State actions seen as too little, too late to spare senior care residents

Cases explode at nursing homes, assisted living communities

Editor’s note: This story has been updated to reflect new information on the number of facilities with COVID-19 cases.

Beth Cayce boiled over with frustration last week as she battled to protect seniors in long-term care from the “invisible enemy.”

Two residents of an assisted living facility she manages in Cobb County tested positive for COVID-19 with unexpected symptoms of weakness and loss of appetite. But health officials could not test many others in her facility with similar symptoms, Cayce said, because they did not meet the state’s testing requirements. Meanwhile, Cayce and her staff were spending hours online every day desperately trying to find more masks and gowns, knowing the state would not send what they needed to keep staff and residents safe.

Worried about what the coming days could bring, Cayce paused to urge Gov. Brian Kemp to immediately do more to help those on the front lines.

» COMPLETE COVERAGE: Coronavirus in Georgia

“I am writing to request that you hear my story,” she told Kemp in a letter, “for we as health care workers are fighting a war against COVID 19 without the necessary resources and protection.”

Kemp on April 1 dispatched the National Guard statewide to inspect and clean long-term care facilities, and so far they have reached more than 370. On April 8, he ordered senior care homes to take aggressive steps to curb the virus, but by then the outbreak had killed at least 81 residents of nursing homes and assisted living communities. On Monday, Kemp said testing would become more widely available, but the virus has crept into so many facilities that state action may be too little, too late for thousands of Georgia seniors.

As of Friday, at least 230 long-term care facilities have confirmed COVID-19 cases, according to the governor’s office. The few homes that have tested every resident and staff member have often found they have dozens of cases, not the handful they suspected with obvious symptoms.

» RELATED: As dozens die in senior care homes, Kemp extends statewide lockdown

» MORE: List of infected nursing and senior care homes nearly doubles

Cayce, a respected industry leader who has four decades of experience in senior care, decided that since the state wouldn’t do what she thought was essential, she paid thousands of dollars last week for a private lab to test her residents and staff.

“What do you want to have happen — have an outbreak?” Cayce said she told health officials, pushing for a way around the state’s bureaucracy. “Then we’re going to clean it up? People die then. These are my friends, and these are my staff, and I can’t have that.”

‘Killing machine’

Unless COVID-19 is quickly recognized when it first enters a long-term care facility, it can rage out of control.

More than three dozen deaths resulted from the nation’s first outbreak in a long-term care facility, Life Care Center of Kirkland in Washington. In early March, the head of the nation’s nursing home industry group described the virus as “a perfect killing machine” for the elderly and warned that strict infection-control steps were necessary to prevent further outbreaks.

Kemp acknowledged the risk at long-term care facilities at a March 5 press conference, and Georgia started following federal guidance to focus oversight on infection control. For years, though, the state's oversight of senior care homes has been lax, even though a significant portion of facilities have troubled histories, and Georgia has had too few inspectors to quickly identify and respond to problems. Infection control has been among the issues at many facilities.

"What do you want to have happen — have an outbreak? Then we're going to clean it up? People die then. These are my friends, and these are my staff, and I can't have that." —Beth Cayce, manager of an assisted living facility in Cobb County

Within weeks of Kemp's press conference, frightening evidence of how fast and deadly the coronavirus infection can be was demonstrated at Windermere Health and Rehabilitation Center, a nursing home in Augusta rated by the federal government as much below average.

After getting word on April 7 of its first positive coronavirus cases, two days later the facility tested all residents. Seventy-four have now tested positive, even though most had no symptoms when they were tested.

Four Windermere residents have died.

At PruittHealth-Macon, the first positive test result came on April 6. The nursing home, rated below average, now has 68 residents who have tested positive.

Some experts say the outbreaks may have been limited if the state had acted more quickly. It could have swooped in to conduct mass testing at any facility with a resident who tested positive, or could have immediately set up facilities reserved only for residents with COVID-19, to better protect those who didn’t have it. But with testing so limited early on, results delayed, and little recognition that elderly people might have more subtle symptoms, the risks remained high.

Many of the infected residents at Arbor Terrace at Cascade showed no symptoms. But after Fulton County did mass testing, it found many of the residents who were asymptomatic had the virus. (Jenni Girtman for Atlanta Journal Constitution)

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At Arbor Terrace at Cascade, an assisted living facility in Atlanta, 15 residents have died of the coronavirus since March 29, according to Fulton County health officials. Once it became clear that the facility had a serious outbreak, Fulton County decided to do mass testing, which found 77 percent of the facility's residents tested positive.

For Dr. S. Elizabeth Ford, interim director of the Fulton County Board of Health, one finding at Arbor Terrace Cascade was especially distressing: Two-thirds of the residents who tested positive had no symptoms on the day they were tested.

Because access to testing has been so limited, most facilities have had to rely on symptoms to try to figure out who is sick and who’s not.

“This is probably one of the main things I’m losing sleep over now — that changes week by week — but this week definitely it’s the long-term care facilities,” Ford said.

No organized system

Ron Westbury operates four long-term care facilities, and he’s working furiously to try to keep the virus contained — or out. Two of his facilities have positive cases and two don’t. It’s critical to have gowns, gloves, masks and shields to keep his staff protected from the virus and to protect residents who don’t have it.

