Washington: Lori Spencer had an uneasy feeling after dropping her 81-year-old mother off at the Life Care Center nursing home in Kirkland, Washington on Feb. 26. She felt even worse the next day, when her mother, Judie Shape, threw an uncharacteristic tantrum - begging to leave the facility.
What the family didn’t know at the time: The home was already dealing with the initial signs of what would soon become the deadliest coronavirus outbreak in the United States. A week before, on Feb. 19, the facility had sent out a patient with respiratory problems for testing, followed by a second patient on Feb. 24. Life Care officials have said they initially suspected flu.
Three days after Shape arrived at the home, Life Care announced that one of the tests had come back positive for coronavirus.
“By then it was too late,” Spencer said. “We couldn’t move her. She was suddenly a prisoner there.”
Shape wouldn’t be tested for 11 more days, as Spencer and her family waited in anguish. Amid a severe shortage of tests nationally - and at Life Care - the home initially tested only those showing symptoms. (For a WIDER IMAGE photo essay, click https://reut.rs/2we9MbQ )
The Kirkland home's deadly outbreak illustrates how fast coronavirus can spread through an elderly care facility. Facilities nationwide have struggled with overwhelmed staff and a national scarcity of testing kits, thrusting families into heart-wrenching dilemmas over how to protect elderly loved ones in need of full-time care or rehabilitation.
King County, Washington officials reported on Sunday that 29 deaths from coronavirus had been linked to the home. The home, as of Friday, confirmed 13 deaths from coronavirus and said it was awaiting test results on 11 more people who died.
Nations around the world are grappling with how to protect older people from the virus. In South Korea, there were two deaths and dozens of people infected at a nursing home in a province with a major outbreak. Nursing homes have also been a major source of concern in Europe, the new epicenter of the global crisis as the number of new cases declines in China, where the elderly are more commonly cared for at home.
In northern Italy, the virus has cut a swathe through the older population, including in some care homes but also in densely populated apartment buildings where many elderly people live. In the United Kingdom, some care homes have begun to bar visitors as the government says it may soon order the elderly to stay indoors. In Spain, where the virus is taking off sharply, the first cluster of infections were focused on Madrid nursing homes.
In the United States, infection control failures have long been a serious problem across the nursing home industry, which houses about 1.7 million senior citizens. Federal health data shows patients in nursing homes experience between 1.6 and 3.8 million serious infections every year, resulting in up to 380,000 deaths.
On Friday, a Trump administration official called on nursing homes nationally to restrict all visitors, with the exception of some “end of life” situations. President Donald Trump vowed to ramp up the distribution of test kits - for the first time acknowledging the severe shortage.
Richard Mollott, executive director of The Long Term Care Community Coalition in New York, said the coronavirus epidemic has made nursing home residents “sitting ducks.”
“They can be very dangerous places to live,” he said. “The industry already has a poor track record of keeping people safe.”
Life Care Center in Kirkland was cited for a violation of infection control regulations after a federal inspection in April 2019. Such violations are common in the industry, said Charlene Harrington, an expert in elderly care at the University of California, San Francisco. The disease-control failures stem in part from chronic short-staffing at most facilities, Harrington said, noting that cutting back on staff is one way the industry has boosted profits.
“National enforcement of nursing home standards has been pathetic,” said Harrington, who has testified in Congress on elder care and written extensively on the regulation of nursing homes.
The American Health Care Association, an eldercare industry group, called such criticism unhelpful in a pandemic. The organization acknowledged challenges in infection-control at nursing homes, in part because of government underfunding and nationwide shortages of caregivers.
"There is always more we can do to improve infection control," an issue in all health-care settings, said the organization's Chief Medical Officer, David Gifford, in a statement. "This pandemic is demonstrating that as a nation we all have to improve how we work to prevent infections, including in nursing homes."
Cleveland, Tennessee-based Life Care Centers of America Inc, which operates the Kirkland home, is among the largest players in U.S. nursing home care, with more than 200 senior-living centers in 28 states. The company said last week that it would take stringent infection-control measures at all its facilities to guard against coronavirus.
Leigh Atherton, a company spokeswoman, declined to answer detailed questions from Reuters about the company’s response to the Kirkland outbreak. In earlier press briefings, another spokesperson, Tim Killian, described an overwhelmed staff acting heroically in the face of a ferocious outbreak. By March 7, more than one third of the 180 staffers were out of action with suspected coronavirus symptoms.
