By the time the Georgia National Guard arrived in late April to offer COVID-19 testing at Westbury Medical Care and Rehab in Jackson, the coronavirus had proven to be a deadly force inside nursing homes.
Jennifer Vasil, Westbury’s director, was doing everything she could to protect the home’s vulnerable seniors after their first resident tested positive in early April. Westbury closed its doors to visitors in March and scrambled to get as much PPE as possible. Vasil had a system in place to separate residents, hoping to shield those showing no signs of infection.
But for her system to work, she needed to know how far the invisible enemy had crept into Westbury. She desperately needed testing, and the National Guard finally answered her call for help.
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The Guard’s arrival with dozens of hard-to-get test kits in hand, however, led to more questions than answers. The tests were administered but Vasil couldn’t get the results. The Guard told Vasil they didn’t have them, according to documents obtained by the AJC. Georgia’s public health officials couldn’t find them either, the records show. It took nine days for officials to find the tests and acknowledge a breakdown.
When results finally came in, the news was grim: Vasil was captaining a ship that had an enormous outbreak. Dozens of residents and workers at Westbury tested positive. Because of the delays, she lost critical days in the fight.
“It is very frustrating,” Vasil said in early May, “to feel that we are not a priority right now when it comes to testing.”
This month, Gov. Brian Kemp issued a press release saying that “100 percent” of the state’s nursing home residents had been tested for COVID-19, citing figures from the Georgia Department of Community Health. But facility-by-facility reports reviewed by the AJC found dozens of nursing homes where nowhere close to all the residents had been tested, including some that had tested only a few.
Nursing homes across the state still struggle to get what they need to protect the vulnerable, the AJC found. More than 1 in 4 homes is short of nurses or care aides. About 1 in 6 don’t have a one-week’s supply of medical gowns, and nearly 1 in 7 don’t have a week’s supply of N95 masks, according to federal reports reviewed by the AJC.
“In Georgia, and elsewhere, we had an opportunity to really invest in protecting nursing home residents and the staff in these buildings and we failed to do that,” said David Grabowski, a health care policy professor at Harvard Medical School.
Thousands of nursing home residents across the state have come down with the coronavirus. As of Wednesday, 1,223 long-term care residents in Georgia have died with COVID-19, about 45% of the state's official total. Meanwhile, the battle is far from over: new senior care homes join the state's official outbreak list almost daily.
Since the onset of the pandemic, 123 Westbury residents have tested positive and 34 of those residents have died. One of the home’s workers died with COVID-19 too, while 40 on staff tested positive.
Grabowski said many of the deaths of frail elderly people across the country could have been prevented. Steps need to be taken now to stop COVID-19 from taking even more lives, he said.
“It didn’t have to be this way and it doesn’t have to be this way going forward,” he said. “There’s still time to make this investment.”
‘It just spread’
Westbury Medical Care isn’t like most Georgia nursing homes, where staff turnover and ownership changes are commonplace. It was founded in 1959 by the Rev. S. J. and Dorothy Westbury. Ron Westbury, a son, was the administrator for 16 years until late last year when Vasil, a long-time employee, was appointed to run the family’s flagship location. Ron’s late brother, James, ran the home for its first 44 years. Many of Westbury’s workers have also been there for years, if not decades.
While Georgia has a high number of homes earning the federal government’s lowest 1-star rating, Westbury’s 5-star rating — the federal system’s best score — places it in an elite group.
Jackson is a small town, about an hour’s drive south of Atlanta. Staff and residents know one another’s families. When the devastation of the pandemic hit, the grief was immense. So many people got sick. So many died. Even Ron Westbury’s wife, who works at the home as a social worker, was hospitalized with COVID-19, but recovered.
During the hardest days, the team remained tight-knit and faith-driven. “I think those elements have helped us weather the storm,” Ron Westbury said.
Exactly why the home got hit so hard is still a mystery. The family is the sole owner and operator of two other Georgia nursing homes that have not had outbreaks, Westbury said, even though they have handled the coronavirus crisis in the same way. Westbury has tried to think of every possible factor, even calling the building’s architect for ideas.
“Somehow, who knows how, it got in that building,” he said. “And once it got in that building, it just spread. And there’s probably about 50% of the facilities [in Georgia] that they’ve had that too, to some extent.”
Homes on their own
In the early days, it was almost impossible for many homes to get the testing they needed. Tests were hard to get across the country. Everything was going to the hospitals and even hospitals were rationing testing.
It seemed like a godsend when the Georgia National Guard finally arrived to test dozens of Westbury residents. But emails obtained by the AJC through the Georgia Open Records Act showed that the state system fell short. Days passed before a National Guard official finally acknowledged that “data gaps” created a problem, according to emails.
Georgia nursing homes and COVID-19 cases (as of 6/18/2020) NOTE: This list includes every nursing home in the state, including ones that have reported no COVID-19 cases. (SOURCE: Georgia Department of Community Health)
“That was frustrating for us because we couldn’t find the test results, we couldn’t get the information we needed,” said Hayla Folden, the public information officer for the Georgia Department of Public Health’s district office that includes Butts County, where Westbury is located. “It was going on around the state. We were not the only one.”
Folden said a process was created to make sure the test kits included all the right information. But many long-term care facilities say they have turned primarily to private testing after frustration with the state’s testing options.
When homes like Westbury started getting battered by the virus, hospitals were still getting most of the attention and most of the resources. Everyone was focused on running out of ventilators and ICU beds. No one could get enough PPE, including the state of Georgia. Especially in the early days, when the state couldn’t fulfill everyone’s requests for supplies, Westbury and other nursing homes were largely on their own to try to find what they desperately needed, whether it was masks, gowns, more staff or testing.
