Add To Favorites

Over 1,000 cases of COVID reported at Idaho nursing homes. 'More needs to be done'

Idaho Statesman - 8/9/2020

Aug. 9--Caroline Faure didn't know her mom was sick until she got a phone call Wednesday, July 29, from an unfamiliar number.

Her mother, Virginia Smith, lived at the Shaw Mountain of Cascadia nursing home in Boise for the past 14 years. An employee there was using a personal cellphone to reach out to Faure.

"She said, 'Hey, do you want to talk to your mom?'" Faure told the Statesman. "She was basically saying, 'Do you want to talk to your mom one last time?' Because she knew what was going on, and we didn't know what was going on. It wasn't until we started asking questions that we started putting the pieces of the puzzle together."

They were told that 90-year-old Smith had lost weight and been bedridden after spraining an ankle, then hitting her head in a fall. But now, she wasn't acting like herself. She was combative and agitated. Mental changes can signal the coronavirus in elderly patients. Faure and her siblings asked the nursing home to test for COVID-19.

Smith was tested for the coronavirus later that Wednesday. The result came back positive Thursday. By Friday evening, she was gone. Her death certificate attributes her death to COVID-19.

Later that night, the nursing home sent an email to residents' families. It said 14 people who lived at Shaw Mountain had tested positive. It didn't mention that one of them had died.

"Why hasn't anybody said anything to us about any of this?" Faure said. "With the facility being closed (to visitors), I think this is a vital thing that everybody wants to know. What's going on in the facility?"

By the time Smith got infected, Shaw Mountain's residents had weeks of potential COVID-19 exposure. Nursing home staff began testing positive in June, according to state and federal data.

The company didn't tell the families of Shaw Mountain residents about those cases, according to two of Smith's children.

It appears that Idaho public health agencies didn't know about all the cases as they happened, either. At one point in June, the state's record showed only three cases, while the facility itself had reported five to the CDC.

A Statesman analysis of state and federal data finds that COVID-19 has infected staff and residents at 78% of Idaho's 82 nursing homes.

The Statesman also has found that the Idaho Department of Health and Welfare's records don't include 13 nursing homes that have been reporting active COVID-19 outbreaks to the CDC.

In addition, seven nursing homes reported outbreaks to the CDC that appear to be stable or resolved, but have never shown up in the state's record of outbreaks.

Another 28 nursing homes have notified the CDC of larger outbreaks than what the state is reporting.

The Idaho Department of Health and Welfare is "aware there are differences in the CDC list compared to our list, and DHW staff are reviewing it and are reaching out to LTCFs (long-term care facilities) that indicate different information to CDC," spokesperson Niki Forbing-Orr said in an email. "DHW staff are in regular contact with the local public health districts and are confident that the state's list accurately reflects the current impact of COVID-19 outbreaks in LTCFs that have been reported."

Two very different sets of COVID-19 data

The state gets its information from local health departments, while the CDC gets outbreak information directly from nursing homes.

Both of the data sources have shortcomings and advantages. Both have contained inaccuracies -- compromised in some cases by human error in a fast-changing pandemic that has overwhelmed long-term care facilities and public health agencies.

Since May, a federal mandate has required nursing homes to report on a weekly basis to the CDC. They report their COVID-19 cases among residents and staff, staffing shortages and their supplies of personal protective equipment. The numbers they report are then published by the Centers for Medicare and Medicaid Services.

For the week ending July 26, the CDC data show 12 nursing homes in Idaho reported a staffing shortage, and six reported not having PPE supplies, including masks.

When the CDC reporting system went live to the public in June, there were huge errors in the data. Nursing homes around the country appeared to have impossibly large outbreaks, due to data entry or processing errors. At least some of those errors have been fixed over the course of 10 reporting cycles. The nursing homes have the ability to fix inaccurate numbers themselves, according to CMS.

Another limitation of the CDC database is that it contains only nursing homes, which are federally regulated.

