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Frustrated by lack of answers and urgency in protecting Pennsylvania nursing homes

Intelligencer Journal - 1/26/2021


At The Gardens at Stevens, a skilled nursing and rehabilitation facility in Denver, 39 residents had died of COVID-19 as of the publication of LNP | LancasterOnline journalist Nicole C. Brambila’s investigative article published in the Jan. 17 edition. “The Gardens at Stevens is a troubling outlier in Pennsylvania,” Brambila reported. “The death toll is second only in Lancaster County to the 446-bed Conestoga View Nursing and Rehabilitation in Lancaster Township, which is five times larger. Statewide, only about 20 of Pennsylvania’s nearly 700 nursing homes have had more deaths.”

So, what went wrong? Brambila asks that question early in her article detailing the devastating, outsize loss that has occurred at the small Denver facility during the pandemic.

We’d like the answer to that, too.

Unfortunately, the surrounding issues are complex and we’ve seen little meaningful response from those who should be accountable.

No explanation was forthcoming from the owners of The Gardens at Stevens, who did not respond to Brambila’s multiple requests via email and phone for an interview with LNP | LancasterOnline.

We find that shameful. Families who have lost loved ones and current residents of the facility deserve answers.

They are the human faces of all this unimaginable heartbreak.

Brambila talked to the family of 73-year-old Charles Christian Groff. They were given short notice that the man they lovingly called “Pop” didn’t have long to live, so they made the long drive from central Florida for the opportunity to goodbye.

“Groff had fallen at his East Earl Township home, fracturing several ribs and two vertebrae,” Brambila explained. “Following a hospital stay, he was sent to The Gardens at Stevens to recover. Less than three weeks later, Groff had COVID-19.”

Brambila also talked to Don Eshelman, whose 69-year-old wife, Sue, had gone to The Gardens at Stevens to recover from an ankle injury.

She was diagnosed with COVID-19 five weeks after arriving and died shortly after Thanksgiving.

Don Eshelman never had a chance to cook the turkey he had waiting in the freezer — he had promised his wife they’d celebrate Thanksgiving together.

“I still feel if she would have stayed home and I’d taken care of her, she’d still be alive,” he said.

Areas of concern

Long before COVID-19, myriad issues have dogged the nursing home industry and impacted the quality of care some of them can provide.

Staffing shortages have been a persistent nationwide problem. Quality of care is strongly tied to staff size, “but staffing — as with most businesses — is expensive and is sometimes kept artificially low to maximize profits,” Brambila wrote.

In this pandemic, insufficient staffing can be a prime contributor to the rapid spread of the novel coronavirus.

But weak Pennsylvania guidelines have also played a role.

Federal research states that average direct-care staffing of 4.1 hours per resident per day is needed at nursing homes, given the age and morbidity of residents.

Pennsylvania, however, requires a state minimum of just 2.7 hours per resident per day. That figure hasn’t changed in more than two decades.

Looking at The Gardens at Stevens, Brambila found that, on average, it provided 3.34 hours of direct care per resident per day in the third quarter of 2020. That surpasses the state minimum, but falls short of the federal number.

Richard J. Mollot, executive director of the Long Term Care Community Coalition, a New York-based nonprofit organization focused on improving the quality of nursing home care, called Pennsylvania’s minimum “woefully inadequate.”

The state Department of Health must use its authority to bring Pennsylvania swiftly in line with the federal guidance on daily hours of direct care per resident – and then strictly enforce that figure.

Brambila also detailed the “perfect storm” of staffing issues that hit The Gardens at Stevens during its deadliest month.

Last autumn, many state nursing facilities had difficulty finding the workers they needed to fill gaps left by sick staff members. That shortage dovetailed with the worst of the health crisis at the Denver facility.

“Once the first residents were infected in mid-November ... the virus tore unimpeded through the facility, sickening all 67,” Brambila reported. “Within three weeks of the first reported COVID-19 fatality, 36 residents were dead.”

Where was the state Department of Health during this time? The pandemic had been underway for more than half a year at that point. Early on, nursing homes had been identified as being incredibly vulnerable.

What were state officials doing to provide support for The Gardens at Stevens while three dozen people were dying?

Nate Wardle, a state health department spokesman, could not tell LNP | LancasterOnline anything specific that had been done for the Denver facility.

“As we continue to combat this public health and economic crisis, accountability and oversight are just as important as ensuring that facilities have the resources they need — like PPE, testing and vaccinations — to combat the virus and protect residents and workers,” Democratic U.S. Sen. Bob Casey told LNP | LancasterOnline in an email. “We must conduct ongoing reviews of what is going wrong and what can be improved.”

Casey has the right idea.

But is the Wolf administration listening?

We continue to be outraged at the seeming lack of urgency to protect Pennsylvania’s most vulnerable residents. We are approaching the second year of the COVID-19 crisis, and it’s past time to find that urgency.

Philadelphia attorney Marty Kardon, representing Gardens at Stevens families, “filed a lawsuit in April with three other firms against the Pennsylvania Department of Health for failing to inspect nursing homes during the first outbreak,” Brambila reported.

“This is not their first rodeo,” Kardon said of the state. “Everyone knows infections can run rampant in a congregate setting.”

Lawsuits can’t get loved ones like “Pop” Groff and Sue Eshelman back.

But maybe they will bring the answers and commitment to change that have eluded us thus far.

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