Nursing Homes becoming Islands of isolation amid shocking mortality rate

STANWOOD, Wash. — At nursing homes where guests are barred because of the coronavirus, adult children talk to their parents through locked glass doors like jailhouse visitors. They worry it may be months before they can hug each other again. Many families are debating whether to move their frail loved ones out altogether and care for them at home.

Thousands of nursing homes and assisted-living centers across the United States are becoming islands of isolation as health care administrators take unprecedented steps to lock them down, hoping to protect some of the nation’s most vulnerable residents from the threat posed by the coronavirus.

On Tuesday, industry leaders recommended curtailing all but essential visits at homes across the country, calling the challenge posed by the novel coronavirus “one of the most significant, if not the most significant” issues the industry has ever faced. Five long-term care facilities in Washington State have been hit, but officials worry the virus could already have spread to far more facilities with still-undetected cases.

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In Washington State, where 18 residents from a single facility in Kirkland have died, families are getting increasingly desperate.

“I’m concerned that the loneliness and helplessness will kill her quicker than the virus,” said Melissa West, whose 95-year-old mother-in-law lives in a nursing home in Seattle that has remained untouched by the virus. “I just think of her being there by herself. Just sitting in her wheelchair all day. Being trapped and waiting.”

Long-term care centers across the country are already curbing outside visits. One nursing home in Oklahoma is trimming back visiting hours and prohibiting anyone who has recently traveled internationally. Another in Maryland shut its doors after a resident developed symptoms of the coronavirus.

Some families have decided they cannot risk being cut off from their loved ones.

Veronique Littlefield said she and her family moved her 86-year-old mother home two weeks ago after she was potentially exposed to the coronavirus at the Kirkland facility, Life Care Center, which has become the center of the outbreak in the United States. Ms. Littlefield said that her mother had been transferred to a nearby hospital and that as they discussed where to take her next, the family had to weigh the risks of exposing themselves to the virus if they elected to care for her.

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With the aid of a hospice service, the family set up a hospital bed in the downstairs of their home, quarantined themselves from the outside world and became round-the-clock caregivers. They wear gloves to serve her red wine. None of them, including her mother, has developed any symptoms.

“She sacrificed so much to be the most loving and caring person we could ever know,” Ms. Littlefield said. “This is why we’re doing this for her.”
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The new guidance on curtailing visits calls for nursing homes to screen all visitors — family, staff members, contractors and government workers — at reception and turn away anyone with signs of illness. According to the new guidelines, which have been endorsed by the federal government, only essential visits should be conducted — and that generally means no families.

News of a death at another nursing home in Washington State, made public on Tuesday, underscored the perils facing older residents. Nicole Francois, a spokeswoman with Issaquah Nursing & Rehabilitation Center east of Seattle, said that one resident had died over the weekend and that five other residents and two staff members have tested positive for the virus.

The facility, which announced last week that it was prohibiting visitors, was in the process of contacting everyone who has visited since early February.

Meanwhile, in Seattle, the Ida Culver House Ravenna senior living complex was also rushing to prevent an outbreak after one of its residents tested positive and later died. And health officials in Snohomish County announced that three people from the Josephine Caring Community center in Stanwood, Wash., had tested positive for coronavirus.

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On Tuesday, Terry Robertson, the chief executive of the Stanwood center, said that the doors had been locked and that every staff member was being screened for fever or cough upon arriving to work. The parking lot of the facility was quiet on Tuesday morning, and the closed front doors included signs saying, “DUE TO CDC RECOMMENDATIONS NO VISITORS AT THIS TIME.”

“That’s incredibly tough for family,” Mr. Robertson said. “We’re very sorry, but we can’t spread this. We have to isolate.”

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Gov. Jay Inslee on Tuesday announced new requirements for nursing homes and assisted living facilities, requiring that residents be limited to one visitor per day. He also ordered that employees and volunteers be screened for symptoms at the start of each shift.

“We know that this is a fatal disease — all too frequently — for those particularly of age, and those with chronic conditions,” Mr. Inslee said.

The federal government has dispatched inspectors to try to understand why the germ is spreading in this community. Candace Goehring, who oversees Washington State’s inspectors as director of residential care services, said the investigations were not far enough along to yield results, but said Life Care Centers of Kirkland has had good inspection reports for overall quality in the past.

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Credit...David Goldman/Associated Press
Rankings provided by the federal government give Life Care five stars out of five stars — “much above average” — for overall care. But the facility received three stars out of five for health inspections, which according to the rankings would mean a higher level of “health risks” than a four- or five-star rating.

Issaquah Nursing & Rehabilitation Center has a four-star rating for overall quality, considered “above average.”

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The nursing home outbreak has been mainly isolated to the Seattle area, though new cases connected to facilities in New York and California in recent days raised concerns that any facility could be vulnerable. In Brooklyn, an employee of the King David Center for Nursing and Rehabilitation has tested positive for the virus, and officials in Sacramento County said on Tuesday that a resident of an assisted-living facility in Elk Grove had tested positive and was being treated.

Ms. Goehring said one factor leading to the spread of the coronavirus in these facilities may be that “the virus has reacted somewhat differently than what we heard about in other locations.” She said that early reports from countries in Asia and Europe had not pointed to nursing homes as a particular problem, possibly catching the United States off guard, and that it may also be that the virus somehow “changed in this population” to become more virulent.

A variety of factors make nursing homes especially at risk to an epidemic: older residents often have weakened immune systems, and many facilities are poorly staffed and have lax infection prevention — partly because visitors are constantly coming and going — which allows germs to spread. On top of that, residents, who live in proximity, often move back and forth to hospitals when they become acutely ill, making them potential carriers of infection.

The Covid-19 coronavirus appears to pose a significantly greater risk to the nursing-home population than a typical seasonal flu — although the two illnesses share some similarities and are often compared. Both can spread easily and attack the lungs.

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Credit...David Ryder/Reuters

“None of those factors play into this. No herd immunity, no vaccine and no treatment,” said Dr. David Dosa, a geriatrician and expert in emergency preparedness medicine at Brown University.

“What is going to happen in each of these cases is the virus will get in, and presuming it’s not easily stopped once it gets in, everybody in the building will get it,” he said. “Then you’ll see mortality and morbidity rates that are very significant.”

That prospect has left Washington State officials scrambling to understand not only how to stop the spread in these facilities but how it appears to be jumping from one place to the next.

Dr. Kevin Kavanagh, an expert in infection control who has been critical of lax practices at nursing homes, lauded the new guidance that restricts social visits. This extreme level of quarantine is sometimes known as “reverse isolation” and was used to effect during the Spanish Flu epidemic, Dr. Kavanagh said.

“As evidenced by the Life Care Center in Kirkland, once the virus starts to spread in the facility it ravages its residents,” he said. He said that “the importance is in delay.”

Some relatives of Life Care residents said they were still frustrated by the pace of testing and the facility’s response. Vanessa Phelps said she got a call on Monday telling her that her 90-year-old mother, a former opera singer, had tested positive for the coronavirus, one of 31 newly reported cases at the nursing facility.

Ms. Phelps said that she desperately wanted her mother transferred to a hospital and felt that she was being left to die by remaining at Life Care. Ms. Phelps said her mother, who has developed a cough, still had not yet learned about her own test results.

“I keep telling her we’re going to take her to the park when the quarantine’s done,” Ms. Phelps said. “That’s not happening.”

Jack Healy reported from Stanwood, Matt Richtel from San Francisco and Mike Baker from Seattle.

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Credit...Chona Kasinger for The New York Times

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Credit...Brynn Anderson/Associated Press

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