Alone, Ignored, And the Virus at The Door
Bloomberg Businessweek|November 09, 2020
Nursing homes responded to the pandemic by blame-shifting, but an investigation into a troubled chain suggests the industry could have done more to stop outbreaks
By Ben Elgin

In early April the Trevecca Center for Rehabilitation & Healing in Nashville received an urgent call. At the time, Tennessee had only 3,000 coronavirus cases, compared with more than 100,000 in the state of New York. But the caller, the nursing director at a nearby kidney dialysis center, was worried. She said one of the home’s residents had been given a routine test before an appointment and had tested positive for the coronavirus. She said she believed that Trevecca, a 240-bed nursing home, might have an outbreak on its hands. Trevecca’s managers were busy, she was told, so she left a message.

Two days later, the caller tried again, insisting that this was serious and asking to speak with the home’s administrator, Carl Young. But she didn’t get through to Young—nor did people from a second dialysis center with an identical warning, say four current and former Trevecca employees familiar with the calls.

The dialysis workers weren’t the only ones worried that something was wrong at the facility. Nashville’s Metro Public Health Department had also gotten a report from a Trevecca contractor who was helping oversee its ventilator unit. The contractor said a Trevecca manager had warned him that sick residents weren’t being tested for Covid. “This just does not seem right clinically or ethically,” wrote the contractor in an email, which was first reported by the city’s NewsChannel 5.

Metro health officials spent several days trying unsuccessfully to reach Young. On Saturday, April 4, Michael Caldwell, the department’s director, drove to Trevecca’s five-story facility and left his card, imploring Young to get back to him immediately. That evening, Young finally did call, assuring Caldwell that everything was under control, according to health department officials. He said no residents were showing symptoms of the virus, and there was no need for tests. (Young didn’t respond to requests for comment.)

It would be another 18 days before health officials came in to test all of Trevecca’s patients and many of its workers. By the time that finally happened, on April 22, the disease had spread widely. More than 45 out of about 300 tests came back positive. In the coming weeks, more than 100 additional residents and staff would be infected. Six would die, including Charles Horton, an 82-year-old former police officer. He’d first showed symptoms, including shortness of breath, in mid-April.

The facility had previously told his son, Tim Horton, that his dad was negative for the virus. But Charles’s symptoms worsened, and he was rushed to the hospital in late April, where he tested positive. He died on May 2. Tim thinks if management had tested the entire building sooner, his dad might still be alive. “These people have shown neglect,” says Tim, who isn’t sure whether his dad was actually tested earlier. He’s hired an attorney to pursue a lawsuit against Trevecca’s owners. “It ain’t right.”

Trevecca is one of nine Tennessee nursing homes acquired over the past four years by CareRite Centers LLC, a chain based in Englewood Cliffs, N.J. In response to a detailed list of questions, Ashley Romano, CareRite’s chief experience officer, said in a written statement that the company has “worked diligently to go above and beyond what is recommended by regulatory bodies to ensure the health and safety of our residents and staff,” including setting up isolation zones, discontinuing communal dining and activities, and supplying protective equipment before I t was required. Romano added that CareRite’s facilities, including Trevecca, passed infection control in spections since the pandemic began. “Our company was founded by people who care deeply about our work and the residents and families we serve,” she said.

Two of Tennessee’s three largest outbreaks at nursing homes to date have been at CareRite homes, Trevecca and the nearby Gallatin Center for Rehabilitation & Healing, and two other CareRite facilities are among the top 15 in Covid cases statewide. As of early October, the company operated 4% of the state’s nursing home beds but accounted for 10% of cases and 11% of fatalities, or 71 deaths in total. The numbers are similarly elevated when compared with facilities around Nashville, a virus hot spot. CareRite’s five homes within 25 miles of the city center suffered an infection rate more than three times that of the metro area’s 26 other homes.

Romano says CareRite has detected a high number of cases because it proactively tested residents and staff“whether or not they are showing symptoms.” She adds: “These measures undoubtedly showcased higher numbers but most importantly allowed us to separate the sick from the well and celebrate countless recoveries.”

But many employees say these high infection rates were entirely predictable, caused by a lack of supplies and a blinkered attitude about the risks the virus posed. “It was a hot mess,” says Tika Johnson, a 45-year-old nurse practitioner who worked as a contractor at Trevecca and spent seven days in intensive care after testing positive on April 24. (She stopped working in CareRite homes not long after she recovered.) “They weren’t prepared for what was coming,” she says.

Outbreaks at nursing homes have become achingly familiar across the U.S., beginning with the one in February in Kirkland, Wash., that killed 35 elderly residents of the Life Care Center. Only 0.6% of the total U.S. population lives in nursing homes and assisted living facilities, but they account for 40% of Covid fatalities, according to data from the Kaiser Family Foundation. Put more simply: Residents of long-term-care facilities are about 100 times more likely to die from Covid than members of the general population. More than 450 nursing homes, out of 15,000 nationwide, have suffered outbreaks that infected 100 or more people.

As industry executives point out, some of the reasons for these high death rates have nothing to do with the homes themselves. Old people who become infected with the coronavirus are much more likely to die from it, and anyone who lives in close quarters with others is at greater risk of infection. “Unfortunately this virus does not discriminate,” said Richard Feifer, chief medical officer of Genesis Healthcare, the nation’s largest nursing home chain, in a May investor call. “It has impacted five-star and one-star centers alike.”

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