Georgia’s oversight of long-term care shaky as COVID-19 cases jump

In Newton County, public officials got copies of an anonymous letter from a “relative” asking for an external investigation of the Riverside Health Care Center. Reports now show that an outbreak in the nursing home that began in early July has ballooned as of Tuesday to 102 residents testing positive and 32 residents dying.

In Atlanta, while Dunwoody Health and Rehabilitation Center had reported it was virtually COVID-free until mid-July, family members described cases of malnutrition, unexpected deaths, unanswered phone calls and callous demands to immediately send a funeral home to pick up their loved ones’ remains. Reports now show 118 residents and 63 staff have tested positive, and 28 residents have died.

“I don’t know how that facility is still in existence,” said Khalid Rashied, who pulled his mother out of the facility, fearing she wouldn’t survive.

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Because of the risk of the coronavirus, for nearly six months families have been barred from making routine visits to check on loved ones in long-term care homes. Representatives of Georgia’s long-term care ombudsman’s office have been locked out, too.

Those tight limits mean that at one of the most dangerous times in history to live in a senior care facility, oversight has been left primarily up to a Georgia agency that has struggled for years to keep a close watch on nursing homes, assisted living facilities and personal care homes.

Georgia lags behind every state but one in completing standard inspections of nursing homes on time, the AJC found. While the reports are supposed to be done annually, federal records show that 42 percent of the state’s nursing homes — 152 facilities — have not undergone a comprehensive inspection for at least 18 months, and some for more than two years.

Georgia also was called out in 2017 as among the nation’s worst at investigating complaints that patients may be at imminent risk of serious injury or death.

The lagging inspections could leave patients at risk in a state that has one of the nation’s highest shares of nursing homes with poor records. One in 4 Georgia nursing homes are rated as well below average, or 1-star, in the federal system.

Shortcomings are widespread as well in the state’s assisted living and personal care homes, the AJC found in an investigation last year.

The state Department of Community Health, the agency responsible for oversight, said delays in inspections are due to a shortage of inspectors and its suspension of routine inspections at the start of the pandemic, which created a backlog. Of the 57 “surveyor” positions Georgia has to inspect nursing homes, 24 are vacant.

DCH also said it followed federal guidance in March to focus only on infection control checks and complaints where residents could be in immediate jeopardy. It did most of that work remotely through the spring.

DCH resumed on-site inspections after the federal government in June ordered states to do so by July 31 to look for infection control issues. Georgia was among the last states to inspect all homes, using outside vendors to help.

DCH said it is complying with a recent federal directive to conduct quick onsite visits at homes that report new outbreaks. DCH said it is also conducting complaint investigations now and coordinating with federal “strike force” teams inspecting nursing homes.

But so far, at least, the state has released to the public only a handful of reports citing homes for violations, even as deadly new outbreaks continue. Residents of long-term care facilities make up about 40 percent of the state’s overall COVID-19 deaths, and the August death count for senior care residents was higher than any month of the pandemic.

Some families say the state must be missing something.

Rashied said while his mother was at the Dunwoody Health nursing home for rehab after breaking a bone, he would call regularly to check on her. But the phone usually went unanswered. He said he was told she would be tested weekly for COVID-19 after being exposed to another resident who tested positive, but she apparently wasn’t, he said. A test done on the day she left was positive, but Rashied wasn’t told of the results for two days. He said his mother was so drugged up when he picked her up from the home she was unable to talk, eat or even sit up, and he contends she wasn’t given proper follow-up care for her broken bone.

“I don’t know if there is a worse place I could send my mother to,” Rashied said. “Hell is the only thing I can think of.”

But it turned out that his mother was one of the lucky ones. Unlike at least 28 other residents at the home, she survived.

Dunwoody Health is operated by Atlanta-based SavaSeniorCare, one of the nation’s largest senior care chains. The company attributed the outbreak to the facility’s location in a “highly populated urban area” where there is a heightened exposure to COVID-19. The company said it was working hard to control the outbreak, but said the pandemic is difficult to contain in a congregate setting.

”There have been residents who have tested negative for the virus and those who have been asymptomatic,” Sava said. “As a result of our efforts, 69 residents currently at the center have recovered (from COVID-19) in our care.”

With high rates of COVID-19 throughout Georgia, many long-term care operators say it’s almost impossible to block the virus completely since employees must come in and out. Even some of the state’s top-rated homes have had deadly outbreaks, especially early in the pandemic when needed amounts of personal protective equipment and tests were impossible to get. But Georgia’s history of lax oversight increased risks for residents in facilities that have records of infection control violations, inadequate staffing or care violations. Plus, with families locked out, residents of sub-par homes no longer had family members stop by to help and protect them.

Families want answers

The Riverside Health Care Center in Newton County, about 35 miles east of Atlanta in Covington, had reported just one COVID-positive resident until early July, when the numbers started to explode. With cases and deaths rising, public officials say they got the anonymous letter asking for oversight, saying calls to the facility weren’t being answered.

The COVID-19 death toll at the 158-bed home is the second-highest among Georgia nursing homes. Local public health officials said they had provided infection-prevention training both virtually and on-site and that DCH was inspecting the home. But no reports on the inspections have been posted.

