Assisted-living facility left families guessing as 11 died
ANGRY RELATIVES: College Station care home took weeks to disclose dozens of COVID-19 cases
Cathy Lester was nearly hysterical. Two residents of the assisted living center where her mom lives had died from COVID-19 the previous day, including one who lived just a few doors down, and the facility had yet to send out a notification.
“I get that if she’s positive, it’s very likely going to kill her,” Lester wrote in an email to staff on March 29. “I just wanted to know so that we can offer her support from out here. It may be that I’ve hugged her, kissed her, and talked to her face-to-face for the last time. We deserve to know.”
A day later, the Waterford at College Station’s executive director emailed families, acknowledging they “perhaps have heard some rumors floating around.”
“To date, we have both employees and residents who have tested positive for the virus,” the administrator said, without mentioning the deaths or providing a number of cases.
It took almost three weeks for the Waterford to disclose the toll of the virus there: 32 of 47 residents were infected with COVID-19. By then, 11 had died and 14
had been hospitalized. Another 13 staff members also tested positive for the disease.
The local health department also refused to provide details, and state health officials do not share information about coronavirus infections by facility.
Lacking official sources of information, the families got creative: They made a group text message where they pieced together what was happening by sharing what they’d heard from staff and loved ones, and any details they received when they individually pressed management.
The more they learned about what the Waterford was doing, the angrier some became about what it was doing — for example, after the first COVID-19 infection, some but not all residents were tested, and the facility wasn’t completely disinfected until 10 days after the first resident died.
At least 7,000 COVID-19 deaths have been reported nationwide in nursing homes and assisted living facilities, accounting for a fifth of the country’s fatalities so far, according to a New York Times tally.
Texas long-term care advocates say a lack of transparency about outbreaks has been a recurring complaint — including at a San Antonio nursing home where administrators withheld information from the state about some fatalities until media reports prompted health officials to probe further.
“It’s the one thing we consistently see to be a challenge, a problem, that needs to be improved,” said Brian Lee, executive director of the Austin-based nonprofit watchdog group Families For Better Care. “That’s the first thing: that there’s some kind of formal communication that’s regularly occurring with the families to ensure that they are managing the problem effectively and that their loved ones are safe from potential additional community spread within the facility.”
Capital Senior Living, the Dallas-based publicly traded corporation that owns the Waterford and 125 other senior communities across the country, said in a statement that it was “deeply saddened by the impact COVID-19 has had in our community” and that the safety and well-being of residents and employees are its top priorities.
The Waterford said it was unable to test all residents and staff at the beginning of the outbreak because test kits were not available. Instead, residents initially were not tested until being admitted to the hospital, another lapse that outraged families.
“Later, we were provided with a limited number of test kits and instructed to test only based on potential exposure or symptoms,” the statement read, adding that the Waterford later secured more for residents beyond those.
As for sanitizing and disinfecting, the facility said staff had already been following Centers for Disease Control guidelines prior to hiring a third-party company to address the building as a whole.
“It quickly reviewed options that could be available locally — evaluating the safety and effectiveness of their materials, processes, as well as their ability to provide their services in a 24/7 environment with limited disruption to our residents,” the statement read. “Upon finding the appropriate partner based out of Austin, the community had to wait a few days, based on that company’s ability to schedule a treatment in College Station.”
In the March 30 email to residents, the company wrote that it is “committed to open communication and keeping you aware of our current situation as it relates to coronavirus, our community and our response.”
Yet family members of Waterford residents interviewed by Hearst Newspapers said their increasingly frantic requests for more information about the outbreak went without clear answers for weeks. Barred from visiting the home by the governor’s March 13 executive order, they were more dependent than ever on the Waterford’s management for information.
“We were left out in the cold,” said Art Aguirre, who lives in Michigan and whose mother Estela was the second patient in the facility to die. “We could not participate in taking care of our own loved ones.”
While grateful for what she learned from the group chat, Cassie Schildknecht, whose grandfather Jack Bryant was the first resident killed by coronavirus, said it shouldn’t have had to come to that.
“It’s sad; it’s pathetic,” said
Schildknecht, who lives in Washington state. “You entrust people when you put your family members in these types of facilities. You expect transparency. You expect them to communicate with you on all levels, good or bad.”
‘This is not stomach flu’
Days before the first residents died, the Waterford told families in an email that there was a “24-48 (hour) stomach bug” going around and that was why it was calling a lockdown, adding “not a single resident has exhibited any symptoms of the COVID-19.”
