California nursing homes are examples of how cruel the coronavirus pandemic can be

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By Scott Wilson, Washington Post, May 15 2020

Family members at the grave of Hortensia Sosa at Smith Mountain Cemetery in Dinuba, Calif., shortly after her burial in early May. (Melina Mara/The Washington Post)

DINUBA, Calif. — The gravesite still has no marker.

No grass has grown over the dry ground here, in a flat cemetery surrounded by some of the richest citrus groves in the country, where Hortensia Sosa and her husband, Luis, are buried together.

The grave is too new for that. Just dug. Just filled.

After she died of the novel coronavirus last month, Sosa’s body was kept for 10 days in quarantine. At first, family members were not allowed to leave their cars during her burial. They finally received permission to do so, but only if they stood well away from the tiny patch of ground as Hortensia’s coffin was lowered slowly on top of Luis’s casket.

“There was no rosary, no Mass,” said Olivia Lopez, the oldest of the couple’s three children. Her only contact with her 92-year-old mother in the final months of her life was through FaceTime. “I could see for two weeks how badly she was deteriorating just over the phone. But I couldn’t help her. I felt like my hands were tied.”

Sosa is among the 1,058 residents of skilled-nursing facilities who have died in California as of this week as a result of the coronavirus, a quickly escalating toll that accounts for about 40 percent of the state’s deaths from covid-19, the disease caused by the virus. While that data is reported by a majority of the state’s registered nursing homes, the total number of such deaths is probably far higher. Such homes have reported 6,250 infected residents, who because of underlying health afflictions and living in close quarters are particularly susceptible to the virus.

The disease also has ravaged front-line workers at skilled-nursing homes, the majority of whom earn little more than minimum wage. According to state public health statistics, at least 23 nursing-home workers have died of covid-19 and more than 3,600 others have been infected.

Such homes have proved to be the most vulnerable of the state’s health-care facilities and are examples of the dangers seen nationwide, from the first crush of cases and deaths in a nursing home in Washington state in late February to the widening nationwide crisis afflicting the elderly and those caring for them.

Three months since the novel coronavirus hit the United States, regulators still have few ideas for how to protect the uninfected, especially in nursing homes. And a shortage of protective equipment, cramped facilities and understaffing — due in part to the loss of workers who fall ill because of the virus — set the facilities up for tragedy and has made them the cruelest venues of this pandemic.

Workers at the Redwood Springs Healthcare Center in Visalia, Calif., listen to the prayers of well-wishers during a break outside the nursing home early this month. (Melina Mara/The Washington Post)

In New York state, there have been more than 2,800 confirmed deaths of nursing-home residents related to the virus. In Minnesota, 47 residents died in a suburban Minneapolis nursing home two weeks ago. No state is immune. Earlier this week, 14 residents of a nursing home in Stanislaus County died of the virus, among the largest single outbreaks in Northern California.

The death toll is so high in California’s nursing homes — including 27 other residents who died along with Hortensia Sosa in the Redwood Springs Healthcare Center in nearby Visalia — that privately run nursing facilities are seeking immunity from lawsuits once the virus passes. Gov. Gavin Newsom (D) has yet to comment on the request, which is ardently opposed by advocates for the elderly. The staff of New York Gov. Andrew M. Cuomo (D) inserted a similar immunity provision for nursing homes and hospitals in the state budget.

At the same time, state health officials are trying to free up hospital beds, offering nursing homes, many of them severely understaffed, up to $1,000 a day to take less serious coronavirus patients. That proposal, too, runs counter to the care that advocates say the elderly should receive.

“We’re really not yet even seeing the epic scope of this in this state’s nursing homes,” said Mike Dark, a staff attorney for the nonprofit California Advocates for Nursing Home Reform (CANHR) who calls the death and infection rates being reported to the state “tremendously unreliable.” “When we look back on this in 10 years, we will view it as more than anything a plague on the nursing homes.”

Officials announce nursing homes nationwide must report covid-19 cases to patient families, the CDCNursing homes will be required to report all covid-19 cases to patients, families of patients and the CDC, officials said on April 19. (The Washington Post)

Job-jumping, little testing

There are more than 1,100 licensed nursing facilities in California, and according to the 83 percent of them reporting to the state right now, 6,600 residents are infected with the coronavirus. All have been closed to visitors — family or otherwise.

State regulations say that those infected should be quarantined within the building and that infected residents are to be cared for at the nursing home for as long as possible, keeping them away from hospitals.