The U.S. Centers for Medicare and Medicaid Services, which regulates nearly all nursing homes, told the AJC Thursday that infection-control checks were done at the home in June, July and August in response to the increase but no public reports on the inspections were available yet. It’s unclear when — or even if – state or federal officials will release any details.

A standard survey of the home Feb. 13, before the pandemic hit, cited the home for five deficiencies, including failing to provide a safe, clean and comfortable homelike environment.

The nursing home did not respond to calls from the AJC, and its website doesn’t include the kind of COVID-19 update that many nursing homes provide online. Marcello Banes, the Newton County Commission chairman, said in a statement that he was “deeply saddened” by what was happening at the home. He called the situation at Riverside “unacceptable.”

The home has a 1-star federal quality rating, the lowest on the federal scale.

At Dublinair Health and Rehab, about two hours south of Atlanta, the outbreak has been sudden and furious. Of the 24 COVID-19 deaths at the home, 23 were reported in August. Local officials said both public health officials and DCH inspectors had been on-site. But no reports had been released. Dublinair also has a 1-star rating.

The 149-bed home appears to have no website, and the administrator did not respond to calls from the AJC.

Bobby Pope, a pastor who officiated the funeral for his father-in-law, a Dublinair resident who died in July, said it’s been difficult to get information from the facility or to get an answer to calls. The family was allowed to enter wearing protective equipment when the death was imminent. He said they were told the cause of death was pneumonia. “Somebody needs to get in there and check to see what is going on,” said Pope, whose mother-in-law is also a resident there.

Chain, the Laurens County Commission chairwoman, said county health officials and DCH were working with the facility to try to contain the outbreak. CMS said inspections were conducted at the home in June and August, but no inspections reports were yet available.

The most recent standard inspection of Dublinair was in September 2018, when among the violations were infection prevention and control issues, government records show.

Home finally punished

When Darryl Harris in early July went to pick up his father, Clarence, from Dunwoody Health and Rehabilitation, he barely recognized him. His father was admitted to the Sandy Springs facility for rehab about a month earlier after a hospital stay for pneumonia, his son said. But even though the facility said his father was ready for discharge, the 92-year-old couldn’t even stand and had lost at least 20 pounds, Harris said. The Korean War vet was admitted to the V.A. Hospital with dehydration, malnourishment and a pressure wound.

While Darryl Harris said the nursing home had told him that his father had tested negative for COVID-19, the hospital tested him and he was positive. He died August 2.

“Dunwoody killed him in my opinion,” Harris said.

Susan Carini wonders what the state oversight agency did in response to all the infections and deaths at the nursing home.

In late June, she and her sister were told their mother, Patricia, had been exposed to a worker who had tested positive, and although within days the 87-year-old started to develop symptoms, they were told repeatedly she tested negative. As her symptoms got worse, the sisters wanted a doctor to see her. But they never heard back about whether that even happened and getting through to anyone for updates was almost impossible.

The sisters felt like they had no way to advocate for their mother, who was wheelchair-bound. “It was as if she were sealed off from us, and in truth, she was,” Carini said.

On July 18, the home reported Patricia tested positive. Two days later, she was dead. The nursing home called shortly after the death and insisted the family pick out a funeral home “within an hour” so her mother’s remains could be removed immediately, Carini said. Other families told the AJC they were also hounded to quickly arrange for their loved ones who died to be picked up.

Carini was incensed when she saw her mother’s death certificate: COVID-19 wasn’t even listed. Diabetes was included. The thing is — her mother didn’t even have diabetes. Carini insisted the record be set straight, so her mom’s death isn’t left out of the pandemic’s deadly toll.

DCH’s last standard survey of the facility is dated Nov. 1, 2018, where federal records show that among the deficiencies cited were problems with infection prevention and control.

CMS told the AJC that state inspectors had done an infection control inspection at Dunwoody Health in mid-July and found no violations. But CMS ordered the state to conduct another check.

The federal agency revealed to the AJC on Thursday that the more thorough inspection discovered a devastating failure of both infection control and tracking of the COVID-19 outbreak. The report said that “as a result of these failures” 94 residents and 47 staff members tested positive for COVID-19, and 14 had died as of July 30.

CMS notified the facility it was imposing a fine of $21,393 per day —for a 13-day period in July and August – for the violations.

SavaSeniorCare said the facility is working on a required plan of correction in response to the findings.

Kimberly Pennell said she is glad the facility is finally being punished, but she said the actions seemed too little, too late.

Her husband got COVID-19 at Dunwoody Health and died unexpectedly in August, five days after she was told he had recovered.

Pennell said she had filed a series of complaints against the facility over several years, including some related to sanitation. Only recently did an inspector call her to inquire about something she said she reported about three years ago. “It takes the deaths of all these people, including my husband, for the state to make a phone call to follow up?” she said. “Come on.”

Pennell said she always tried to follow the chain of command in making complaints, going to the facility, the corporation, the state, the ombudsman’s office.

“I did it for years,” she said. “Nothing changed. Things got worse.”