The Register Citizen (Torrington, CT)
Covid clusters: Seniors at risk
WASHINGTON — For Eva Bettencourt, the wait lasted 48 hours.
“I just flipped out, like, ‘How does this happen?’” she recalled recently, sitting on her porch in Peabody, Mass.
That’s how long it took to find out if the COVID-19 test given to her mother, Arnalda, 81, by a Boston-area nursing home was positive for the disease that has killed more than 68,000 Americans so far.
Forty-eight hours — two days.
“It was the worst. I couldn’t focus,” she said in an interview.
The coronavirus test came back positive.
Another showed pneumonia.
Arnalda went to the hospital hours after the diagnosis, on April 1.
Thirteen days later at 7:39 in the morning, the woman who emigrated to the U.S. from Portugal and raised four kids, took her last breath.
In Eva’s view, the nursing home where her mother had lived for about a year, Brentwood Rehabilitation and Healthcare Center, did not do enough to prevent the spread of the virus.
“It was between sadness, and then the rage and the anger took over,” Bettencourt said. “One-hundred percent in my soul, in my heart, I believe this was not her time to go.
“My anger, my rage was directed, and completely and still is, to the nursing home facility that she was at because they did not protect her. That was their duty,” she said.
New guidance to states
No other demographic group has suffered greater than residents of nursing homes and other long-term care facilities, as home after home has been unable to keep the virus from tearing through the ranks of their older residents. While the count of deaths in nursing homes is still imprecise, Arnalda Bettencourt would, by one estimate, be one of at least 16,000 deaths attributed to COVID-19 through April 23.
At Brentwood, located in Danvers, north of Boston, 13 residents including Bettencourt have died after testing positive for COVID-19, the facility said, and as of last week there were 78 residents who had tested positive for the virus, including some who were asymptomatic.
That facility, the Hearst Television National Investigative Unit has learned, is one of thousands singled out for socalled “COVID-focused” inspections, an effort launched by the federal Centers for Medicare and Medicaid Services to ensure nursing homes’ compliance with regulated standards of care.
In a March 20 memo sent to states, CMS directed state health departments to prioritize “Targeted Infection Control Surveys” ahead of routine inspections to focus on facilities where residents may be in “immediate jeopardy for serious injury or death.”
Brentwood passed the focused inspection March 31 with no infection control deficiencies, after having been cited for those types of problems in each of the past two years, according to state and federal records.
In a statement, the facility’s administrator, Carly Veiga, said the facility has “never wavered from our commitment to protect and care for our residents.”
Veiga continued, “We meet or exceed all federal and state health guidelines, which change regularly, and have restricted visitors, frequently sanitized, screened staff for symptoms and closely monitored the medical conditions of residents.”
Nationwide COVID-19 inspections
In all, the Hearst Television National Investigative Unit obtained and reviewed hundreds of pages of new, preliminary COVID-19 focused reports from inspections of 181 facilities in 22 states since midMarch.
They show that, even as the coronavirus was spreading rapidly across the U.S., some nursing homes were still failing to follow infection control standards. Infection control deficiencies were noted in 22 percent of the homes inspected, an analysis shows.
In eight of the facilities, the deficiencies were so severe that they put residents in “immediate jeopardy” of contracting COVID-19 or other infections, inspectors found. At The Hearthstone in Seattle, home to 245 residents, deficiencies were severe enough to warrant an immediate jeopardy finding for a lack of staff protection in its skilled nursing area, among other items. In a statement for this story, administrators there said their “immediate actions corrected these process lapses” and it returned to “full compliance” nine days after surveyors identified the issues.
At Aperion Care Chicago Heights in Illinois, inspectors determined residents were in “immediate jeopardy” after they found residents eating, playing cards, playing basketball and otherwise walking around without following social distancing procedures. Spokeswoman Heather Levine said in a statement the facility “is taking a proactive approach in protecting our residents by following” federal health recommendations.
