NURSING HOME PREPARES FOR THEWORST— AGAIN
After 24 residents died from COVID-19 in spring, the Alief facility keeps fighting to avoid a winter outbreak
Ted Thornell was working at his desk when the worst possible news arrived: A hospitalized resident from his nursing home had tested positive for COVID-19.
It was May 22. Focused Care at Westwood, the facility Thornell runs in Alief, hadn’t previously detected a single case of the new coronavirus.
Crushed, Thornell wondered: Who else has it?
Though he didn’t know it yet, the coronavirus was rampant at Westwood. Itwould infect at least 65 of some 80 residents. Twenty-four would die — more than at any nursing hom ein the Houston region so far this year.
Nowhere has the tragedy of COVID-19 been more clear than at the nation’s nursing facilities, which primarily care for the elderly or disabled. More than 65,000 residents across the country have died. The federal government banned visitors in mid-March to protect a vulnerable population but took months to distribute testing machines, and the virus still got in.
As hospital doctors and nurseswere praised for heroic efforts last spring, nursing home staffs felt under siege. Individual facilities reported staggering case counts. Nurs-
ing home employees, also at risk, continued bathing and feeding their patients.
These employees helped residents cope with isolation as months passed without in-person visits. The state began allowing some visitors in August. But in a cruel twist, infections in nursing facilities have been rising again, mirroring increases in individual communities.
In Texas, residents now account for around 25 percent of deaths, down from a peak of 40 percent in June, a drop reflecting national trends. The American Health Care Association attributes the decline to a better understanding of the virus, improved treatment and increased government resources.
At worst, there were 10,223 resident infections in July in the state and1,264 deaths in August. In contrast, nearly 4,700 Texas nursing home residents were infected in the first half of November, and more than 400 have died.
Westwood’s experience offers a window into how nursing facilities dealt with the crisis and the emotional toll it took.
Focused Care employees said they felt they did all they could to battle the outbreak at their facility last spring. Health guidance was changing, testing was limited and protective equipment was in short supply.
Thornell worked seven days a week, wearing scrubs instead of buttondowns. It took three weeks to get state-sponsored test results for the facility; he fought an invisible enemy.
From the perspective of the state’s long-term care ombudsman, Patty Ducayet, the effort still fell short.
“(The) facility didn’t do as well as others to identify its first case and contain the spread,” Ducayetwrote in an emailed statement. “In most cases, other facilities working under the same guidelines fared much better.”
It took more than two months for Thornell’s staff to eradicate the virus; the facility has since remained largely COVID-free. The company allowed staffers to be interviewed to share the impact that fighting the virus had, an impact others will face.
“It’s the toughest thing I’ve ever been through,” said Thornell, 50. “It tested my limits, for sure. I believe it tested everyone’s limits.”
Thornell is afraid they could have a winter outbreak. They are better prepared and now do their own testing, but he knows the virus can spread like wildfire. Watching the news Thursday, he felt terrified to think they might relive what they experienced.
Thornell has spent 17 years in long-term care, the last two at the four-wing brick facility in southern Harris County that Focused Post Acute Care Partners bought in 2019.
His job had challenges before the pandemic, but they were “a walk in the park” compared to what happenednext, he said. He prepared for the virus without fully realizing what was coming.
Focused Care managers dialed in for daily 7 a.m. phone calls inMarch, grappling with what needed to be done. TheWestwood facility is one of the Fort Worth-based company’s 31 nursing homes.
They considered what it would take for their employees to work in one facility instead of shuttling between two jobs, to reduce the chances of spread. They bought personal protective equipment wherever they could find it, including medical
gloves from their food purveyor.
State inspectors visited Focused Care atWestwood from April 22 to 24, part of a federal directive to check infection control plans at nursing homes. Westwood was low on their priority list of places to visit, based on its inspection history.
The state had a 78-item checklist: Did staff wear masks when needed? Did they disinfect high-touch surfaces? Did they handle laundry appropriately?
They found Focused Care at Westwood in compliance.
The virus got in anyway.
The first resident to test positivewas Emily Liu’s 88year-old mom, Cheng Li.
Liu waited to talk with her by phone, while Matt Dietz, her common-law husband, tried to keep her occupied.
Her mother moved to Focused Care atWestwood
after having a stroke. Dietz’s 88-year- old dad, Thomas, was already there, having suffered a stroke as well.
A 66-year- old real estate broker, Dietz trusted the staff to care for his dad.