The state list contains not only nursing homes but also state-regulated residential assisted living facilities and group homes for people with disabilities. People who live in those facilities need less intensive nursing care and assistance than nursing home patients.

The Idaho Department of Health and Welfare began publishing a list of COVID-19 cases in Idaho facilities in June, after the Statesman threatened to sue the state for withholding the information. It is now posted weekly under the "long-term care" section at coronavirus.idaho.gov.

The state list is a third-hand source. It compiles information the state receives from public health districts. The districts get their information from long-term care facilities and contact tracing. The list has contained clerical errors, and at one point included a home whose information was released by mistake.

While the CDC records break down the number of cases among staff versus residents, the state releases only a combined total, so it's impossible to tell how many patients are infected versus their caregivers.

Having trouble seeing this table? Click here to open it in a new tab or window.

Meanwhile, families say they get confusing, conflicting or delayed information about COVID-19 from the facilities that house their loved ones.

Karen Russell, a Nampa resident whose mother is in a long-term care facility with an active outbreak, told the Statesman that "most days, I'm speechless as to what's going on" with the state's response to the pandemic.

"I'm a born-and-raised Idahoan, and I want to move out of the state right now, because nobody's protecting the state," she said.

The facilities, too, are in a difficult position. State and federal guidelines change by the week, and they sometimes conflict.

The state's guidance to long-term care facilities says that when a staff member tests positive, "it is ... recommended that facilities notify residents and their designated representatives and families within a reasonable timeframe." It doesn't say what that timeframe would be.

The federal rules, though, say nursing homes have until 5 p.m. the next day, even on weekends, to notify all residents and their families about any confirmed case in the facility.

The state also says long-term care facilities must report any case of COVID-19 to the public health district within one working day of a positive test result. The Department of Health and Welfare said the penalties for non-compliance include fines or imprisonment, but that it likely wouldn't impose a penalty during this pandemic, unless a facility repeatedly did not report cases.

"Instead, we would work to educate the facility about the importance of reporting and the benefits to the facility to report and receive guidance from their local district health department," Health and Welfare spokesperson Forbing-Orr said.

If a facility doesn't report its COVID-19 numbers accurately to the CDC, the Centers for Medicare and Medicaid Services says it will cite the nursing home and impose a fine -- which could potentially cost thousands of dollars depending on how quickly the error is corrected.

"It just seems like more needs to be done with the nursing care facilities and how that information is being relayed to family members," Faure said. "... I would want to know if another resident in that facility was ill (with coronavirus). I would want to know. Not that I could come steal my mom, but I would just want to know so that I could ask appropriate questions and I could ensure that additional things were being done."

The 'weight of it all' hits Idaho nursing home staff

Central District Health moved Ada County back to Stage 3 of Gov. Brad Little's Idaho Rebounds plan in late June. Stage 3 prohibits visitors at senior living facilities. Employees who interact with residents and patients must follow hygiene and infection-prevention protocols.

That meant Faure and her siblings couldn't be by their mother's side in her final days.

Smith's death was not calm or peaceful, surrounded by loving family members, two of her children told the Statesman. They said the nursing home's doctor placed her on comfort care, giving her morphine to quell her pain but discontinuing her schizophrenia medication. Based on the behaviors her nurses described, Smith's children believe she endured hallucinations in her final hours.

The night Faure's mother died, Faure talked with the health care worker who'd called from a personal cellphone. "And this gal was just bawling," she said. "I think the weight of it all was hitting them."

Faure, a professor at Idaho State University, hopes her mother's story will help Idahoans recognize the seriousness of COVID-19.

"On Facebook there are people who may doubt the validity of this disease," she said. "They think that those are just bots that are putting out these horrific stories of patients who die in a day. I'm not a bot, and my mother was not a bot. She was a real human being who deserved a lot more than what she got in her final days."

Virginia Smith was a military wife, who became a military widow when her husband died in the Vietnam War in 1969. Raising the children as a single mother became her "sole focus" for 17 years, her obituary says.

