Nursing homes see death surge in shadows
When COVID-19 tore through Donald Wallace’s nursing home, he was one of the lucky few to avoid infection.
He died a horrible death anyway.
Hale and happy before the pandemic, the 75-yearold retired Alabama truck driver became so malnourished and dehydrated that he dropped to 98 pounds and looked to his son like he’d been in a concentration camp. Septic shock suggested an untreated urinary infection, E. coli in his body from his own feces hinted at poor hygiene, and aspiration pneumonia indicated Wallace, who needed help with meals, had likely choked on his food.
“He couldn’t even hold his head up straight because he had gotten so weak,” said his son, Kevin Amerson. “They stopped taking care of him. They abandoned him.”
Separate death wave
As more than 90,000 of the nation’s long-term care residents have died in a pandemic that has pushed staffs to the limit, advocates for the elderly say a tandem wave of death separate from the virus has quietly claimed tens of thousands more, often because overburdened workers haven’t been able to give them the care they need.
Nursing home watchdogs are being flooded with reports of residents kept in soiled diapers so long their skin peeled off, left with bedsores that cut to the bone, and allowed to wither away in starvation or thirst.
Beyond that, interviews with dozens of people across the country reveal swelling numbers of less clear- cut deaths that doctors believe have been fueled not by neglect but by a mental state plunged into despair by prolonged isolation — listed on some death certificates as “failure to thrive.”
A nursing home expert who analyzed data from the country’s 15,000 facilities for The Associated Press estimates that for every two COVID-19 victims in longterm care, there is another who died prematurely of other causes. Those “excess deaths” beyond the normal rate of fatalities in nursing homes could total more than 40,000 since March.
These extra deaths are roughly 15% more than you’d expect at nursing homes already facing tens of thousands of deaths each month in a normal year.
“The healthcare system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope,” said Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco, who conducted the analysis. “There are not enough people to look after the nursing home residents.”
Others’ health affected
Comparing mortality rates at homes struck by COVID-19 with ones that were spared, Kaye also found that the more the virus spread through a home, the greater the number of deaths recorded for other reasons. In homes where at least 3 in 10 residents had the virus, for example, the rate of death for reasons besides the virus was double what would be expected without a pandemic.
That suggests the care of those who didn’t contract the virus may have been impacted as healthcare workers were consumed attending to residents ill from COVID-19 or were left short-handed as the pandemic infected employees themselves.
Chronic understaffing at nursing homes has been one of the hallmarks of the pandemic, with a few homes even forced to evacuate because so many workers either tested positive or called in sick. In 20 states where virus cases are now surging, federal data shows nearly 1 in 4 nursing homes report staff shortages.
Long Island outbreak
On New York’s Long Island, Dawn Best saw that firsthand. Before COVID-19 arrived at Gurwin Jewish Nursing Home, she was pleased with the care her 83-year- old mother Carolyn Best received. She enjoyed activities, from tai-chi classes to visits from a pony, and was doted on by staff.
But when the lockdown started and the virus began to spread in the home, Best sensed the staff couldn’t handle what they had been dealt. The second time her mother, a retired switchboard operator, appeared on screen for a scheduled FaceTime call, she looked awful, her eyes closed as she moaned, flailed her arms above her head and just kept repeating “no.” Best insisted a doctor check her out.
A few hours later, the doctor called, seemingly frantic, saying she only had a moment to talk.
“The COVID is everywhere,” Best remembered her saying. “It’s in every unit. The doctors have it, the nurses have it and your mother may have it.”
In the end, 59 residents at Gurwin would be killed by the virus, but Best’s mother never contracted it. She died instead of dehydration, her daughter said, because the staff was so consumed with caring for COVID-19 patients that no one made sure she was drinking.
Lost access
When facilities sealed off across the country in March, advocates and inspectors were routinely kept out, all while concerning reports trickled in, not only of serious injuries from falls or major medical declines, but of seemingly banal problems that posed serious health issues for the vulnerable.
Mairead Painter, Connecticut’s long-term care ombudsman, said with dentists shut out, ill-fitting dentures went unfixed, a factor in mounting accounts of malnutrition, and with podiatrists gone, toenails went untrimmed, posing the possibility of painful conditions in diabetes patients.
Even more widespread, as loved ones lost access to homes, was critical help with residents’ feeding, bathing, dressing and other tasks. The burden fell on aides already working tough shifts for little pay.
“I don’t think anyone really understood how much time friends and family, volunteers and other people spent in the nursing home and supplemented that hands-on care,” Painter said.
Strict rules barring inperson visitation persist in many homes, but as families and advocates have inched back inside, they’ve frequently been stunned by what they found.
When June Linnertz returned to her father’s room at Cherrywood Pointe in Plymouth, Minnesota, in June for the first time in three months, she was struck by a blast of heat and a wall thermometer that hit 85 degrees. His sheets were soaked in sweat, his hair was plastered to his head and he was covered in bruises Linnertz would learn came from at least a half- dozen falls. His nails had been uncut so long, they curled over his fingertips and his eyes crusted over so badly he couldn’t get them open.
The father, 78-year- old James Gill, screamed, thinking he had gone blind, and Linnertz grabbed an aide in a panic. She snipped off his diaper, revealing genitals that were deep red and skin sloughing off.
Two days later, Gill was dead from Lewy Body Dementia, according to a copy of his death certificate provided to the AP. Linnertz always expected her father to die of the condition, which causes a progressive loss of memory and movement, but never thought he would end his days in so much needless pain.
“What the pandemic did was uncover what was really going on in these facilities. It was bad before, but it got exponentially worse because you had the squeeze of the pandemic,” Linnertz said. “If we weren’t in a pandemic, I would have been in there … This wouldn’t have happened.”