In Miami, at Golden Glades Nursing and Rehabilitation Center, inspectors issued an “immediate jeopardy” finding after discovering that staff were not aware that a resident was possibly infected with COVID-19 and so were not taking safety precautions, among other lapses.
‘You are scared’
Golden Glades is now isolating coronavirus patients on its fourth floor, according to an employee at the facility who works in a different part of the building and asked not to be identified for fear of jeopardizing her employment.
“Working there, it’s rough. But somebody needs to do the work,” she said in an interview after a recent shift.
“Yes, you are scared, but you have to have faith.”The facility did not provide comment after a two weeks’ worth of requests, but did resolve the inspector’s “immediate jeopardy” finding, according to the report.
‘Lots of mistakes by lots of people’
Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, reviewed the inspection reports at the National Investigative Unit’s request, identifying a common theme that she said left her “most disturbed.”
“Lots of mistakes by lots of people and lots of fundamental mistakes,” she explained. “Not washing their hands, not changing their gloves, not disinfecting medical equipment between residents, very basic, long-standing requirements, still making the same mistakes.”
“The consequences for residents we know can be lifethreatening,” she said. “People could die. People are dying in many states.”
CMS pledges ‘all our resources’
Contacted for this story to confirm the authenticity of the inspection reports and its survey priorities, CMS said in a lengthy statement it has now scheduled 7,000 COVID-19focused infection control inspections and it pledged to “publicly post and report information on completed surveys soon.”
The inspection reports reviewed for this story are preliminary as part of pending investigations and CMS pointed out a provider “has a right to full due process so until they waive or exhaust their appeal rights, the findings might change based on a ruling from an Administrative Law Judge.”
CMS Administrator Seema Verma addressed the agency’s inspection initiative during a brief interview last month, saying her agency wants to “assess nursing homes across the country for infection control. And we’ve actually used all our resources to do that.”
“We’ve been putting out regulations and guidelines almost every couple of weeks to make sure that state and local health officials are supporting the nursing homes that are extremely vulnerable to the impacts of the coronavirus,” Verma said.
‘Misleading and completely counterproductive process’
But the leader of the nation’s largest organization representing nursing home argues the inspection system CMS is touting is part of a “very antiquated, misleading and completely counterproductive process.”
Mark Parkinson, CEO of the American Health Care Association, advocated in an interview for a more “collaborative” system modeled on how hospitals are currently surveyed, and said some of the deficiencies listed on the inspection reports — even if cured — would not have prevented the pandemic from sweeping into America’s long-term care facilities.
“If the thought is that if these folks were washing their hands a little bit longer or changing gloves a little bit more, that that would have stopped this — that’s just simply ignoring the vicious nature of this virus,” Parkinson said.Parkinson said his members need more testing kits, personal protective equipment (PPE), and money from state and federal governments to stop the spread of COVID-19 and protect residents and staff.
“The battle is in nursing homes and we had been treated as second class citizens,” Parkinson said. “Our call now is for the country to rally around nursing homes the same way that it did around hospitals.”
On Thursday, days after the interview, the White House announced it would send PPE shipments to all 15,400 nursing homes certified by Medicare and Medicaid and disperse $81 million to states for increased facility inspections.
‘It should not have happened’
By one measure, long-term care residents now make up one out of every four COVID-19 deaths, the Kaiser Family Foundation calculated using data from states that are publicly reporting the figures.
It’s a staggering toll that includes Arnalda Bettencourt, in Massachusetts.
“It’s insane,” her daughter, Eva, said, sitting next to a collage of photos of her late mother.
“There is no reason for this. It should not have happened this way.”
Mark Albert is the chief national investigative correspondent for the Hearst Television National Investigative Unit, based in Washington D.C. Kevin Rothstein and April Chunko contributed to this report.
Have a coronavirus-related tip? Send information and documents about this topic to the National Investigative Unit at investigate@hearst.com.