Inside Rosewood
New Zealand’s Covid19 mortality rate is the envy of the world. But it would be much better were it not for one Christchurch rest home. Martin van Beynen reports. The rest home with over half of NZ’s Covid-19 deaths
Fridays figure strongly in the grim numbers coming from the Rosewood Rest Home and Hospitals in Christchurch. The first confirmed case of Covid-19 came on Friday, April 3. The first death was on Good Friday, April 10. The 10th death was on Friday, April 24.
Residents of the red-brick rest home, which prides itself on its garden, barbecues on the deck and frequent outings, account for more than half of New Zealand’s Covid-19 fatalities.
It’s a heavy responsibility for the 64-bed rest home and hospital to bear.
The home was divided into three sections – one for rest home residents, one for people requiring hospital care, and one for dementia patients who also needed hospitallevel care.
Some time in March, in a way that may never be known, the coronavirus that causes Covid-19 got into the Rosewood community.
The deaths associated with Rosewood mean the Canterbury area has the highest Covid-19 mortality rate in New Zealand by far. As at May 1, the Canterbury District Health Board (CDHB) had 162 cases with 10 deaths, while Auckland, 173 cases, and Counties Manukau, 127 cases, had no deaths. At the same date, the Rosewood cluster stood at 54 cases (18 recovered).
The count of 10 dead associated with Rosewood is likely to increase. A nurse who worked with the 20 Rosewood patients in Burwood Hospital’s Ward GG told a Stuff journalist no-one was likely to come out of the ward alive.
Given the vulnerability of the Rosewood elderly, it’s not surprising many succumbed once the virus got in.
But why Rosewood? Was it just incredibly unlucky?
One of the first Rosewoodconnected deaths was former boxing coach Bernard William Pope, 78, who died in Burwood Hospital on Good Friday. His health had been poor and he almost died before Christmas.
Bernard’s older brother Fred visited about twice a week, bringing him a chocolate fish and giving him a shave.
The last visit was ‘‘just normal’’, says Fred, who has no concerns about the quality of care for his brother. As he left, he asked Bernard if he was all right.
‘‘He would look right through you and he just wandered off around the corner. I just thought, ‘Oh well, he’s going away to his bed now or wherever he was going to go’ and I went away and left him. That’s just all it was. I was sad I never [saw] him again.’’
A health professional who knows some of the workers at Rosewood well, and who spoke on condition of anonymity, says the questions are hurtful for those who did their very best for the residents.
‘‘These men and women were loved – by a wife, a husband, a daughter or a son. And they were cared for in their rest home by an amazing team of nurses and caregivers, some of who also became sick with Covid-19. Fingerpointing and tongue-wagging about the quality of these residents’ care has been untimely and cruel.
‘‘Several of these rest-home staff were admitted to hospital. They have been separated from their families for days and weeks, sick and frightened and fighting for every breath. They have also been incredibly saddened, burdened with the grief of losing so many of the residents they felt responsible for, and came to know and care for.
‘‘We cannot imagine the depth of pain they are feeling.’’
An angry worker at the rest home told Stuff she was disgusted by the media coverage suggesting staff were at fault. ‘‘We were in lockdown two weeks before anyone else. We screened people. We are hearing a lot of lies.’’
The first case
Rosewood received the news it was dreading on Friday, April 3, 10 days after New Zealand went into alert level 4 lockdown. Tests confirmed at least one of the residents in its most vulnerable group, the dementia patients, had Covid-19.
The patient would have to be isolated, as would other patients, staff and visitors who had been in contact with the wing.
Two days after the first positive tests, the Ministry of Health announced 10 Covid-19 cases were associated with the rest home and by Monday, April 6, all 20 patients in the dementia wing were moved to Burwood Hospital, where a ward had been prepared for them.
By then the Rosewood cluster had shot up to 15 confirmed or probable cases – 12 residents probable or confirmed and three Rosewood staff members probable.
With most of Rosewood’s staff in self-isolation, the CDHB essentially had to take over running the facility to look after the remaining residents. An acting manager was appointed.
A week after the first positive test at Rosewood, a woman from the home died at Burwood Hospital. She was New Zealand’s second Covid-19 fatality.
By then three CDHB staff who helped transfer the 20 residents to Burwood had contracted Covid-19.
An inquiry into how the CDHB staff became sick with Covid-19 found the staff – busy with moving the Rosewood residents into Burwood – had not changed their PPE frequently enough.
‘‘It is believed damp masks may be the source of the breach. Some staff reported their PPE had become moist with the physical exertion that occurred over some hours that day,’’ said the CDHB incident controller, Dr Sue Nightingale.
On April 11, the CDHB moved 20 Rosewood patients who were in the hospital wing at the home to other facilities around Christchurch. They had all tested negative.
By April 24, nine of the 20 Rosewood residents shifted to Burwood had succumbed and another Rosewood resident had died elsewhere. By then, the cluster of confirmed or probable Covid-19 cases connected with the home had grown to 50, including 20 Rosewood staff and six CDHB staff.
CDHB incident controller Dan Coward says none of the treatment plans for the Rosewood residents included escalation to ICU.
‘‘Due to existing comorbidities (other health problems) the use of ventilators would not have altered the outcome for these patients.’’
The families of those dying in Burwood Hospital expressed gratitude for the care of their loved ones, through the CDHB media team. The comments included glowing references such as:
‘‘It was so special that the staff caring for her could take photos and a video of mum in our sacred korowai. We will treasure it forever.’’
