‘We’re putting other people at risk.’ Coronavirus deaths mount at Idaho care facilities
As the coronavirus has quickly claimed more American lives than the Vietnam War, few have been harder hit than nursing homes, assisted living and other long-term care facilities.
The dangers facing those facilities in neighboring states like Oregon and Washington have been well-documented. But staff in some Idaho facilities have raised alarm — saying their patients are falling ill, and they’re being asked to report to work sick, often against their better judgment and with scant protections for residents or coworkers.
Meanwhile, public health agencies haven’t been uniform in their disclosures about outbreaks in Idaho.
In one instance, Idaho’s most populous health district issued a press release about a large outbreak at a local nursing home. But another health district, which includes the Magic Valley and Wood River Valley, withheld similar information about outbreaks in its facilities.
Central District Health, which covers Ada, Elmore, Boise and Valley counties, has logged outbreaks in at least five long-term care facilities. Of the 62 confirmed or probable coronavirus cases at those facilities, health district spokeswoman Christine Myron said 33 were staff and residents from Avamere Transitional Care and Rehabilitation in Boise.
Within a month and a half of Idaho’s first reported COVID-19 case on March 13, the virus had struck 16 nursing homes, assisted living facilities and group homes across the state. It infected 150 people who lived and worked at those facilities. And the known or suspected infections at the facilities made up nearly half of the recorded COVID-19 deaths in Idaho by April 23.
Those deaths happened amid a perfect storm of bad circumstances and failures, described to the Statesman in numerous interviews.
Caring for Idaho’s most vulnerable residents
Before the new coronavirus came to Idaho, nursing homes and group homes already held some of Idaho’s most vulnerable people. The facilities already were hard to staff appropriately — with physically and emotionally demanding jobs that paid relatively low wages, due to strapped funding sources like Medicaid. Some of the facilities already struggled to meet health and safety standards.
Then, a pathogen arrived that was perfectly suited to attack each of those vulnerabilities.
The coronavirus could spread quickly in shared spaces. Its apparent fatality rate among the elderly and infirm was much higher than the flu. And it could take out Idaho’s workforce; if too many nurses or staff members had to quarantine when they got sick or were merely exposed to the virus, where would a manger find someone to fill in for them?
“Being a physician and looking at this from a medical standpoint, we did this all wrong. We did this way wrong,” said Dr. Tom Young, a former state health care official and a partner in Interim HealthCare of Southwest Idaho. That’s a local agency that provides care to people, including at local nursing homes and assisted living facilities.
“We should have locked (down) group homes, nursing homes, assisted living facilities; tested people going in there at least once a week, twice a week; isolated people who got it immediately, and tested the people living there on a regular basis,” he said. “We didn’t. We decided to shut everybody down and really didn’t focus on taking care of those people.”
By April 23, the coronavirus had killed at least 26 people in Idaho nursing homes and other long-term care facilities.
Coronavirus hits Idaho group homes, nursing homes
Throughout the month of April, the virus gained a foothold at some Idaho care facilities.
Life Care Center of Lewiston said Thursday that 17 of its residents have died since the coronavirus was discovered at the facility about a month earlier. Eight of those people tested positive for the virus, according to the facility. The center accounts for almost all of the confirmed COVID-19 cases in its North Idaho county, with 34 of the center’s residents and 14 staff members testing positive.
Obituaries for two women who recently died at Life Care Center said they died of COVID-19. Both obituaries thanked the staff for the care they provided. “They are incredible,” one obituary said. “She felt lucky to be there,” said another.
The virus also has killed people in the southern part of the state and infected elderly residents at senior care facilities. At least 14 staff and residents had COVID-19 at one Boise nursing home, Avamere Transitional Care and Rehabilitation, as of April 14. One of the residents had died.
At one facility in Twin Falls, four residents with COVID-19 symptoms died in a single night, according to emails obtained through a public record request.