The Waterford said in a statement that was because gastrointestinal symptoms at the time weren’t commonly associated with the disease.
Once the first resident tested positive, the Waterford notified families by phone, though some, including Aguirre, said they never received such a call.
Family members said they believe the facility could have done more and sooner to address the outbreak, such as widespread testing and disinfecting the facility earlier, as well as providing families with data on infections and reports on caregiver checks on temperature and other health indicators.
An email obtained by Hearst Newspapers from the Waterford to families shows that rooms were not disinfected until April 7. Aguirre said he called repeatedly in early March trying to get information about what precautions the facility was taking, and it took days to get hold of staff.
By the time his mother came down with a fever, she was rushed to the hospital and died less than 48 hours later. Aguirre’s brother David, who lives in town, had to wait in his car in the parking lot, as he was not allowed inside the hospital, which Aguirre said still “breaks my heart.”
“There’s really nothing I can do for my mom at this point,” Aguirre said. “My concern is really more as an advocate for people in my mom’s position. … Transparency is paramount. That’s what I’m advocating for now.”
As of Wednesday, 252 nursing homes and 75 assisted living facilities in Texas had at least one COVID-19 positive resident or staff member, state data shows. The virus has killed 164 in nursing homes and 43 in assisted living facilities — making up more than a third of the state’s total deaths.
Long-term care facilities across the state have been similarly tightlipped about disclosing outbreaks.
Southeast Nursing and Rehabilitation Center in San Antonio, where 74 tested positive for coronavirus and 18 have died, failed to report five fatalities until media reports caused local health officials to press administrators.
Families of residents at The Resort at Texas City, where 83 tested positive and one has died, have said the nursing home was slow to inform them about positive cases at the facility and many took issue with the medical director prescribing an unproven drug to treat the disease without asking for their consent.
Ann Criswell, a former Houston Chronicle food editor who lives at the Waterford, said she found out from her daughter, not from staff, that there had been a confirmed COVID-19 case there.
“They kept saying it was stomach flu, stomach flu, stomach flu,” Criswell said. “After about four days, I thought you know, this is not stomach flu; this is coronavirus.
“It drives me crazy because my whole career was about getting information, and I’m a big believer in information and telling people the truth,” she continued. “We all guess what’s going on and that’s a lot worse than knowing. That bothered me a lot.”
New federal rules
As federal officials have moved to address the communication gaps evident in the coronavirus response, their solutions so far don’t cover assisted living facilities like the Waterford at College Station, which are subject to less oversight than nursing homes.
On April 19, the Centers for Medicare & Medicaid Services said it will require nursing homes to notify residents, their families and representatives within 12 hours of a confirmed case of COVID-19 as well as when three or more individuals develop respiratory symptoms over a 72-hour period.
The new rules also require nursing homes to report COVID-19 cases to the CDC to help the federal government better track outbreaks and work to prevent them. The facilities were already required to report that data to state and local health officials.
Assisted living centers won’t be subject to those rules, however, because unlike nursing homes, they’re not federally regulated and instead are overseen by the states.
Texas inspects assisted living facilities once every two years, whereas federal regulators inspect on an annual basis.
With in-person visits from the state’s long-term ombudsman on hold, fewer inspections from state regulators and families and other visitors barred from entering during the coronavirus pandemic, those extra eyes and ears on resident care are missing.
“It’s pretty much a free-for-all right now in nursing homes and assisted living centers,” Lee said.
Meanwhile, nursing homes and other health care facilities have pushed for and received temporary immunity from civil lawsuits in several states, including Connecticut, Illinois, Massachusetts, Michigan, New Jersey and New York.
Lawmakers in Texas have made no such proposal.
U.S. Sen. Ben Sasse, R-Neb., has proposed similar legislation at the federal level.
Keeping negative
After Lester pressed for a test for Criswell, who has several underlying illnesses, including diabetes, heart failure and high blood pressure, she tested negative in early April.
For now, all that Lester, Criswell and other families with residents remaining in the facility can do is hope for continued negative results. Criswell tries to occupy her mind by reading, lately a collection of Christmas stories, and spending time with her daughter during visits at her window.
Criswell attributes her good health so far to her choice to selfisolate in her room even before the facility called for residents to do so, but she said she still worries her luck could change.
“I don’t see how I have possibly escaped,” Criswell said. “But as long as I’ve got a book, I’m OK.”
Criswell was tested again Monday. Still negative.