A nursing home pushed to its limit
Staff and families struggled as Greeley facility came under siege
Kirby Weeden visited his wife, Darlene, at Fairacres Manor in Greeley just about every evening over the past five years, but when he arrived March 10, the doors were locked.
Fairacres’ decision to bar visitors coincided with news its leaders had been dreading: An administrative worker across the street from the residents had developed symptoms consistent with COVID-19.
Weeden shrugged at the interruption of the couple’s routine. There would be no watching “Jeopardy!” together that night or eating dinner while they caught up. He said he went to the mall instead, unconcerned.
“I just didn’t think much of it,” he told The Denver Post.
But by early March, the signs were clear that the pandemic could be devastating in places like nursing homes where older residents live in close quarters. Nationally, as authorities work on a complete accounting, more than a third of deaths can be traced to senior-care facilities.
To better understand what was happening as nursing facilities across Colorado closed their doors, The Denver Post interviewed a half-dozen families who lost a loved one at Fairacres Manor at the height of the pandemic — at least two of them from COVID-19 — as well as members of the home’s staff and medical professionals. Their accounts together show the frantic efforts taken to combat one of the earliest outbreaks among scores that occurred in facilities invaded by the virus in Colorado.
On March 29, Darlene Weeden, a 78year-old devoutly religious woman who spent her years working at Denver’s Calvary Temple, died. Despite test results, her family suspects there were complications associated with COVID-19.
Just days before her death, state health
officials declared an outbreak inside Fairacres.
“I feel like Fairacres was caught in this perfect storm of everything happening all at once, and it was really hard for them to navigate what was happening,” said Audra Casseday, Weeden’s daughter.
Fairacres agreed to make staffers available for interviews at a time when other facilities, still reeling from their outbreaks, were reluctant to do so. Several other nursing homes declined to speak in depth about the early days of the pandemic and their efforts to counter it.
Fairacres’ operator also was eager, in light of the public attention given to hospital workers in recent months, to shed light on the less-heralded efforts by nursing home staff members as they dealt with a surge of sickness and death the likes of which they’d never seen.
“It was scary — it just hit us really fast,” recalled Mary Meraz, a certified nursing assistant at Fairacres for 19 years who helps residents with failing memory complete daily tasks. “Everybody pitched in. … We tried to comfort the residents who were getting really sick. Their families couldn’t be there for them, so it was really hard.”
In all, skilled-nursing, assistedliving and independent-living facilities in Colorado with outbreaks have reported 869 deaths of residents with confirmed or probable COVID-19 as of Wednesday — accounting for roughly 53% of deaths statewide of people who had the illness.
At Fairacres, which has 116 beds, 13 residents died after testing positive for COVID-19 or being presumed to have had it, state data show. The dead were among 40 residents reported to have the virus. Another 46 infections occurred among Fairacres staff, all non-fatal. The state declared the outbreak resolved in mid-may.
At one point, Fairacres’ outbreak was among the worst in Colorado in terms of illnesses and deaths. That changed as the virus overran other senior-care facilities across the state. Fairacres now ranks 17th in the number of deaths directly attributed to COVID-19, or presumed so, among the 162 senior-care facilities that have had outbreaks, according to a Post analysis of state data.
While nearly all families interviewed by The Post lauded Fairacres’ staff for its dedication and commitment to care, some expressed concerns about poor communication or a lack of clarity and information about their loved ones. It was a frustration that made a difficult, confusing time even more distressing.
Fairacres said it couldn’t discuss specific instances, but its staff navigated this uncharted terrain with compassion.
“Fairacres, as with any nursing home, was following guidelines that were being provided at the county, state and federal levels, all with the purpose of minimizing the virus,” said Nancy Schwalm, a spokeswoman for Vivage Senior Living, which operates Fairacres.
Mixing together large numbers of elderly people who are among the most vulnerable to the virus simply made for easy prey, experts say. In Colorado, state health data show that people aged 60 or older have come down with only 25% of recorded COVID-19 infections — but account for nearly 90% of deaths.