The emails showed that between April 6 and April 16, at least 20 staff and eight residents tested positive for COVID-19 at four care facilities in South Central Idaho. The emails showed at least 10 more people had probable coronavirus infections or had symptoms. (The emails did not identify the patients or infected staff.)
Employees and residents at more facilities had symptoms, the emails said, but it’s unclear if they were probable or confirmed cases of COVID-19.
At Jerome group homes, staff worked while sick
There was at least one outbreak between April 6 and April 16 at group homes owned by CommuniCare, a chain of facilities for people with intellectual disabilities in the Treasure Valley and Magic Valley.
At least six staff and two residents at the company’s Jerome facilities tested positive for the virus in that time, according to the emails. (CommuniCare Jerome resident Rex Dean Wilson died April 8 from COVID-19, according to his obituary.)
Several employees of the chain told the Idaho Statesman that their company didn’t provide masks to protect staff or residents until after people began falling ill. They said the company never provided the type of masks capable of filtering the virus. Some said employees were pressured to work with COVID-like symptoms when they couldn’t find anyone to take shifts.
The Centers for Disease Control and Prevention currently recommends that long-term care facilities screen employees for illness, that workers stay home if they’re sick or have a fever, and that workers wear masks.
But the CDC also says workers may wear cloth masks, which are less able to prevent the virus from spreading. The CDC has looser COVID-19 guidelines for health care businesses that are short-staffed. For example, it allows them to decide that workers “with suspected or confirmed COVID-19 (who are well enough to work) could return to work in a health care setting” before they meet all the CDC criteria to safely return to work.
Employees of CommuniCare told the Statesman they worked with COVID-19 symptoms, including fevers, with only surgical masks and social-distancing attempts to protect their clients. Some employees later tested negative for the virus, but the Statesman confirmed through public records that at least six CommuniCare staff members tested positive for the virus.
“We’re putting other people at risk (and) putting our clients at risk,” said an employee who didn’t want to be named due to fear of retaliation.
Another employee, who didn’t want to be named for the same reasons, echoed those fears for their clients and coworkers. Because they were unable to find someone to cover their shift, the employee told the Statesman they worked a full shift with COVID-19 symptoms before receiving confirmation they tested positive for the virus. The Statesman confirmed portions of the employee’s account by reviewing a copy of their work schedule.
“I don’t think it’s fair for them or anyone that has to be near me,” the employee told the Statesman.
CommuniCare CEO Bridger Fly, who also presides over the Idaho Health Care Association board, did not respond to messages from the Statesman.
The association’s executive director, Robert Vander Merwe, declined a request from the Statesman for an interview about the outbreaks in nursing homes and group homes. Instead, Vander Merwe provided a lengthy emailed statement that said the association is “devastated by the losses in any long-term care facility” in Idaho and the U.S.
The statement said outbreaks in Idaho’s long-term care facilities “are not the result of inattentiveness or a shortcoming of facility staff,” which was not something the Idaho Statesman suggested.
“It is the combination of the behavior of this virus and the unique threat it presents to the people we care for — older adults and those with disabilities who also have multiple underlying health conditions,” the statement said. “Even doing everything right, this virus is still getting into some of the best buildings in the nation due its unpredictable and extremely contagious nature.”
Idaho’s long-term care facilities have implemented their infection control plans, followed state and federal guidance and done “everything we can” to keep residents safe and stop the coronavirus from spreading, he said.
Vander Merwe said nurses as well as “housekeepers, social workers, cooks, dietary aides, activity staff and even maintenance directors are sitting at the bedside” of vulnerable residents. “Not only are these heroic staff doing their assigned tasks, they are providing one-on-one care, and filling the void of residents’ families who are not allowed to visit during this quarantine.”
The Statesman has heard repeatedly from frontline workers, who describe not getting the help they need to keep those residents safe. Those concerns are among the reasons the Statesman reached out to the association.
“Criticism at this time is only designed to increase concern about the preparedness of our health care providers and is not helpful during a pandemic,” Vander Merwe wrote. “We hope that America will rally around our residents and caregivers the same way they have around hospital patients and workers.”
