Virus victim’s family wants action
After Troy Center death, concerns arise over those who work at multiple sites
The family of a Troy nursing home resident who died during a recent coronavirus outbreak is calling for the state to take a deeper look into the facility’s handling of the crisis after it was revealed that an employee who worked at the site of another local outbreak may have carried in the virus.
The employee in question worked as a nurse at both the Troy Center for Rehabilitation and Nursing and the Diamond Hill nursing home in Schaghticoke, which had an outbreak of COVID-19 earlier this year and periodic cases since. The employee allegedly did not disclose to the Troy Center that they also worked for Diamond Hill, said Eileen Riley, an ombudsman for the Troy Center.
Rita Drozdzal, 91,died Aug. 8 after becoming infected at the Troy Center. But Denise Benoit, her, niece said she questions whether the facility really didn’t know about the employee’s other job.
“It seems very convenient for the organization to blame it on an individual not disclosing their full employment,” Benoit said.
A spokesman for the facility did not directly respond when asked to confirm if the employee had with
held this information. Rather, Jeffrey Jacomowitz said that for per diem employees like this one
“it has been traditionally our policy that we cannot limit the earning potential for these employees since they have to take care of their families.”
Nursing homes pay nurses and nurse aides less than hospitals, with aides’ salaries near the minimum wage. Direct care staff often work multiple jobs to make ends meet.
Rich Crist, director of operations for Rensselaer County, said the Riverside Center in Castleton also experienced an outbreak this summer that appeared to stem from someone with multiple nursing home jobs, and said the county nursing home prohibits outside employment for this reason.
“They don’t do that at these other (homes) and we see a lot of cross exposure,” he said. “A lot of these people migrate from job to job. I mean, all of these places have been on lockdown since March. How else is the virus getting in?”
Troy Center outbreak
The outbreak at Troy Center was first reported publicly July 30 after the county health department said 22 residents had tested positive in the previous 24 hours. But the origin of the outbreak remains unclear.
The county, facility and state Health Department have all provided different dates for the first cases at the home.
Jacomowitz, who serves as spokesman for the home’s parent company, Centers Health Care, said the facility was alerted to positive test results among residents July 29. He did not respond to a question about when the first staff case occurred but said the facility was notified that the Diamond Hill employee had tested positive for the virus July 24 — six days after the test was administered.
“Our labs are inundated with specimens, therefore they had been delayed,” he said.
Nursing homes are required to test staff weekly for the virus in an effort to curb its spread. But the number of tests that must be processed has led to backlogs at laboratories. Another Centers facility — the Essex Center in Elizabethtown — saw the virus spread unchecked for more than two weeks because of a 19-day turnaround delay. As of Wednesday, 88 people associated with the home had been infected and six had died, local media reported.
Jacomowitz said the Troy Center responds “proactively and quickly” after a positive case is discovered among employees, and works with the state to test all residents after each occurrence.
“Once the facility identifies a COVID positive employee, the center’s responsibility is to immediately remove the staff according to local and state mandatory quarantining per the Department of Health,” he said. “Additionally, according to the guidelines, employees are not allowed to return to work until a negative test is provided.”
By the time the facility says it learned of the Diamond Hill case, the employee had been work
ing with residents while infected for at least six days.
Benoit and her cousin Mary Ann Berghela say they’re mystified by this timeline.
The very first communication they received from the home about a positive case came July 30 — six days after the facility learned of the positive Diamond Hill employee. While nursing homes are required to notify families of cases among residents within 24 hours, they are only encouraged to acknowledge cases among staff, said Jeffrey Hammond, a spokesman for the state Department of Health.
Whether the center complied with the resident notification requirement is also in question.
County officials say they were first notified of a positive case among residents July 25. Hammond said the state was first informed that a resident had tested positive July 27, and went to the facility the next day to assist with testing. Benoit and Berghela said they received a call from the home July 28 seeking permission to test their aunt for COVID-19 as part of a “routine sweep.” No one said anything about positive cases at the facility, they said, and Benoit was told “there was no cause for alarm.”
Benoit said she learned the home was battling a large outbreak two days later when she saw it on the news.
“I immediately contacted the home and was glibly informed that Rita had tested positive for COVID,” she said. “I asked why we had not been contacted and was told that her results came in very late at night.”
Official communication in the form of a letter arrived Aug. 1, she said. On July 30, Benoit said her aunt’s medical provider (who was not affiliated with the home) called to let her know they had given Drozdzal an X-ray to see if she had pneumonia.