‘‘Many thanks to all the staff who cared for my dad to the end. I will always hold a huge part in my heart for you. So kind of you to play Dad’s video. I am sure it helped him pass. I hope to one day be able to thank you both in person. Bless you both.’’
Difficult questions
It’s important to find out who or what brought the virus into the rest home, but the answer will be difficult.
The rest home was a busy place, with an international staff who spoke 15 languages. The facility encouraged family visits and residents were taken on trips most Tuesdays and Thursdays. A hairdresser visited weekly and a podiatrist every six weeks.
Most of the residents had their own rooms but their ensuites catered for two rooms.
Even with the most stringent procedures, a high-needs dementia facility is a difficult place to keep infection under control. One nurse who works in the area told Stuff it was virtually impossible to change into fresh PPE for each resident.
With inquiries under way, health authorities have been reluctant to provide much information on possible causes.
Director-general of health Ashley Bloomfield talked about clusters showing ‘‘deficiencies in the actual procedures and how those were being implemented’’.
The Ministry of Health was unable or disinclined to elaborate on whether Bloomfield was talking about Rosewood or what exactly the deficiencies were.
CDHB chief executive David Meates says it was highly likely a staff member took the virus into the dementia unit, given strict visiting restrictions under the level 4 nationwide lockdown.
Neither the ministry nor the CDHB provided any more detail about how the virus infection started at Rosewood.
CDHB medical officer of health Dr Cheryl Brunton says ‘‘how and when Covid-19 was introduced into Rosewood rest home is still the subject of investigation, including the possibility that the infection was introduced by a staff member who may have been asymptomatic at the time’’.
Wider issues may have been at play in the introduction and rapid spread of the illness. Unions representing caregivers and nurses have for years advocated for higher rest-home staffing levels, saying care rationing compromised safety.
Yearly audits of the Rosewood rest home, which looked at infection control among other aspects of care, raised few red flags.
An audit last year found only three areas requiring improvement. These related to consent and enduring power of attorney/ welfare guardian documentation, residents’ records, and chemical handling and education.
An infection prevention and control programme was led by a newly trained infection control coordinator with support from the facility manager, who had experience in the field, the audit report said. ‘‘Staff demonstrated good principles and practice around infection control, which is guided by relevant policies and procedures. Regular education on infection prevention and control is available for staff.’’
Families content
After a calamity such as the Covid19 outbreak at Rosewood, angry families sometimes contact media to express concerns and point out shortcomings. This hasn’t happened – in fact the reverse.
Beverley Humphries’ husband, Dave, 82, a retired bus driver, has been in hospital care at Rosewood for two years and Beverley says his care has been superb.
‘‘The staff are fantastic and treat all the patients as one big family. Dave feels like it is home now.’’
Beverley was a cook in a rest home for 10 years and has a good handle on the difference between average and good care. ‘‘Rosewood has taken the brunt of the backlash and I just think it’s unjust. I know the staff go to work to look after the residents as if they were their own loved ones,’’ she says.
Shane Fairmaid’s elderly father, Alex, a retired West Coast farmer, was a dementia patient and a resident at Rosewood for six years.
‘‘Dementia is a terrible disease that takes loved ones slowly. Patients are confused and difficult to look after and it takes a very special person to work in these environments. No-one that goes into Rosewood recovers.
‘‘Dad died last year . . . Rosewood staff were some of the most compassionate and committed health professionals I’ve ever encountered. Dad wasn’t a patient to them, he was part of the Rosewood family. They looked after Dad as if he was their own.
‘‘At times Dad could be difficult to care for and could be unsettled and abusive. Nothing ever bothered the Rosewood staff.
‘‘Our family are forever indebted to the Rosewood staff for the care of Dad. I can only imagine the grief they will be feeling from this terrible impact of the virus.’’
The rest home is owned by Christchurch residents Malcolm and Lynda Tucker, who have declined to speak to media. Lynda is a former trainee community nurse at Burwood Hospital and the couple have owned the rest home for about 20 years.
They have a number of other business interests, including St Johns Hill Healthcare in Whanganui, which looks after about 28 elderly people.
Aged Care Association chief executive Simon Wallace says the Tuckers have been longstanding and active members of the association and are well regarded by the aged care community.
If there are lessons to be learned from Rosewood, it’s important they are disseminated fast.
Of New Zealand’s 19 deaths, at least 13 can be traced to rest homes and about 140 Covid-19 infections are in aged-facility clusters. A cluster is defined as 10 or more cases connected through transmission.
Overseas the picture is similar. UK-based academics say about half of all Covid-19 deaths appear to be happening in care homes in Italy, Spain, France, Ireland and Belgium.
Bloomfield has commissioned a review of all the rest-home facilities where cases of Covid-19 have emerged. ‘‘In some of those instances, the cases have been able to be bounded very quickly with no further transmission, and in others, we’ve seen just how tricky this virus is and that it can spread quite rapidly.
‘‘So we think it’s a very good point in time to undertake a review of both the facilities where we have had cases to learn about what’s worked well and where we could improve, but also to look at some facilities that might be similar where they haven’t had cases.’’
Wallace defends his industry, saying it put in place safeguards well before the rest of the country.
‘‘Even with the best precautions in place, it’s not fail-safe.’’