“For a lot of these seniors, they are really isolated in there, and that is also not good for anyone’s health, especially if you already have other conditions,” said Long Beach Mayor Robert Garcia, who estimates that a majority of his city’s 27 deaths have come within nursing homes. “It’s really sad to see.”

Nearly every care home is looking to add staffers. A banner hanging above the Brighton Care Center in Pasadena, where dozens of residents have been infected, advertises a “sign-on bonus” for front-line workers. All shifts, the banner notes, are available.

Pasadena, a relatively wealthy city northeast of downtown Los Angeles, has 16 skilled-nursing facilities, all in proximity. That means the job-jumping that many care workers do to make ends meet in an expensive area creates exposure and spread concerns.

On April 12, Pasadena issued a health order that states that “facilities should avoid, by any means possible, utilizing employees who have worked at another facility.” Other cities have done the same.

Of Pasadena’s 28 coronavirus deaths reported by the last week of April, all had come from within care homes.

“Nobody has prioritized testing for people in skilled nursing, and so what happens is people are unknowingly spreading the virus from building to building, many because they don’t know if they’re asymptomatic,” said Deborah Pacyna, director of communications for the nonprofit California Association of Health Facilities, which represents about 900 skilled-nursing homes in the state. She said having jobs in multiple facilities is a “common practice” in the industry. “Our caregivers are exceptional people, and it’s true that they are not getting paid enough.”

The coronavirus ravaged a Kirkland nursing home – leaving families to pick up the piecesMeet two families associated with the Life Care Center of Kirkland, Wash. As one family copes with their loss, the other visits their mother through a window. (Drea Cornejo, Alyse Young/The Washington Post)

In Antioch, a city in California’s East Bay, where a number of nursing homes have seen outbreaks, the Lone Tree Convalescent Hospital has recorded zero coronavirus infections among nearly 100 patients and staffers. Phylene Sunga, the administrator, put stringent “infection control” rules in place very quickly after the virus began to flourish and stepped up the care home’s cleaning routine.

The staff quadrupled the times “high touch” areas are disinfected each day. Nine staff members work at other care homes, as well. But before coming to Lone Tree they must change their clothes and shoes and wash as much as possible. One staff member who was infected at another care home was taken out of the rotation at Lone Tree.

“I told her not to come back, it wasn’t worth it,” said Sunga, assuring that the job is waiting for her when she recovers. “It’s working — so far.”

Joseph Sosa removes flowers from his mother’s grave in Dinuba. (Melina Mara/The Washington Post)

A thinning staff

Lisa Cook sent a catered barbecue dinner to the front-line workers at the Stoney Point Healthcare Center in Chatsworth, a valley town in northern Los Angeles County, to show her appreciation for the care they have given to Bruce, her husband of more than three decades.

Bruce and Lisa, high school sweethearts, were senior managers at a baby-supply store called the Juvenile Shop, working there together until Bruce suffered a stroke in December 2018. He was just 60 years old and lost function of much of the right side of his body.

Lisa Cook’s travels through a complex, expensive health-care system began — a trail well marked by the piles of legal documents, letters to and from hospitals, and legal pads of research that sit along the fireplace of her Northridge home. There is a box of rubber gloves on the kitchen table, a mask nearby.

Last fall, Bruce ended up at Stoney Point Healthcare, a 110-bed care facility about a half-hour drive away. The two could communicate through FaceTime, though Bruce needed help from an orderly to push the right iPhone buttons.

“I felt like he was getting really good care,” Cook said. “It was when this covid-19 thing hit that it got out of control.”

The biggest loss, immediately, was access to Bruce. Cook got a call from the administrator on the morning of March 14 telling her she would no longer be able to visit, because the care home was in lockdown.

Workers started to get sick — more than two dozen have been infected in recent weeks, five of whom have recovered and returned to their jobs.

“We see now who really matters in this country, who really makes it work,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “People who stock the grocery shelves, the people who are delivering the mail, the people who are picking up the garbage — those are the people that matter.”

Members of Mount Zion Apostolic Church in Visalia pray for staffers at Redwood Springs. (Melina Mara/The Washington Post)

As the Stoney Point staff dwindled, Cook had almost no way to check on her husband. He had not been infected, but had he been placed in a safe room, away from those who had the virus? Was the TV she bought him hooked up if he had been moved?