Westbury said that the limited resources just weren’t getting to the people who needed them the most. “That was the folks that were in our buildings,” he said. “I don’t think it was intentional. I don’t know. I think we’re still trying to feel our way through it. If you look at the news they can’t tell if we’re at the end of the first phase or the beginning of the second phase of this thing.”
When Kemp announced in a press release this month that “100 percent” of Georgia’s nursing home residents have been tested for COVID-19, he characterized it as an important milestone.
But the AJC found that some homes reported testing more residents than they currently have, while others have reported testing far fewer, including some that reported testing zero residents or just a handful. Most homes have fewer residents now than they did when the pandemic started, due to deaths and drops in admissions during the crisis.
Georgia personal care homes and COVID-19 cases (as of 6/18/2020) NOTE: This list includes every personal care home in the state, including ones that have reported no COVID-19 cases. (SOURCE: Georgia Department of Community Health)
The state reached its 100% claim by recording 30,000 tested residents in nursing homes at a time when homes had about 30,000 residents. But many of those tests are tied to residents who have died or gone home.
“It’s incredibly misleading,” said Dr. Harry J. Heiman, a clinical associate professor at Georgia State University’s School of Public Health. “When the average person thinks about 100 percent that means everyone.”
Meanwhile, the Centers for Disease Control and Prevention is recommending weekly testing for nursing home workers in homes that have cases. But in Georgia, fewer than 3 in 4 nursing home workers have been tested so far, let alone every week.
“It just confirms how far we are still from where we need to be in terms of having the systems and practices in place to protect people,” Heiman said.
Assisted living and large personal care homes are even farther behind: fewer than half of residents and staff have been tested so far, said Tony Marshall, president of the Georgia Health Care Association.
Neil Pruitt Jr., one of Georgia’s largest nursing home operators, said ongoing testing is critical to combating the virus. He said Georgia has made testing more widely available for nursing homes than it was, and that the state has also helped with staffing in some instances. But he said nursing homes need to test residents and staff repeatedly, on an ongoing basis, to effectively combat the virus, especially in parts of the state where the virus is common in the community.
Some states are requiring such frequent testing and paying for it, too, Marshall said.
Pruitt's chain includes 58 skilled nursing homes in Georgia, some that have been hit almost as hard as Westbury. A Pruitt home in Albany was among the first to get ravaged by the virus with 22 deaths, according to state reports. PruittHealth operates Christian City Skilled Nursing and Rehabilitation Center in metro Atlanta, which has the second-highest number of deaths behind Westbury at 27, with more than 100 residents testing positive, the reports show.
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Pruitt, who was appointed last week to a national commission on the coronavirus in long-term care, said that the virus continues to make its way into facilities, even as PPE and testing have become more available. He said other states have done more than Georgia so far to support nursing home operators whose businesses models have been upended by drops in admissions and revenues, accompanied by big increases in staffing and supply costs.
“We’re going to do whatever is necessary to take care of our patients, but we do run out of money if we don’t change things,” Pruitt said. “It’s a little disappointing for me personally because in my home state of Georgia — and I know the governor and everyone’s trying to help us — but they are the one state we operate in that hasn’t reacted to the crisis with funding.”
The legislative session that concluded last week added new COVID-19 planning and testing requirements for nursing centers, assisted living and large personal care homes. But it's still unclear if the homes will eventually get a big financial boost from a cash-strapped state.
Death, resilience at Westbury
Some families who lost loved ones wondered if Westbury could have been more prepared. Others say that if anyone dropped the ball, it was the state and federal players who didn’t support Westbury when the outbreak hit. Some were especially troubled by the delays in getting residents tested.
“We’re one of the families that are very, very pleased with the way Westbury has handled it and very, very upset that they didn’t get the help they needed,” said Patty Rowland, who oversees the care for her aunt, who is a resident.
Rowland said her aunt, who worked in insurance, is 88 and has severe dementia. She said so far, her aunt has not tested positive. Westbury’s employees, she said, “have done everything they possibly can to take care of her. I tell them that. Every time I talk to a nurse on the weekend, I say thank you for working on the weekend.”
She blames the size of the outbreak and the deaths on the home not being able to get the testing it needed and having to wait for the results when testing kits finally did arrive.
“The government has let us down,” she said.
At Westbury, with the outbreak stabilized, the home is now focused on recovery and keeping everyone’s spirits up. Aides and nurses have worked long hours under tough conditions since the pandemic began. Residents haven’t been able to sit with their family members for months now.
Vasil, the administrator, presided this month over the 100th birthday celebration of Irma Gooden, a resident who had contracted the virus and recovered. The celebration was marked with streamers, music and balloons outdoors, so her family could see her, even if hugs weren’t allowed. Gooden is one of more than 80 Westbury residents who had COVID-19 and are now in the clear.
The activities staff makes it way through the halls with special snacks and games to try to combat the isolation. Some extra special “window visits” have taken place, including a bride and groom’s arrival outside the window of the groom’s grandmother. They wore their wedding attire and held a mini-reenactment of the ceremony so that Jacqueline Cavender could experience their wedding from her nursing home bed. It was a special moment for Cavender, a former county clerk who was well-known in Jackson, said Karla Tuggle, her daughter.
Tuggle visits her mom frequently at her window. Her mom uses the phone to speak, and Tuggle writes messages on a dry-erase board since her mother doesn’t hear well. She has known the Westbury staff for years, she said, and says they are doing a great job.
“Honestly, when this all started I was worried sick,” she said. “But within a couple of days, I turned it all over to God. I said this is completely out of my control. There is not one thing I can do besides pray.”