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Nursing homes struggle to keep residents safe as coronavirus cases surge outside their walls

St. Louis Post-Dispatch - 11/23/2020

Nov. 22--ST. LOUIS -- It was late September when Virginia Minner's mom called her from the Potosi Manor nursing home in Washington County.

"Well, the virus is here," said Judy Carron, 78, who has advanced Parkinson's disease, one kidney and congestive heart failure.

The coronavirus had yet to find its way into the facility, home to about 55 residents. But as cases surged in the counties surrounding its walls, it became harder to keep the deadly virus out.

Ten residents tested positive in the week ending Sept. 20, federal data shows. The next week, 25 cases were reported along with the facility's first COVID-19 death.

Over the next few weeks, it spread to nearly all the residents, including Carron, a mother of four and homemaker who at one time worked as a cook in her daughter's restaurant.

"My heart jumped up into my throat," said Minner, who lives near Nashville, Tennessee. "I thought, 'She's going to pass away in there, and I'm not going to be able to get in there and see her.'"

In quarantine, Carron's delusions got worse. She lost 25 pounds. She had a fever and stomach aches. But the woman they call "Teflon grandma" because of her toughness, Minner said, slowly got better.

By Oct. 11, however, seven other residents had died of COVID-19.

Despite strict visitor policies, daily symptom checks and routine testing of staff, nursing home administrators say they are fighting an impossible battle to keep Missouri's most vulnerable residents safe as the state faces record levels of positive cases, going from averaging less than 2,000 new cases a day a month ago to nearly 5,000 now.

Missouri Gov. Mike Parson has taken a decentralized approach to curbing the spread, leaving local governments to pass their own mask mandates and business restrictions. Most have not, however, resulting in a patchwork of a strategy against a virus that knows no boundaries.

All of Missouri's counties, except Audrain and Mercer, have reached the "red" level -- the highest level of community transmission based on data such as rate of new cases, positivity rate and deaths per capital -- according to the latest White House Coronavirus Task Force report for the week ending Nov. 15.

Roy Temple's mom is in a nursing home in Dexter that is experiencing its first COVID-19 outbreak.

"The reality is those residents are only as safe as the most careless person that staffer interacts with outside the facility," said Temple, 56, of Kansas City. "That's what they carry with them back in that facility the next day."

Nearly 75% of coronavirus cases in Missouri's nursing homes have been reported in the last three months -- going from 3,045 residents and 2,078 staff infected by Aug. 9, to 11,208 residents and 8,308 employees infected by Nov. 8, the latest federal data shows.

About two-thirds of the COVID-19 deaths in Missouri's nursing homes have also come in the last three months, with no signs of letting up. As of Nov. 8, the virus has killed 1,680 residents, 263 more than just the previous two weeks.

Twenty-three employees have died, three more than the previous two weeks.

The U.S. Centers for Medicare and Medicaid Services began collecting and publicly reporting the data on May 24. The weekly reports only include federally licensed nursing homes, including 522 in Missouri.

The federal reports do not include assisted-living and other types of residential facilities licensed by state or local authorities. Missouri's health department has refused to issue detailed reports about those facilities.

The residents are among the most vulnerable to dying from the virus because of their age and health conditions. While they represent a fraction of the cases, nursing home deaths represent nearly half of all COVID-19 deaths reported in Missouri.

Minner said her family was told by administration at Potosi Manor that they did not know how the outbreak started. The administrator did not return a phone call from the Post-Dispatch seeking comment.

Federal data shows five staff members tested positive in the few weeks before the first resident case. As cases increased among residents, they also increased among staff -- to 26 total.

With the home not allowing visitors since March, Minner said, she suspects staff exposed residents to the virus after becoming infected in the community.

Washington County hardly saw any coronavirus cases among its population of 24,730 until August, when numbers began quickly rising. The county saw its highest seven-day average of 35 daily cases on Nov. 10.

The latest tally of 1,323 cases means Washington County has the 28th highest per capita rate in Missouri, higher than the rate in the city of St. Louis and its surrounding urban counties, state data shows.

"That area down there, it's very like, 'Let's go party, let's have some fun.' That's why they've got 1,000 cases or more now," Minner said. "I knew sooner or later it was going to trickle in there, because you can only hold people down so long."

Prayers keep changing

As November approached, John Langley thought maybe the virus was going to miss Cypress Point Skilled Nursing in Dexter, where he has been the administrator for 26 years.

Langley wanted to do something special for Thanksgiving, to make up for missing the large holiday meal they typically host for families. He managed to get approval from the local health department and the facility's owner, Americare, to cook Thanksgiving dinner for different families each week.

Family members could sit at the ends of a long table with plexiglass between them and celebrate the holiday together.

The first round of meals was joyous, Langley said. But it all came to a halt Nov. 7, when two employees tested positive. Further testing revealed the facility's first positive case in a resident.