Liu’s mom put on needed weight. With so much confusion around the coronavirus, Dietz felt the employees were doing their best.
“Man, it’s all over the world,” Dietz told his dad, a formermachinist, trying to keep his spirits up. “You should be happy you’re there.”
Before Liu got to speak again to hermomto tell her she loved her, she died. It had been two days since her positive test. The family was unprepared for the news, Dietz said.
Dietz remembered Liu wondering: How could her mom be the only one?
Later, Liu’s brother called Thornell, sobbing. Thornell cried toowhen he got home.
But there was little time to grieve.
officer, felt disappointed. What had they missed? How could they do better?
Founder and CEO Mark McKenzie sometimes worried the company was in a battle it could never win.
The virus was here now — not just on TV — and Thornell wondered if he would survive it. Worried, his mom begged him to find another job. She was a former nursing home director too.
He pleaded with anyone he could for the remaining test results.
Staff relied on infection control, reworking how they passed out meals, distributed medication and gave showers. They came close to running out of personal protective equipment but never did.
Thornell gathered staff daily for meetings, sharing updates from the state and his corporate team. They were learning about the potentially deadly virus while facing it. He brought sodas, snacks and candy to boost morale.
Massa Jarrett, a 38-yearold certified nursing assistant, worked the hot zone, wearing gowns that made her sweat so much she lost weight. Residents recognized her voice. She introduced herself entering a room in her N95 mask, shoe covers and face shield.
“Why do you look weird?” a resident might ask.
“Well, it’s for me to protect you and to protect myself,” Jarrett would say.
Always, the mother of two put herself in the residents’ shoes. She knew that she had to convey calm. She took it one day at a time. “You need to still take care of them,” she later said. “You need to still make them feel like it’s OK.”
Privately, Jarrett felt heartbroken seeing those who once did for themselves get sick.
A woman who dutifully took care of her blind roommateno longer could. A man who never missed a shower and eagerly awaited dinner now refused to bathe and eat.
Routine was robbed even from those who stayed healthy. No more could they gather for dinner or get coffee. Sisters or husbands who before camedaily could onlywave through the window.
The dining room was reserved for staff, with one chair at each table.
In the dark at the end of each shift, Jarrett took off her contaminated shoes. She drove home on a car seat covered with plastic. She undressed in the garage and headed straight for the shower, to avoid infecting her teenage sons.
On June 8, exactly three weeks after they’d been tested, Thornell got the complete numbers: 36 employees and 36 residents positive. It was too late for
these to be useful. Some might have already recovered.
(A spokesman for the Texas Division of Emergency Management, which helped coordinate the statewide facility testing, said lab capacity was limited and demand high.)
“Those numbers are just insane,” Dietz thought when he got the email updates.
Focused Care executives sought a contractor to do its own testing. No one knewwhen thiswould end.
State surveyors visited repeatedly, Thornell said, finding the facility in compliance with infection control policies. Before sunrise June 14, Thornell met National Guard members in their fatigues, back to spray the building with disinfectant.
Nurse Emukah developed a fever. She stayed home, instructing her children to leave food at her bedroomdoor. She lost her sense of smell and taste. She got chills. She knew she had the virus.
Emukah drove herself to the hospital. A few days later, she drove herself home. She waited 14 days before getting tested again — three times, all negative — and returned to work.
At Westwood, 22 residents known to have COVID-19 died in June. Staffers were accustomed to death, a reality of working at a nursing home, but this was so much more, so much faster.
Those gone included a woman who often raised her cup, hoping for warm milk. A 103-year- old who ate like a teenager. A man who did tai chi in hiswheelchair and doffed his hat when he said hello.
All but six passed away in a hospital. Staff heldmoments of silence in their memory. They sent sympathy cards and released balloons into the sky.
Dietz and Liu are still processing her mom’s death.
OnMonday, Dietz visited his dad for the first time.
Thornell has gone over in his mind a hundred times how it got in and still doesn’t know. A visitor from overseas? A staff member?
Focused Care bought new sanitizing equipment and hired an infection control nurse to review its policies. Thornell’s staff gets tested weekly. The federal government promised most nursing homes rapid test machines by the end of September. The facility was just cleared to use theirs.
The trauma for those still here feels fresh. For some staffers, residents were like family. Jarrett thought about her patients on her days off. Emukah didn’t ever think they would forget those who died.
“We took care of them,” Emukah said. “Look at what the virus did.”