Smith was a devout Catholic who attended Mass every day.

"When the last of her children left her nest in 1987, she joined a secular order of Carmelite nuns and devoted her days to scripture, solitude and prayer," the obituary says. "For her last 14 years, with her children spread 'round the world, Virginia was loved and comforted by the staff at Shaw Mountain. Unfortunately, in her final days, Virginia fell victim to the COVID-19 virus."

The facility where she lived is one of the many battling coronavirus outbreaks.

There have been more than 140 outbreaks at Idaho long-term care facilities. The virus has infected more than 1,300 people who live or work there, according to state and federal data. Outbreaks are active and growing in at least 74 nursing homes, assisted livings and group homes, the data show.

Death is not a new reality for Idaho's long-term care workforce. But in the coronavirus pandemic, nurses and aides are dealing with multiple deaths a week -- or, in at least one facility, multiple deaths a day.

"You are true heroes, and we are thankful for the sacrifices you make every day to care for your residents and patients," Virginia Smith's family wrote in her obituary. "We hope you, too, find peace and reassurance amidst the uncertainties of this horrible virus."

Smith was one of at least 125 people who have died from COVID-19 in Idaho's long-term care facilities. Their deaths make up more than half of all the pandemic's casualties in Idaho.

Having trouble seeing this map? Click here to open it in a new tab or window.

Saying a final goodbye, over the phone

Caldwell Care of Cascadia, which is owned by the same company as Shaw Mountain, lost 12 residents to COVID-19 in the past month, according to Idaho Department of Health and Welfare records.

One of them was Gary Bringman, a doting grandfather who died July 25 at age 76. Bringman had battled Alzheimer's for about five years, and it was a coronavirus infection that finally ended his life.

His obituary didn't mention the virus because, while COVID-19 was his official cause of death, "we felt like whatever he would have caught ... would have taken him" due to his underlying health problems, said his wife, Cecily Bringman.

Bringman says she got a call around the 4th of July, telling her that Gary had tested positive for COVID-19. When she called his regular nurse to ask about his symptoms, the nurse checked his chart: actually, he'd tested negative.

"They retested, and it was negative, but a week later it came back positive," said Cecily, who is a former Statesman employee.

The nursing home said it would test patients on a weekly basis, to catch any asymptomatic or pre-symptomatic cases. That testing has since turned up 103 cases, making it the largest known nursing-home outbreak in Idaho.

Gary had fevers that would spike, and he was "out of it," she said. "He wasn't really communicating, and they were barely getting water into him."

She said Gary received liquid morphine for comfort, and that the drug also helped to slow down his racing heart rate -- another symptom of COVID-19.

Cecily was eating dinner with the couple's granddaughter on July 23 when she got a call from Gary's nurse. He was unlikely to come back from this, the nurse said.

"Any chance you can put the phone up to his ear?" Cecily asked.

They both said their goodbyes to Gary, in case it was their last chance.

"I love you. Your family is OK," Cecily told him. "He mouthed the words, 'I love you.'"

He died two days later. The couple's daughter was granted a brief in-person visit. Gary's granddaughter, who adored him, wasn't allowed to enter the building. So Cecily stayed home with her, so she wouldn't be the only one who didn't get to visit.

Gary wasn't religious, but he was spiritual. Farming, hunting, fishing and being outside "brought him closer to his higher power," she said.

The family plans to scatter his ashes in North Idaho, in a place where he spent a lot of time outdoors.

Gary loved to camp in the backyard with his granddaughters, "telling stories, roasting marshmallows and going to sleep watching the fire burn," his obituary says. "At Gary's request, there will be no service. He asks that you spend time in the outdoors with a child. If you don't have one of your own, borrow one."

Nursing homes must test, but face shortages

The outbreak at Caldwell Care exploded over the past month. State and federal data show cases first reported among staff and residents in the last week of June.