Each day has brought more cases. By Thursday, 44 residents out of 58 had tested positive, Langley said. With no more room in the facility's isolation wing, residents had to quarantine in their rooms with plastic over their doors.

The first death came Friday, a man in hospice care for cancer.

"Our prayers keep changing," Langley said. "First it was 'God, just let it pass over us.' Then it was 'Let it be contained.' Now, it's just 'Let them recover and symptoms be mild.'"

One pair of roommates sobbed after one tested positive, forcing them to separate, Langley said. A son whose mother has dementia worries she won't remember him whenever he's able to see her again.

Some residents' health is deteriorating from the lack of interaction. Others aren't eating as well. "It's hard for the residents to understand," he said.

The coronavirus also spread through the staff, with 27 -- more than a third of the employees -- testing positive by Thursday.

Employees who test positive but don't develop symptoms are still able to care for residents who are also positive. It's not ideal, Langley said, but there's no other choice.

"It's just become a day by day, shift by shift, do what you can do to get through," Langley said.

An impossible task

Cypress Point is in Stoddard County, where cases of coronavirus did not start climbing until the first week of September. They continued increasing, peaking at an average of 36 cases a day on Nov. 14.

With a population of 29,025, its 1,475 total places its cases per capita among the top third in the state. Currently, about 40% of tests in the county come back positive.

"When you have a virus where (infectious) people can be asymptomatic and showing no symptoms, it's just, how do you keep it out?" Langley said.

Ben Sells is president of the family-run Paradigm Senior Management, which operates Winchester Nursing Center in Stoddard County as well as two other nursing homes in the Missouri Bootheel.

During the last two weeks of October, Winchester saw the most resident COVID-19 deaths per occupied beds in Missouri, according to a tracking site created by Chris Prener, a sociologist at St. Louis University. Prener took the federal nursing home data and made it easier to compare only Missouri facilities.

The small facility with about 30 occupied beds saw 13 staff members and 28 residents test positive in October. Five residents died. Paradigm's Sikeston facility is also seeing an outbreak, Snells said.

"Our facilities have been surrounded by community spread but have been able to keep it out just until recently," he said. "It just goes to tell you how widespread the virus is in the communities. It's beyond anything I've ever seen in my entire life."

He's had to turn to strapped temporary staffing agencies and pull employees from other buildings. Still, staff are working 12-hour shifts. Some must spend hours recording COVID-19 testing and protocol data.

"We've been handed an impossible task," Sells said. "It seems the government can't come up with anything else but more regulations, more reporting, and change this. And we are out here fighting for our lives, fighting for our residents' lives."

'A moment of truth'

Shunda Whitfield, 50, of Bellefontaine Neighbors, works as a certified nurse assistant at the nearby Estates at Spanish Lake nursing home in north St. Louis County. The county has averaged a record 754 cases daily over the past week.

She's also the center of her family, she says, helping watch after her nieces, nephews and grandchildren.

Whitfield had COVID-19 in April, but worries she could get it again. She says other workers test positive after recovering from an infection in the spring. Last month, the Estates at Spanish Lake saw its most ever -- six staff members and 16 residents -- test positive in one month, federal data shows.

"You don't know who you are coming into contact with, who has it," she said. "You are scared for your family. You are scared for your residents. You are scared for your other employees, because you just don't know, and you could expose everybody to it."

Marjorie Moore, with VOYCE, a Creve Coeur-based nonprofit that advocates for nursing home residents, said facilities have stepped up their infection-control measures but the virus finds it way in.

Despite their protective gear, staff spend many hours up close with residents, moving, dressing and bathing them. They brush their teeth and take them to the bathroom.

"That's why it spreads so quickly in facilities," Moore said.

Family members complain they have trouble getting updates about their loved ones from the facilities, but that's because they are so short-staffed, Moore said. "That is a huge problem."

Temple said his mom, Ruth Temple, has managed to stay among the dozen or so residents at Cypress Point who have avoided the virus so far. She spent her 81st birthday last week in quarantine enjoying lunch brought in from her favorite Dexter BBQ.

Ruth Temple once served as mayor of Puxico. She organized and led a union at the factory where she made leather coats. She makes the best of any situation, her son said, but he's worried how COVID-19 would impact her chronic obstructive pulmonary disease.

Roy Temple is also angry. He's frustrated the governor, a Republican, refuses to give in to pleas by hospital leaders to pass a statewide mask mandate and restrictions on businesses. Temple served as the former chair of the Missouri Democratic Party but says he's putting partisanship aside.

"They (nursing homes) could do everything right, and still have patients at risk through no fault of their own because of what is happening outside that building," he said. "It's a moment of truth for elected officials."

Minner said with cases increasing, she wonders when she'll be able to see her mom. Carron is so stubborn that she refuses to visit family members on the other side of a window.

But Minner is determined to celebrate her 79th birthday in February.

"I don't care if they drag her to a window. I don't care what she says," Minner said. "I'm going to make her see us through the window, and if nothing else, we will have a birthday party through that window."

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