As of June 11, the AARP estimates at least 43,000 long-term care residents and staff have died nationwide, according to state-reported data it compiled.
Where the virus strikes, and how deadly it is, doesn’t seem to follow much of a pattern.
Just a mile down the road from Fairacres, at Centennial Healthcare Center, a similar numbers of illnesses were recorded, but 24 people died — tied for third-most in the state — according to the most recent data released by the Colorado Department of Public Health and Environment.
And it mattered little whether a home was highly regarded or not. Facilities such as Fairacres, a fivestar institution according to federal inspection and quality measures, were as easily overwhelmed by the pandemic as those with only a single-star rating.
In Colorado, three of four nursing homes that last year were cited as the most heavily fined and under threat of federal oversight have reported no Covid-19-related deaths. The fourth has reported only one. Combined, they have had fewer resident illnesses than some of the state’s top-ranked homes, data show. The worst of them had none.
Fairacres’ five-star rating doesn’t mean it was perfectly prepared — and indeed, a state infection-control inspection in the midst of the chaos at the end of March noted a handful of lapses in sanitary procedures that resulted in quick correction.
R. Tamara Konetzka, a health services research professor at the University of Chicago, on May 21 told a U.S. Senate Special Committee that her recent research of nursing home outbreak data found the pandemic was not particular about where it settled in.
“While some nursing homes undoubtedly had better infection control practices than others,” she told senators, “the enormity of this pandemic, coupled with the inherent vulnerability of the nursing home setting, left even the highest-quality nursing homes largely unprepared.”
March 5: Coronavirus arrives in state
Five days into March, Gov. Jared Polis announced the first two confirmed cases of COVID-19 in Colorado. The first alarm for nursing homes, however, came five days earlier when word of the first coronavirus outbreak in the country — at a nursing home in Kirkland, Wash. — made headlines.
The news shook nursing home operators and regulators. Coronavirus had been on Colorado’s radar, but now the risk for the elderly and those with pre-existing health conditions was underlined, as more than four dozen residents and staffers displayed symptoms inside that one Washington facility.
“We, as an organization, started fast and furious beginning March 5,” said Cynthia Coenen, the chief clinical officer for Vivage, the Lakewood-based company that manages Fairacres Manor. That meant the development of a strategic action plan for Vivage’s 30 skilled-nursing facilities, along with a review of infection control policies and placing restricting signage on doors.
Communal dining and all group activities were stopped at Fairacres and other Vivage-run homes. Doors were shut to non-essential visitors such as Kirby Weeden.
Vivage purchased hundreds of tablet computers to aid with video visits and telehealth appointments, minimizing residents’ need to leave the facilities. The company made plans for townhall-type video conferences and phone calls to inform families of residents.
“Part of (Vivage’s) strategic plan,” Coenen said, “was doing that wave of education and training on infection-control practices and hygiene — and educating people on the virus and educating them on the spread. As an organization, I like to think we were much more proactive because we began having 100% of our staff wear masks before we even had any cases.”
The day Weeden was stopped from visiting his wife, on March 10, Vivage President and CEO Jay Moskowitz sent a letter to residents, their family contacts and staff members saying the company’s goal “continues to be to keep the virus out.” Vivage was adopting the same infection protocols as for influenza, and Moskowitz announced restrictions on visitation, except in situations such as “end of life.”
But by then, Fairacres had its first sign that the virus was in its midst: A staff member in a business office in the complex’s administration building had begun showing symptoms of respiratory distress and other indicators for COVID-19 on March 6 or 7, recalled Ben Gonzales, an assistant administrator who served as acting director through the crisis.
“The minute she started showing signs and symptoms she was sent home and at that point, then, we waited for her test results — and that’s how we determined that it was indeed our first case,” Gonzales said.
Testing turnaround was slow in the early offing, with results taking up to two weeks. In the meantime, Kirby Weeden said Fairacres told family members about the presumed positive in the facility.
“Early in March, they did a group phone call, saying that one of the business office workers was positive,” he said, though as he took in that news he didn’t recall hearing about the visitation restriction until he tried to see Darlene.