“Again, there was no communication regarding the results,” Benoit said, adding that she called the facility two days later to find out and was told her aunt had pneumonia.
Rita’s medical care
In the days to come, both Benoit and Berghela — who were Drozdzal’s health care proxies — said the facility never initiated contact with them to provide updates on their aunt’s status.
Whenever Benoit called for updates, she said she was told her aunt was “resting comfortably,” had good oxygenation levels, and had no symptoms other than a loss of interest in food and drink. She had also been placed on an IV cocktail of saline, antibiotics and blood thinner for the pneumonia.
“I asked if she needed to be in a hospital, and they informed me that she was fine and being treated inhouse,” Benoit said.
Benoit said that when she called again on Aug. 7 the facility told her the same thing — that her aunt was comfortable and didn’t require hospitalization. They said her oxygenation level had dipped slightly, but indicated there was “nothing to worry about” and said they had begun providing her aunt with mouth care — a form of palliative care that can reduce the risk of aspiration in pneumonia patients.
The next day, Benoit and Berghela got a call just after 5 a.m. informing them Drozdzal had died.
“We were absolutely shocked,” Benoit said. “There had been no indication that it was dire.”
The family questions why Drozdzal wasn’t seen by a physician or transferred to a hospital in the days leading up to her death. According to her death certificate, the last time Drozdzal was seen by a physician was nine days earlier on July 30 — the day she was diagnosed with COVID-19.
Asked why Drozdzal wasn’t seen by a physician closer to her death, Jacomowitz said Drozdzal did not have an acute illness that required a physician visit prior to her 30-day routine visit.
“Her underlying diagnosis included hypertension and heart failure, which initiated a comfort care status from her family members,” he said. “’Comfort Care’ care plan status indicates care measures that are less aggressive and oral food and fluids will be given as tolerated and/or as desired.”
He also said she had a physician’s order that included a Do Not Resuscitate, Do Not Intubate and Do Not Hospitalize order.
Benoit disputed that her aunt had a DNH order. As her health care proxy she would have known, she said.
“At the time we put the DNI/DNR order in place, just after she entered the home, it was contentious in the family whether to even put that into place, as we had a family member who objected to that,” she explained. “We finally convinced him that if she had a heart attack, we would see that as God’s will. But absolutely no DNH from the family.”
Benoit said the issue even came up when the medical provider called to inform her they would be X-raying her aunt for pneumonia.
“She said, ‘Well, you know she’s DNI/DNR,’ and I said I’m aware of that but that doesn’t mean don’t treat. That doesn’t mean don’t give antibiotics. It doesn’t mean if she needs to be hospitalized don’t hospitalize her.”
She also questioned how her aunt could have had underlying hypertension or heart failure without her proxies knowing.
“She was elderly and
91, so she wasn’t skipping across campus,” Benoit said. “But she was healthy, not on any medications or anything like that. She didn’t deserve to die that way.”
State investigates
A total of eight residents have died at the Troy Center, the most recent announced Saturday, according to figures kept by the county. The county has also recorded 31 resident and six staff infections at thehomeasofaug.24.
The state Department of Health says it conducted two unannounced inspections at the facility this summer — one June 11 and one July 28 — but declined to share the results. Hammond said the department has been working with the facility since it first learned of the positive staff case.
He also said the department is investigating a complaint against the facility, but declined to describe the nature of the complaint or whether it was related to the facility’s handling of the outbreak, citing an “ongoing investigation.”
“Every complaint is kept confidential, and at the conclusion of every investigation the outcome is shared with the complainant,” Hammond said. “Individuals who have a complaint or concern about a nursing home should contact the Centralized Complaint Intake directly at 1-888-201-4563, so appropriate action can be taken.”
Drozdzal, who never married or had children of her own, was beloved and cared for by many nieces and nephews, her family said. They moved her into the Troy Center in 2017 after police found her wandering the streets in winter without a coat, unsure of where home was or how to get there.
In Drozdzal’s obituary, Benoit described her aunt’s death as senseless and urged people to remember her situation when voting in the election this fall. In her view, the federal government’s failure to take the virus seriously contributed to the widespread contagion in communities and nursing homes.
“I believe the vulnerable people at the mercy of these nursing homes, and their families who care for them, deserve better communication regarding their care, deserve to be treated by a physician when they are ill, and deserve better than my aunt was given.”
“She was elderly and 91, so she wasn’t skipping across campus. But she was healthy, not on any medications or anything like that. She didn’t deserve to die that way.” — Denise Benoit, the niece of Rita Drozdzal