By Jack Dolan, Matt Hamilton Los Angeles Times April 7, 2020
With coronavirus sweeping through nursing homes at a deadly pace, Los Angeles County’s public health director on Tuesday took the extraordinary step of telling families it would be “perfectly appropriate” to pull loved ones out of long-term facilities for their safety.
More than 120 nursing facilities and other communal living institutions in Los Angeles County alone are suspected of having coronavirus infections, including a home in Redondo Beach where four people have died and 38 others have confirmed cases.
Outbreaks have also been reported at homes across California, alarming officials because the residents there are at high risk of serious health problems or death.
Dr. Barbara Ferrer, the Los Angeles County public health director who offered the advice, said some families are able to care for an infirm loved one now because so many people are working from home. But she acknowledged the “horrible choice” faced by families who cannot care for their loved ones at home.
A spokeswoman for the Kensington in Redondo Beach, the facility whose outbreak sparked Ferrer’s comments, agreed that some residents could go home with families, but others are better off staying put.
“In some instances, where an older adult is relatively independent and just needs help with meals and medications, it would be perfectly appropriate to bring them home, and we would respect that decision,” said Andrea Obston. “In other instances, where the person is in need of professional care, it may not be appropriate, and it carries significant risk.”
Nursing homes, with their concentrations of elderly residents with underlying health problems, are turning into ground zero in the battle against the deadly new virus.
There have been hundreds of deadly outbreaks in facilities across the country, with experts warning of a death rate approaching 50% at homes where the virus gets loose because residents are so vulnerable.
“If my mother or grandmother were in a nursing home right now, and I had the capability and the wherewithal to bring her home, I would,” said Dr. Michael Wasserman, medical director at the Eisenberg Village skilled nursing facility in Reseda and president of the California Assn. of Long Term Care Medicine, which represents doctors, nurses and others working in nursing homes.
“Most nursing homes in the country, no matter how good they are, are going to be challenged by this,” Wasserman said. “Some will do better than others, but sooner or later, the virus will find its way in.”
When that happened at the Life Care Center nursing home in Kirkland, Wash., site of one of the first COVID-19 outbreaks in the U.S., two-thirds of the residents and 47 workers fell ill, and 37 people died.
Of the 173 deaths in Los Angeles County as of Tuesday, 36 have been residents of skilled nursing and assisted living facilities, Ferrer said. That’s more than 20% of all deaths in the county so far.
Ferrer said the vast majority of institutions that are being investigated for having residents or staff positive for COVID-19 — more than 80% — have had fewer than three cases.
But Ferrer and other public officials are warning the public to expect more outbreaks as the virus runs its course.
The pace of the spread can be explosive. In Northern California, the number of infections at one nursing home has nearly doubled in four days.
On Friday, Contra Costa County public health authorities reported that 27 people at the Orinda Care Center had tested positive for the virus. On Tuesday, that number had grown to 49, said Karl Fischer, a spokesman for the county health agency. One resident has died, and four others have been hospitalized, Fischer said. The others who tested positive remain segregated at the center.
The advice to pull a loved one out of a nursing home, even temporarily, sets up an agonizing dilemma for many families. Nobody is suggesting the decision is easy or should be made lightly.
Dr. Edward Schneider, the former dean of the USC Leonard Davis School of Gerontology, said he was reluctant to advise family members to bring a loved one home. People are typically in a nursing facility because they have complicated health issues, including dementia in many cases, which is what made it so difficult for their families to care for them in the first place.
“There are a lot of questions to ask,” Schneider said. “Are you equipped? Do you have the ability to do that?”
There’s also the question of whether every family member is willing and able to rigorously follow social distancing recommendations, so they won’t be just as likely to infect their at-risk loved one.
“I’d be loath to recommend anyone taking them home unless they thought the [nursing] home was not taking good enough care or doing enough screening,” Schneider said. “Be sure you can shield them better than the nursing home is shielding them from the virus.”
One woman, who asked that her name not be used to protect her privacy, told a Times reporter that her grandmother lives at the Kensington and tested positive for coronavirus. “She cannot, unfortunately, come to my home,” the granddaughter said. “We have at-risk people here, too.”
So for now, her grandmother, who has since recovered and tested negative, remains at the Kensington, but the family is exploring other options. The process has been difficult, however, because other facilities are trying to limit their own potential exposure to the deadly pathogen. “We need other facilities to not be on lockdown. They are hesitant to have new residents come in,” she said.
The result is a mix of uncertainty and anxiety for loved ones.
“The Kensington assured us that she’d continually be isolated from others. The next day, she was in the common area, so I don’t know how isolated” she is, the granddaughter said.
In an email to residents and family members on Monday, the Kensington’s executive director, Robert May, acknowledged the cases among residents and staff and confirmed that four residents had died.
“Some had other complicating medical conditions, and it has not been determined whether they passed from comorbidities or the virus, or a combination,” May wrote.
He also said 16 of the 17 infected staff members had recovered and cleared the 14-day quarantine period, and many of them had returned to work.
Charlene Harrington, professor emeritus at UC San Francisco’s School of Nursing who has studied nursing homes since the 1980s, has been warning for weeks that families should consider pulling their loved ones out of the facilities.
“Once the COVID virus is in a facility, it can spread like wildfire,” Harrington said on Tuesday.
A chronic lack of trained staff made infection control in many California nursing homes a serious problem long before the coronavirus pandemic. But with the arrival of the deadly new virus, a lack of appropriate protective equipment and training has made life in a nursing home even more treacherous.
But Harrington acknowledged that many nursing home residents are too impaired to be cared for by family even on a temporary basis, and many others have no family at all. So they have no choice but to stay where they are.
Wasserman, who is lobbying state officials to set up isolated facilities — empty hotels, dormitories, cruise ships — for nursing home patients who test positive for COVID-19, agreed that pulling a loved one out of a facility is an option only for the lucky few.
“I would estimate that somewhere between 10% and 20% of nursing home residents could be cared for by their families at home,” Wasserman said.
Times staff writer Maura Dolan contributed to this report.