Fairacres Manor was now in lockdown.
March 12: First resident displays symptoms
Right about the time Colorado public health officials banned visitations at all nursing homes in the state — March 12 — the nursing staff recognized COVID-19 symptoms in a resident for the first time, Gonzales said.
He said it was an older woman, but Vivage declined to provide identifying details about its COVID-19 patients.
Another Fairacres employee said the new coronavirus might have been there even earlier: A resident battling the illness had shown symptoms of pneumonia in late February. That’s possible, as state health officials have acknowledged that the virus was likely circulating in the state as early as late January.
“It was a scary time — I mean, you’re waiting to see what those test results are going to bring,” Gonzales said of the business office employee’s illness. “Yet, at the same time, we don’t have time to wait for those test results. You have to act immediately to be able to keep everybody as safe as possible.”
Ultimately, both the infected employee and the first resident recovered, Gonzales said. Amid the rising number of illnesses, he said he remembered the solemn commitment on his staff members’ faces.
Nevertheless, the impact of seeing the virus up close remains with Fairacres nurse Gwen Nienhueser.
“Yeah, it was pretty obvious (that it might be COVID-19),” she said. “I mean, there’s a lot of secretions — thick secretions. Struggling for air, coughing. And that’s when we knew right away we needed to isolate that person. We did it immediately. It’s a struggle to watch them.”
Outside Fairacres Manor, confirmed reports of COVID-19 were spreading across Greeley and Weld County, and not just from nursing homes. As of March 23 — two days before Polis issued a statewide stay-at-home order — Weld County was already home to one of the state’s earliest community outbreaks, with 48 confirmed cases and its first two deaths.
By the end of April, the number of cases topped 1,800, with deaths approaching 100 — both totals ranking third among Colorado’s counties. Nearly half of the deaths occurred in a handful of health care and skilled-nursing facilities, county officials said at the time.
Emerging national data is clear: Nursing homes were deadly vulnerable once the virus was on their doorsteps.
“People who walk in the door, predominantly staff, are a lot more likely to be carriers, even though they’re probably asymptomatic,” said Vince Mor, a professor of health services policy and practice at Brown University. He’s conducted grant-funded research on outbreaks at facilities
run by Genesis Healthcare, a company that owns nursing homes across the country, including several in Colorado.
Nursing homes have inherent vulnerabilities, Mor said.
“You can try social distancing, but it’s kind of hard to be socially distant when two staff people have to pick up a 180-pound resident who’s unable to participate in getting up,” he said. “Their faces are going to be within inches of one another, and they’ll be within inches of the patient. Even with protective equipment, it’s intimate work.”
March 21: A family visit turns to vigil
In some of Fairacres’ cases, the symptoms of COVID-19 played out over two weeks or longer, and many recovered. Other residents’ health deteriorated rapidly.
The family of 90-year-old Harold Lebsack, who had Parkinson’s disease, wondered about his health throughout March. Celia Kirkpatrick, his daughter, said family members saw him about a week before visitations were shut down. After that, she said she called the nurse’s station periodically to check on him.
Kirkpatrick waited until March 21 to come with her husband and two children for a visit through her father’s window.
“They said we could come down, stand outside Dad’s window and wave to him, to let him know we’re still here — that we didn’t forget about him,” she said.
She called the staff when they arrived.
“Suddenly, we’re told that we had to wait — that he was being moved to a separate room for us to visit him,” Kirkpatrick said. “They told us he had an infection and was running a temperature.”
The family was shuttled through temperature checks, forms had to be filled out, masks and gloves were put on.
“When we got inside,” Kirkpatrick said, “that’s when we realized he was being moved because he was dying. We didn’t know he had COVID. We didn’t know what was happening.”
X-rays had shown Lebsack was suffering from double pneumonia, she said. Tests would later confirm it was COVID-19.
“It really didn’t register at first that this was all that bad, because no one had called us to say he had taken a turn,” Kirkpatrick said. The death that day of a woman who lived on the same hallway heightened her concern.
