with residents, and workers moving between units with and without known coronavirus infections – potentially serving as conduits to spread the dangerous disease.

Kevin Fortune was a resident at Healthcare at Foster Creek when he got sick with the coronavirus and died. Fortune's brother is now suing the nursing home. Here Fortune is in his 1979 high school graduation photo. Photo courtesy Fortune family

It’s impossible to know if the state’s drawn-out response contributed to the immense death toll at Healthcare at Foster Creek. But Charlene Harrington, a professor at the University of California San Francisco, said delays almost certainly cost lives.

“Every day of delay was spreading it,” said Harrington, who has been researching senior care oversight for two decades. “They had the authority. I don’t understand why they didn’t act sooner.”

The state could have put in place a temporary management company, immediately gone into the facility, or sent inspectors to monitor Foster Creek’s workers, Harrington said.

“I feel sad when I see a leadership failure,” Harrington said. “They could have saved lives.”

The newsroom’s findings, based on more than a dozen interviews and more than a thousand pages of documents obtained through public records requests, underscore the chaos of the state’s overall response to the pandemic in the first months after coronavirus emerged Feb. 28 in Oregon.

The state became overwhelmed by an onslaught of unemployment claims filed by laid-off workers. It repeatedly held back information vital to the public. But nowhere was Oregon’s failure more stark than at Healthcare at Foster Creek.

Healthcare at Foster Creek, now closed, saw the largest and most fatal coronavirus outbreak in the state. Kevin Fortune was one of the residents who died. His brother is now suing the nursing home. July 3, 2020. Beth Nakamura/Staff

State officials knew how devastating the disease could be if left unchecked inside a nursing home, where residents are mostly elderly and suffer from underlying health conditions, making them the most likely to die from COVID-19.

In Washington, a nursing home outbreak near Seattle drew international headlines and accounted for more than half of all known coronavirus deaths across America by mid March. In Oregon, officials already had two weeks’ experience responding to an outbreak at a veterans home in Lebanon that ultimately infected 38 and killed 8.  (Click to Continue)

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‘A catastrophic outbreak’: How Oregon failed to slow coronavirus before death overtook nursing home

More than 25,000 nursing home residents and 400 staff have died during pandemic, federal report shows

A patient is transported out of Brooklyn's Cobble Hill Health Center in late April. (John Minchillo/AP)

By Debbie Cenziper, Peter Whoriskey and Joel Jacobs

More than 25,000 residents died and 60,000 were infected as the coronavirus swept through U.S. nursing homes in recent months, particularly affecting facilities with a history of low marks for staffing and patient care, the federal government reported Monday.

The virus also infected 34,000 staff and took the lives of more than 400, according to the Centers for Medicare and Medicaid Services, the federal agency that oversees the nation’s nursing homes.

The numbers represent the first official national accounting of fatalities in the 15,000 nursing homes that receive Medicare and Medicaid funding. The tally, however, is incomplete. Only about 80 percent of the nation’s nursing homes reported data to the federal government, and they were required only to include cases since early May.

CMS officials nevertheless said they were confident the figures offer a reliable snapshot of the pandemic in the nation’s hard-hit nursing homes.

“This represents a good picture of where we’ve been,” CMS Administrator Seema Verma said in a call with reporters Monday afternoon.

A Washington Post accounting of cases and deaths in nursing homes shows a higher toll and that tally rounds up data from less than half of the states. Based on reports from 21 states since the beginning of the pandemic, The Post found that more than 28,000 residents have died.

Of the homes that reported data to CMS, 1 in 5 recorded at least one death from covid-19, the disease caused by the coronavirus, and 1 in 4 had at least one positive case. In the District of Columbia and three states — New Jersey, Connecticut and Massachusetts — more than 1 in 10 nursing home residents died, according to the data collected so far by CMS.

An early analysis by CMS showed that nursing homes that have received poor marks for nurse staffing and patient care were more likely to see higher case counts than those with stronger track records.

Statistical analyses touted by the industry, by contrast, suggest that the outbreaks have little to do with the quality of nursing homes. Instead, studies indicate that a home’s location and size are better predictors of an outbreak.

"Significant research from leading health experts, including analysis from Harvard Medical School and Brown University as well as testimony to Congress by the University of Chicago, has shown no correlation between covid-19 outbreak and [Medicare’s] star rating system,” said Beth Martino, American Health Care Association senior vice president of public affairs, referring to the government’s quality grades for nursing homes. “In fact, the first covid case was at a five-star rated facility. As this research shows, the amount of covid-19 cases in nursing homes has been directly linked to the level of the virus in the surrounding local community.”

On Monday, Verma focused heavily on infection control, saying the agency would strengthen enforcement, including civil penalties, of nursing homes with persistent violations of federal standards meant to prevent the spread of illness. The move, according to CMS, would “help prevent backsliding, improve accountability and ensure prompt compliance."

Nursing homes across the country have struggled with infection control both before and during the pandemic. In April, a Post analysis of about 650 homes with cases of the coronavirus found that 40 percent had been cited more than once for infection control deficiencies in recent years.

Verma said the agency will distribute $80 million to states to increase infection-control inspections of nursing homes during the pandemic. States that fail to inspect all Medicare-certified homes by July 31 will be required to submit a corrective plan to the federal government. Those still lagging by August will lose some of the money.

The new federal data, while limited, comes after months of criticism from watchdog groups and patients’ families, who argued that transparency is critical during a public health emergency. Since the first known outbreak at a nursing home, in Washington state in February, some states have repeatedly declined to name affected facilities or describe the scale of the problem, forcing families to plead for information from homes that were often reluctant to release details.

“I think people have a right to know what’s going on — and not all this hiding,” said Toby Edelman, a senior policy attorney at the nonprofit Center for Medicare Advocacy. “If the nursing homes would just tell the truth, people would respect them a lot more than this language about ‘We love our residents.’”

In April, CMS announced that all nursing homes would be required to report case information to the Centers for Disease Control and Prevention on a weekly basis. CMS requested data by May 17 but gave nursing homes a two-week grace period to report. The agency also announced a new rule requiring nursing homes to report cases to all residents and their families.

Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, said the newly reported numbers validate the need for widespread testing and more support for nursing homes.

“Especially as we continue to expand testing for residents and staff in long term care centers in June, we should anticipate the number of cases to rise as asymptomatic residents and staff will be identified," he said. "While an increase in these reported numbers may be startling, it will improve our ability to confront this threat and protect our residents.”

The data released on Monday did not include case or death counts for individual homes. Those numbers are expected to be released on Thursday.

Jacobs is a graduate student in journalism at Northwestern University’s Medill Investigative Lab.

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More than 25,000 nursing home residents and 400 staff have died during pandemic, federal report shows