Vander Merwe didn’t respond to a follow-up email asking to discuss issues that his statement didn’t address — like what happens when a worker gets sick and a manager can’t find anyone to fill the shift, or whether nurses and other staff have enough access to protective gear to keep themselves and their residents safe before and during an outbreak.
Idaho’s nursing home strike team
Idaho Gov. Brad Little assembled a “strike team” in March to help nursing homes and other long-term care facilities steer through the pandemic.
Through March, Idaho’s nursing homes began to lock down and not allow visitors. They began to check the temperature of anyone who entered. But those measures could only help so much, because someone who is contagious with COVID-19 may not have a fever right away — or ever.
Things like masks, gloves, face shields and gowns can keep the virus from spreading to staff and their patients. But a chronic shortfall of that equipment kept it from being distributed in abundance to frontline workers in all areas of the health care industry.
Testing for COVID-19 followed the same theme: Idaho had a shortage of tests, with few making it to smaller and rural health care organizations that weren’t tapped in to large networks. The tests were prone to problems — taking as long as two weeks to get back results, and some of those results were inconclusive.
The strike team Little put together is chaired by Dr. Marcia Witte, with the state’s public health division, and Tamara Prisock, who runs the state bureau for inspecting and licensing Idaho health care facilities.
Neither of them was available for an interview to discuss personal protective equipment — like masks and gloves — or staffing challenges during a pandemic. They offered the following statement and a document that outlines their actions and priorities as of late April.
“If unable to obtain (personal protective equipment) through normal supply chains, long-term care facilities can request PPE through their local health districts,” the statement said. “The state supply of PPE is managed by the Department’s Division of Public Health’s Preparedness Program and the Idaho Office of Emergency Management. The LTCF Strike Team does not manage PPE distribution to facilities, but the team’s constant communication with nursing homes and assisted living facilities allows the team to facilitate communication about PPE inventory and needs between facilities, local health districts and the state.”
Young said last week that he’s trying to problem-solve on his own. He is working with a businessman whose factory in China can produce a massive number of N95 masks. He hopes to bring some of them to Idaho.
“I don’t want our staff to be the thing that brings this into someone’s home,” he said.
Beyond the facilities, agencies struggle
The pandemic is altering the landscape of Idaho’s services for people with disabilities.
One group warns that could have long-term effects on vulnerable Idahoans, and on Idaho’s health care system.
“As a result of the public health emergency, community-based providers are experiencing a severe workforce crisis in residential settings and an inability to maintain center and school-based services which relied on group settings,” the Idaho Association of Community Providers said in a news release that called on state leaders to help agencies survive the crisis.
“As community providers close, vulnerable Idahoans will be forced to rely on emergency services to have basic needs met,” it said.
Community Partnerships of Idaho is one of the largest agencies in the state, providing a slew of services across Idaho. But with the stay-home order, serving clients out in the community sometimes isn’t possible, and families aren’t comfortable with staff coming to their homes.
CPI’s revenue dropped by half since the COVID-19 crisis began, according to Elizabeth Caval-Williams, executive director. The agency laid off about 150 employees in recent weeks.
CPI has better access to protective gear than many smaller agencies, Caval-Williams said. But even its most dedicated workers worry about risking their health as they go out into the community to care for people. Agencies can’t afford to give workers hazard pay without more funding from the state, the Idaho Association of Community Providers says.
“It’s a matter of where people are at, in terms of their own comfort and, honestly, their own appetite for risk at this point,” Caval-Williams said. “They live in systems and in worlds and affect loved ones that don’t necessarily make them good candidates to be deploying out.”
The Idaho Association of Community Providers has warned that the layoffs — and, in some cases, total agency shutdowns — might be long lasting.
“We will continue doing everything we can to protect these critical services and continue supporting Idahoans with behavioral health and developmental disabilities,” Executive Director Lydia Dawson said in the news release. “We urge state leadership to fund community providers and the health care staff out in the community through these unprecedented times.”