But Westbury has primarily been on his own to find the items because the state hasn’t provided much, even though it has access to federal supplies and the General Assembly, at Kemp’s request, authorized millions of dollars for medical supplies and equipment.

He said his company submits a request every week to the state for personal protective equipment. “We’ve received either none or a fraction of what we have requested and need,” he said.

» RELATED: Coronavirus exposes gaps in infection controls for senior-care homes

» MORE: Types of risk for residents at long term care facilities

Others in long-term care say the same thing. Debbie Meade, CEO of Health Management, said the state provided requested supplies to two long-term care facilities she manages, but two others have made requests and received no supplies. “We really do not see an organized system in providing the PPE,” she said.

Westbury said the state told him it simply can’t fulfill all of his requests and encouraged him to work with private vendors. Typically, he’s working with one day’s worth of supplies and trying to make that last. He’s searching everywhere, including China, working every contact and trying to come up with work-arounds. Last week, he searched every dollar store he could find for the kind of disposable rain ponchos people wear at sporting events, so that his staff could wear those over their gowns to try to make them last longer.

“Not to be over-dramatic, but no firefighter would be expected to enter a building without the proper protective equipment,” he said.

“We definitely feel like the population we care for and our caregiviers ought to be the top priority,” he said. “We’re trying to stop this virus from killing people. That’s what everybody is trying to do. Our population has the highest fatality rate if they contract it. It’s over 20 percent vs. 1 percent of the general population, so we need all the PPE we can get our hands on.”

"Not to be over-dramatic, but no firefighter would be expected to enter a building without the proper protective equipment." —Ron Westbury, an operator of four long-term care facilities

The governor’s office pushes back at the notion that it isn’t providing supplies. Cody Hall, the governor’s press secretary said it had gotten requests from 841 long-term care facilities across the state, and that it had sent items in response to 831 requests. Facilities with confirmed cases are getting priority, Hall said, and the state is trying to get more items from the federal government.

He said nearly 3 million masks had gone out from the state to hospitals, nursing homes and other providers along with hundreds of thousands of gowns and face shields.

While what’s handed out may seem like a big number, one nursing home could go through 1,500 gowns a day, if it used them as they were designed.

Tony Marshall, CEO of the Georgia Health Care Association, which represents nursing homes and assisted living centers, said other states are in the same fix. The state is trying to buy supplies, so are the facilities and the suppliers. “Nobody has the ability,” he said.

Waiting for tests

Where Georgia clearly has lagged behind other states is with testing, ranking 45th nationally for testing per capita in spite of ranking 11th for its number of confirmed cases.

Those working in the long-term care industry say that the faster that the state can roll out the expanded testing that Kemp announced, the faster they can separate residents who have the virus from those who don’t.

Dr. Delutha King, a resident of Arbor Terrace at Cascade assisted living community, died April 3 after being infected with the coronavirus.(Photo courtesy of family)

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“If the state really wants to do something to stem the outbreak, they need to make rapid testing available in all long-term care communities and to home health providers,” said Ginny Helms, president and CEO of LeadingAge Georgia, which represents non-profit organizations that provide senior care and housing.

The idea is to get as much information about how widespread the virus is in every long-term care setting before it’s too late and more die. If an outbreak isn’t recognized very early on, even the best-prepared facilities will struggle.

At Arbor Terrace at Cascade, the first report of a resident testing positive for coronavirus came from a hospital on March 26. Atlanta-based Arbor Company, which operates more than 40 senior care communities in 11 states, had a plan ready to go. The facility was placed in full quarantine, with all residents staying in their individual apartments. Visitors had been blocked several weeks earlier. A professional cleaning company was brought in, and the Georgia National Guard later arrived to sanitize the building, too. Arbor had stockpiled masks and gowns and made sure the staff was using the supplies properly.

Lois King died April 10 of the coronavirus, a week after the infection had claimed her husband’s life. (photo courtesy of family)

Credit: Family photo

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Credit: Family photo

The facility made all the right calls to public health officials, who immediately tried to help. Yet within a week, 12 more residents had tested positive while hospitalized.

That’s when Fulton County health officials decided to test the whole building and learned that most residents tested positive. As of Friday, 34 staff members have also tested positive, and five had been hospitalized. Arbor said about 80 staff work at the facility.

Two Fulton County Commission members on Friday said they were hearing from family members distressed about the safety of residents and wanted everything possible to be done. The 15 deaths at the facility make this one of the state’s worst outbreaks so far.

“We are certainly all grieving these losses,” said Judd Harper, Arbor’s president. “It has been very sad for our company, but also for the Arbor Terrace Cascade community and the families that we have there, please please know that our hearts and our prayers are with every Arbor Terrace family right now because it has saddened us that this virus has done this there.”

Among those who died were Ron Loving’s parents, Delutha and Lois King. Dr. Delutha King, a well-known Atlanta urologist, had been to the hospital twice, but wasn’t diagnosed with the virus until he was near death. Only Loving, his wife and daughter attended King’s funeral because of social distancing. When they got back from the funeral they got a call: His mother, Lois King, had just died of the virus, too.

The Kings were the second married couple at the facility to die in the outbreak. Lois and Delutha King were both 96. His mother’s graveside service was Friday.

“That’s our consolation,” Loving said, “that they are together again.”