The state Bureau of Facility Standards conducted a coronavirus infection control inspection at Caldwell Care in late June. It found no violations. The facility had 59 residents at the time.

The week of that inspection, the state reported there was one case of COVID-19 at Caldwell Care. The following week, that one case had grown to 25. The number of people infected has more than quadrupled since then.

"These situations, unfortunately, fit into the evolving narrative we are seeing all around us in Ada and Canyon counties, as well as other areas around the state," Steve LaForte, Cascadia Healthcare's director of strategic operations and general counsel, wrote in an email to the Statesman.

Since the state moved to Stage 4 under Gov. Little's reopening plan in June, the virus spread and "worsened the risk for those of us on the front lines of care of our elderly and vulnerable adult populations," LaForte said in the email.

"Additionally, this risk continues to be exacerbated by the problems with testing availability and the timing required to get results," he wrote. "We continue to follow all applicable guidance from (the Centers for Medicare and Medicaid Services), the CDC, and Idaho'sDepartment of Health and Welfare, as well as continuing to work with all of our community partners ... to find ways to provide safe care and mitigate the damage of COVID-19 as we deal with this crisis situation."

State and national guidelines say long-term facilities should test on a regular basis for COVID-19, to ensure staff don't unknowingly introduce the virus to a place where vulnerable people live. The guidelines call for ramped up testing as soon as one case is discovered.

But now, more than five months since Idaho's first confirmed case of COVID-19, shortages of test kits, equipment, manpower and laboratories still make that hard to do.

The Idaho Bureau of Laboratories in late May told long-term care facility operators it could take "an increased volume of specimens" for coronavirus testing. The state lab, in Boise, runs tests at no cost, with a rapid turnaround time.

The Idaho Department of Health and Welfare, which oversees the IBL, created a "testing strategy" for long-term care facilities to follow.

The highest priorities for COVID-19 testing, it said:

-- All symptomatic residents and health care workers.

-- All new residents moving into facilities.

-- All health care workers and residents, in the event of a new confirmed case of COVID-19.

It also recommended repeat testing for residents and health care workers in facilities with a confirmed COVID-19 case. That would help identify cases "among persons who initially tested negative, either because they were in the incubation phase of infection or had not yet become infected," it said.

But by the end of the month, Idaho was in its largest COVID-19 wave, and the state lab was struggling to manage the flood. The IBL issued a notice to facility operators on June 30, saying it "cannot support all long-term care facility testing needs."

Facilities would need to find other laboratories for some of the routine testing, such as surveillance to catch the virus before it has a chance to spread.

A week later, the IBL issued another set of guidelines, aimed at helping facilities carry out their testing strategy.

"Implementation of these testing recommendations may be challenging," it said. "Specific challenges may include: limited availability of testing materials (e.g. swabs and viral transport material); uncertain access to laboratories able to support rapid turn-around of test results; lack of prior experience with respiratory specimen collection; limited experience in knowing when and how to contact local public health authorities for assistance; and cost."

The outbreaks grow as Idaho continues to struggle with shortages and delays at every step of its response to the pandemic: Testing people for the virus. Then, contact tracing to find other cases. Then, having enough health care workers for patients. And securing supplies, like N95 masks, to keep the virus from spreading.

Faure encourages people with loved ones in Idaho nursing homes to ask questions about coronavirus testing. Call every day, ask for video chats, "demand that they keep the facilities closed to the public," she said.

She recommends asking how the nursing home is testing employees and if the staff have protective equipment.

"My mom didn't have COVID. She didn't just get COVID. Someone brought it in," Faure said.

But she doesn't blame the nurses and aides.

"It's certainly not the frontline workers who are the bad guys in this situation," she said. "They're doing everything they can under impossible circumstances."

Idaho Statesman reporter Rachel Roberts contributed.

___

(c)2020 The Idaho Statesman (Boise, Idaho)

Visit The Idaho Statesman (Boise, Idaho) at www.idahostatesman.com

Distributed by Tribune Content Agency, LLC.