“All I could do was hold his hands, to let him know we were there,” she said. “We were singing, praying, reading to him.”
As the family prepared to leave, Kirkpatrick’s two children lifted their own masks and gave their grandfather a final kiss. Despite the loving gesture, the county health department required them to self-quarantine for two weeks.
Lebsack, a lifelong farmer remembered as eager to help other farmers, died the next morning.
“He’d been in and out of nursing homes and hospitals for a year,” Kirkpatrick said of her father. “His health was an issue sometimes, but nothing that gave him lots of problems. This was all so quick, so sudden.”
The day Lebsack died, Duane Rau said he received a call from nurses at Fairacres saying his mother, 94-year-old Mary Evaline Rau, wasn’t well.
She’d lived in Fairacres for nearly three years after a fall, and during that time she’d survived a couple of bouts with pneumonia, Duane Rau said. She also had a heart condition. So the pandemic stoked new worries, as well as frustrations, as his mother grew lonely amid the isolation.
He said he told the nurse who called that he wanted to see his mother, “but they said no, I couldn’t,” Rau said. “I tried to call her a few times, but she didn’t answer the phone. It was hard on the phone for her. Face-to-face was better. That’s why I wanted to see her.”
March 24: State confirms outbreak
Two days later, on March 24, Fairacres alerted Duane Rau again. The news was grim.
“They told me it had happened that afternoon,” he said, his voice cracking. “They asked if I wanted to see her.”
He paused.
“You’re kidding,” Rau recalled thinking. “They wouldn’t let me see her when she was alive. And you ask if I want to see her dead. You’ve got to be joking.”
Rau said the pandemic was the last thing he thought would take his mother, a strong-willed homemaker from Eaton. But COVID-19 is cited on her death certificate, he said.
“She had a bad heart and a prognosis that she beat,” he said. “She’d fallen numerous times, fractured a bone in her hip, and beat that, too. She knew there was a bad virus going around, but didn’t seem concerned. And then she dies from COVID. I mean, really?”
The day Rau died, state health officials declared what staffers already knew: The nursing care facility was at the center of an outbreak. It took two positive resident tests to make it official, and there was still a big lag.
Despite that, nurses and other staff faced a public perception that nursing homes didn’t have it as rough as hospitals. Nienhueser, who started her 47-year nursing career in labor and delivery wards in hospitals and has since worked in several nursing homes, rejected that notion, saying: “I can guarantee that, because I’ve worked in both places.”
As they competed with higher-priority hospitals for the scarce supplies, nursing homes struggled to stock enough disposable gowns, masks and other personal protective equipment.
“There were times where ... you felt like it was out of your hands,” Gonzales said, “even though you know you were doing everything that is possible to help contain this and protect our residents. Sometimes it was very overwhelming.”
March 28: Darlene Weeden takes a turn
A call from Fairacres on March 28 reported that Darlene Weeden’s condition was bleak. It had been just a couple of days since Kirby, her husband, had noticed during a morning phone call that she was having trouble breathing. She was coughing.
Darlene had suffered from obesity and protracted pain for years, so shortness of breath wasn’t that unusual, Kirby said. But her husband chose to call her nurses just the same, thinking that “it just sounded like corona.”
Two days later, the deterioration of her condition caught her family by surprise.
“It baffled me that we were getting the call basically when she’s already incoherent,” said Casseday, her daughter. “I don’t think we realized she was in such dire straits and I don’t think it was communicated well that we needed to get there.”
When Kirby Weeden entered her room, covered in protective
gear, Darlene “was already unresponsive,” he said. “My gripe is they hadn’t notified me while she was still conscious — but maybe it was already a blessing.”
“I knew I might not see her again,” Weeden said. “The next morning, I was already showered and ready to go see her when I got the call. She had already died that morning.”
The family had been told by Fairacres that tests for COVID-19 came back negative, but they have their suspicions, especially since false-negatives have been a recurring issue with tests. Darlene’s nurses, including one from the insurance company, told them that her symptoms were consistent with COVID-19, Casseday said.