“This is an acute care facility that is accustomed to treating patients with infectious diseases,” Killian said that day. “But really we are dealing with an unprecedented level of outbreak here, with a virus we know little about.”
The staff response was initially “limited,” by a lack of test kits, he said, even as the center saw patients with no symptoms start to display acute symptoms within an hour, requiring hospitalization.
“We’ve had patients die relatively quickly under those circumstances,” Killian said.
As of Sunday, the World Health Organization reported that most than 150,000 cases of coronavirus had been confirmed worldwide, with more than 5,700 deaths. The United States had reported more than 3,800 cases and 69 deaths as of Monday.
Waiting On Testing
Spencer knew little of the disease threat at nursing homes when she arrived at Life Care with her mother. But the day her mother begged to leave - two days before the home confirmed the outbreak - Spencer drove to the facility with the intention of removing her. A nurse calmed them down, assuring them that a broken bedside buzzer to summon staff had been repaired. When no one responded to the buzzer for two hours on the mother's first night there, she had eventually been forced to bang on her tray table to get the attention of a staffer to help her to the bathroom.
Spencer broke into tears when the nurse said he was worried about her, too, and asked how long both women had been dealing with hospital stress before arriving at Life Care.
Spencer had another quandary: Her mother had just had blood clot surgery and was suffering from a severe stomach infection. She could not walk, and couldn’t return to her full-time retirement community nearby until she was mobile. She came to Life Care for rehabilitation.
“But I will live forever with that tantrum,” Spencer said, “because I meant to take her home that day.”
Confusion reigned at the facility after it first told families on Feb. 29 about the outbreak, Spencer said. Officials said the facility was in “lockdown” - no visitors allowed. In what has become a heartbreaking daily ritual for many families with relatives at the center, Spencer would stand outside the window of her mother’s room, able to see her but not touch her, trying her best to provide comfort over the phone.
Life Care never prohibited residents from leaving the home, Killian said in a March 12 briefing. But it became impossible for many families to move a relative. Hospitals would only accept those with acute symptoms, while other facilities would not accept patients from a facility with an outbreak. Many of Life Care’s residents were too sick to be cared for at home.
“There’s nowhere else for these patients to go,” Killian said.
Spencer couldn’t take her mother back to the retirement home where she had lived before her surgery. “They needed a test showing she didn’t have the virus - but there was no testing,” Spencer said. “It was massively confusing, and poorly managed.”
Shape was finally tested for coronavirus on March 8. The first batch of test kits – 45 in total, still not enough – had arrived at the facility three days earlier.
On March 10, before getting the test results, Shape woke up feeling ill, like the beginnings of a severe head cold. She had a runny nose and chills.
Later that day, Spencer called the nurses station for a full medical report. She asked about the coronavirus test - and found out the results had already come in, but no one had called her.
Shape’s test had come back positive: She had contracted Covid-19.
When Did They Know?
Spencer’s guilt and fear about her mother’s condition is mixed with suspicion that Life Care knew a powerful virus was sweeping through the facility when she placed her mother there on Feb. 26 - but failed to warn her.
Life Care Center officials said they had no inkling of a coronavirus outbreak until they were informed just after midnight on Feb. 29 of the first positive coronavirus test.
“We had no medical reason to suspect COVID-19 at the time,” Life Care’s Killian said in a press briefing. “Earlier in February we started to have respiratory illness symptoms showing up in our facility. That’s common for our facility ... We see between three and seven deaths in a normal month.”
Hours after the first test confirmed coronavirus, nearly all the families of about 120 residents inside had been informed of the positive result. Since Feb. 19, Life Care has said, 66 residents have been transferred to hospitals.
By March 13, according to Life Care, 44 residents still lived there. Twenty-six have coronavirus, including Judie Shape, with tests on another nine either pending or incomplete.
Spencer continues to talk to her mother several times a day by phone, usually looking at her through the window of her room. Shape isn’t sleeping much. She tries to remain upbeat. Her coronavirus symptoms so far have been less severe than many others of her age and medical condition, giving her and her family hope.
The mother struggled with isolation and loneliness before her hospital and nursing home stays. She has grown more fearful - and angry - watching the TV news on coronavirus while cooped up in her room.
“My mom is isolated, at the end of her life,” Spencer said. “She doesn’t deserve this.”