“So many of these places have become more like warehouses and less like health-care facilities,” said Dark, of CANHR. “As you lose staff, your infection control goes out the window. But traditionally if you get a citation here, it was always just the cost of doing business.”

Pacyna, the spokeswoman for the state’s skilled-nursing homes, said she would like to see some of the large venues that some cities have opened as emergency hospitals to be used to help separate noninfected patients such as Bruce Cook from those with the coronavirus.

Los Angeles County, for example, turned its large convention center into a field hospital, which has been only lightly used. Neither the convention center nor the USNS Mercy, the 1,000-bed Navy hospital ship deployed to the Port of Los Angeles, takes coronavirus patients.

“What you’re doing now is trying to create an area or a space where you can accommodate everybody,” Pacyna said. “But you’ve been in these buildings: They’re old, they’re small. Many were built in the 1950s. We’re just pushing right now for more creative alternate ways to protect these people.”

As of last week, six Stoney Point residents had died of covid-19. Under the testing rules in place at Stoney Point, and in other care homes across the state, patients are tested only if they show symptoms or if they choose to be.

“His care just appears to have deteriorated so quickly,” Lisa Cook said. “We know people are dying in this facility, and we just can’t get any information.”

In a statement, Stoney Point administrator Timothy Mason pledged to “evaluate all protocols and procedures from this pandemic in the not-too-distant future to see how we can improve upon all aspects of our communications with family members, patients, and staff.”

Richard and Olivia Lopez at the grave of her parents, Hortensia and Luis Sosa. (Melina Mara/The Washington Post)

Waiting too long

The cluster of roses in the wide vase on top of Hortensia and Luis Sosa’s grave are from Olivia Lopez’s garden. She changes them a few times a week. And on a bright Sunday, the grassy cemetery attracting only a few families, a brother and sister talked about what the carved stone on their parents’ grave might say.

“It has to mention her laugh,” said Joseph Sosa, a mental health counselor for troubled youths, recalling that he could hear it blocks away walking home from school.

“Everyone has some thoughts,” said Olivia Lopez, his big sister. “So we’ll have to get a lot of opinions.”

Luis, who picked grapes in the San Joaquin Valley his whole working life, died in the Redwood Springs home in Visalia just before Christmas.

He was 92 and in poor health, but Olivia Lopez was unhappy with the care he received toward the end of his life. She wanted to move him into another care home. As the coronavirus began to emerge, though, there were no beds available nearby.

Her mother had checked into Redwood Springs with him in April 2019 — also 92 and suffering from dementia.

The mother and daughter FaceTimed almost daily, but in late March, after Hortensia was diagnosed with the coronavirus, she visibly weakened. Officials from Redwood Springs told Lopez to put her mom in hospice care, essentially to wait out her death.

Instead, Lopez demanded that her mother be admitted to a hospital. She received a call the following day from Redwood Springs, telling her an ambulance was on the way to get her mother and take her to Kaweah Delta Medical Center. Lopez met here there, still sealed off from actually seeing her.

“The doctor looked at me and said, ‘What took you so long to bring her here?’ ” Lopez said. She added that a nurse echoed those comments later the same day.

The next day — April 10, Good Friday — Hortensia Sosa died. Lopez discouraged friends and family from attending the viewing, where only 10 at a time would be allowed to see her mother, encased in a coffin and placed safely beneath a plexiglass dome to seal off the possibility of infection. There were few at the burial, and no reception followed.

“We will, though, we will have a Mass right here in town when this is over,” Lopez said.

In a statement, Redwood Springs administrator Anita Hubbard said the company has been vigilant and was an early adopter of local, state and federal guidance for the care of the frail and vulnerable residents in their care.

“This incident underscores the service and sacrifices made by our dedicated team every day,” Hubbard said. “We’re grateful for their continued efforts. Our top priority remains the health and well-being of everyone in our facility.”

The complex is festooned now with purple-and-white banners and yard signs that read “Heroes Work Here.” The public has expressed almost unequivocal support for the nursing and orderly staffs at even the most virus-plagued care homes, including Redwood Springs.

But the Lopez family has another worry ahead.

Lopez’s husband, Richard, has a brother in another care home where the coronavirus has broken out. Porter Lopez is 79 years old and suffers from Parkinson’s.

“There’s not much we can do,” said Richard Lopez, a retired county probation officer. “We’re just praying he doesn’t get it.”

A sign at the Redwood Springs Healthcare Center early this month. (Melina Mara/The Washington Post)