By Ken Carlson and Kristin Lam, Merced Sun-Star, Updated April 30 2020
Ambulances wait outside the Turlock Nursing and Rehabilitation Center on Friday, April 24, 2020. Several employees and patients tested positive For COVID-19, according to the care facility. BY BRIAN CLARK
Another death was reported Wednesday at a Turlock nursing home, pushing the total coronavirus fatalities to 11 in Stanislaus County.
The person who died was an adult female with underlying health conditions, county spokesman Royjindar Singh said. No further information was released.
Updated test results for Turlock Nursing and Rehabilitation Center on East Tuolumne Road showed 97 people have tested positive in what’s the largest outbreak in Stanislaus County. The six deaths related to the outbreak make up more than half the county’s death toll.
In perhaps a positive sign, only one additional resident and two staff members tested positive in the updated results, pushing the totals to 67 residents infected and 30 staff members. All told, 167 have tested negative and eight people are still awaiting results.
Stanislaus County reported an additional 15 cases of the coronavirus on Wednesday, bringing the county’s total of confirmed cases to 339.
Bruce Ocken found out his brother, who lives in the Turlock facility, tested positive on Friday.
When he asked the staff by phone about the situation that day, Ocken said they told him only two other people had COVID-19. But by Saturday, a friend texted Ocken that 54 people tested positive.
“Jiminy crickets, that’s crazy,” Ocken said. “They must not be testing all their help or something.”
Ocken said he worries about Brent, 66, noting his younger brother has diabetes and cerebral palsy. He has been in the facility for about a month after getting hip surgery, which he needed after falling in his home. Ocken calls his brother every other day from his home in Nevada, he said, and feels frustrated.
“There’s really nothing I can do about it,” said Ocken, 71. “I can’t visit. It takes me five-and-a-half hours to get there. If I drive all the way over there I can’t do anything.”
CORONAVIRUS SPREADS IN CROWDED SETTINGS
The coronavirus likes to spread in settings where people are in close quarters, like cruise ships, homes shared by multiple families, and nursing homes.
A Sacramento Bee analysis found that residents of long-term care facilities — nursing facilities and assisted living homes — accounted for 40 percent of COVID-19 deaths in California.
The Turlock center has placed residents who test positive in a separate wing and cares for patients who tested negative in separate area of the facility. The center said in a notice that it mourns with the families who have lost their loved ones.
Experts state the obvious that nursing homes and their residents are vulnerable to the novel coronavirus, and Turlock Nursing and Rehabilitation Center is not an exception.
The residents are older and typically have chronic illnesses, making them susceptible to COVID-19 complications sometimes leading to death, according to Dr. Michael Barnett of Harvard’s T.H. Chan School of Public Health. Barnett co-authored an article for the Journal of the American Medical Association Health Forum.
“Unlike a hospital, a nursing home is someone’s home,” the authors wrote. “Often, residents live in close quarters with one another. So it can be quite challenging to move or quarantine residents once they are sick.”
Up to three patients may share a room in a skilled nursing facility. Residents need extensive care from staff members, who help them brush their teeth, wash their face, use the bathroom and eat meals.
“Our workers are in very close contact with the people they care for,” said Deborah Pacyna, public affairs director for the California Association of Health Care Facilities. “We know this virus targets the elderly with underlying health conditions and those are the people in our skilled nursing centers.”
MORE COVID-19 TESTING IS KEY
Pacyna said that after making a plea for personal protective equipment early in the pandemic, the industry association asked state government to make testing of health care workers a priority.
The government’s priority for testing earlier in the outbreak focused on people with symptoms. Another factor that makes coronavirus so contagious is that an infected person can spread the virus for two days without exhibiting the signs of illness including a fever, cough and shortness of breath.
“If you get test results in six or seven days, it’s useless, because the person can be spreading it without anyone knowing they’re infected,” Pacyna said.
Turlock Nursing and Rehabilitation has not been an open book about how the coronavirus took root in the nursing home and spread to 67 residents and 30 staff members.
The facility owned by Covenant Care, based in Aliso Viejo, said in notices last week that an employee had tested positive and two other staff members and three residents later had positive tests.
Emanuel Medical Center, across the street, sent a team over to handle the testing of all residents and employees, which suggests the facility didn’t have good access to testing on its own as coronavirus spread in the county in recent weeks.
Visitors have been barred from local nursing homes for many weeks. But it’s possible that staff members or anyone else carrying the virus could get past the temperature check at the door if they’re asymptomatic.
Singh, the county spokesman, said, under standard practice, the 30 staff members testing positive at the Turlock center would be quarantined at home. And they’re provided with guidance for self-isolating at home to avoid spreading coronavirus to family members or others in the community.
After the outbreak surfaced, Turlock Nursing and Rehabilitation asked county public health if personnel resources were available in case the center needed to fill staffing needs created by positive tests or sick employees.
The county said staffing resources are available but the center has not requested it yet, Singh noted.
CALIFORNIA ADVOCATES FOR NURSING HOME REFORM
With outbreaks at nursing homes, residents quarantined inside may suffer from COVID-19 symptoms and fear, and they’re cut off from the emotional support of family members, said Mike Dark, a staff attorney for California Advocates for Nursing Home Reform.
“At this point, so many facilities in the state have infected patients,” Dark said. “Being cut off from family members that help provide care for them is causing even more harm and misery right now.”
Close to 600 nursing home residents in California have died as a result of coronavirus, according to state data. Nursing home deaths, combined with fatalities in assisted living homes, make up 40 percent of COVID-19 deaths in the state, the Sacramento Bee reported.
One of the deadliest COVID-19 outbreaks in the state resulted in 24 deaths at Redwood Springs Healthcare Center in Tulare County.
Pacyna, an industry spokesperson, and Dark, an advocate for nursing home reform, both said it’s common for lower-paid nursing home employees, such as cooks, janitors and nursing aids, to work at multiple facilities, increasing the likelihood of spreading a contagious virus from one facility to another.
It happened with the disastrous coronavirus outbreaks at nursing homes in Kirkland, Wash., in February and March.
No information was available on whether any Turlock Nursing and Rehabilitation employees work at other facilities.
In his opinion, Dark said a poor track record of infection control is leading to outbreaks at nursing homes in the state.
“You can’t have social distancing in a nursing home,” Dark said. “Part of the trouble is that regulators have not taken infection control violations very seriously. That has taught the nursing home industry not to worry too much about it.”
TURLOCK NURSING AND REHABILITATION CENTER RATING
Turlock Nursing and Rehabilitation Center has an average, 3-star rating from Medicare’s Nursing Home Compare program. In September, regulators ordered corrections at the center after noting deficiencies in control measures for patients whose intestines were inflamed with c-diff bacteria.
Covenant Care, the center’s owner, said the company serves more than 4,000 patients at 30 healthcare facilities and rehabilitation centers, including Vintage Faire Nursing and Rehabilitation in Modesto. The company is not related to the nonprofit Covenant Village in Turlock.
Pacyna said the state is making hotel rooms available at free or reduced rates for nursing home workers to take showers and remove contaminated clothing without infecting family members at home.
To fill staffing needs after employees test positive, nursing homes turn to staffing registries, or counties bring in health care volunteers, Medical Reserve Corps or mutual aid. National Guardsmen have stepped in to assist troubled nursing homes in the Los Angeles area.
Pacyna said about 80 percent of care homes in California are free of coronavirus. What’s needed is point-of-care diagnostic devices providing test results in 15 minutes or so to see if patients or staff are positive.