March 31: Staff members dig in
The tail end of March and early April brought heartbreak to other families. The outbreak was taking a toll on staffers, too.
For weeks, many had developed post-shift rituals — shedding clothes on their doorsteps, immediate showers and laundry, sometimes practicing physical separation from family members — to keep the virus from coming home with them.
At work, they lost residents they’d helped bathe and dress and care for, in some cases for years.
Meraz, the nursing assistant, remembers that period as the most emotionally draining. Staff members with symptoms had to stay home, and residents in the memory-care unit she works in had difficulty understanding why they needed to stay in their rooms.
Nienhueser remembers one resident particularly fondly, a man who died in April.
Early in the month, around Passover, Nienhueser’s daughter had organized a group through work at a State Farm insurance office to come to Fairacres. They provided hearts to put on all the doors, for good fortune. They spoke to residents through the windows.
Her daughter and granddaughter sang “You Are My Sunshine” to the man, she said, since that was his favorite song.
“Well, at the end, when he was struggling, it was just really sad to watch him, and I stayed with him and let his wife know that I was there,” Nienhueser said. “I tried to sing that (song) to him at the end.”
But there were victories, too, as many COVID-19 patients recovered.
“The first one that I remember (having COVID-19) is still with us,” Nienhueser said, recalling a woman in the long-term care unit. “She survived — she’s 90-some years old, too — and she’s a strong little lady. …
“Every time she sees me coming down the hall, she’ll open her arms and she’ll just say, ‘I love you, I love you, I love you!’ ”
April 9: Life continues, including death
As the coronavirus raged inside Fairacres Manor, the regular beats of life continued, including deaths from natural causes. In some cases, quick declines spurred questions, but not always answers, about whether COVID19 was involved.
Josephine Stutts, 91, died on April 9.
She had moved in about two years before after breaking her hip, needing more care than her senior housing in Greeley could offer. She flourished at Fairacres, said her son, Kenny Stutts. But during the pandemic, her family worried she was developing dementia. Afraid a window visit would confuse her, they arranged video chats.
“We’d get updates from the nurses, to be sure she was OK,” said Janet Millsap, Josephine’s daughter. “They were awesome, with as much as they had going on there. I just felt bad for them all.”
A couple of days before she died, Josephine complained of some pain and was running a slight fever, Kenny Stutts said.
“We were really worried, bigtime worried,” he said of the pandemic. “Hoping she didn’t catch it was an everyday thought. Then two days later, just like that, she’s gone.”
The family isn’t certain if the coronavirus played a part in Josephine’s death, but Stutts said the worry had worn them down.
April 20: Beginning of the end
Visitation is still restricted at Fairacres Manor, though state health officials are discussing potential new accommodations. Dozens of nursing homes continue to battle outbreaks.
But Fairacres is in the clear, at least for now.
It last reported an illness suspected to be COVID-19 on April 20, and the state health department determined its outbreak was “resolved” 28 days later, on May 18.
That week, there was some relief in her voice as Meraz, the nursing assistant, looked back on the most difficult days of her career.
“We’ve never gone through something like this,” she said. “I think this is the hardest that we’ve had from all the time I’ve been here . ... Just trying to keep all our residents alive and safe, it was just really hard.”
The death toll at Fairacres stands at 13, with eight fatalities confirmed through testing and five considered probable.
Fairacres and other residential health facilities face uncertain months, or maybe even more than a year, until a vaccine is developed. But testing has improved, as have understanding of the coronavirus and strategies for monitoring any new spread.
Pilot testing by Colorado State University and the state this spring found that in a sample of nursing homes, an average of 12% to 14% of staff members were carrying the virus without knowing it, said Randy Kuykendall, director of the state health department’s Health Facilities and Emergency Medical Services Division.
“We didn’t understand until just in the last month and a half to two months that there are asymptomatic carriers out there,” Kuykendall said.
Looking ahead, he said, “we are absolutely not out of the woods. There is still disease occurring in the buildings that are out there. This is going to be long-term battle.”