Lori Spencer felt uncomfortable after dropping her 81-year-old mother into the Life Care Center in Kirkland, Washington on February 26th. The next day, she felt worse when her mother, Judie Shape, threw an uncharacteristic tantrum – begging to leave the facility.
What the family did not know at the time: the house was already dealing with the first signs of a deadly coronavirus outbreak in the United States. A week earlier, on February 19, the facility sent out a patient with breathing problems for testing, followed by a second patient on February 24. Life Care officials said they initially suspected flu.
Three days after Shape arrived home, Life Care announced that one of the tests had come back positive for coronavirus.
"By then it was too late," said Spencer. "We couldn't move her. She was suddenly a prisoner there."
The mold would not be tested for another 11 days as Spencer and her family waited fearfully. Amidst a severe lack of tests at national level – and at Life Care – the home initially only tested those who showed symptoms.
The fatal outbreak of the Kirkland House shows how quickly the coronavirus can spread in an elderly care facility. Facilities across the country are struggling with overwhelmed staff and a nationwide shortage of test kits, putting families in a heartbreaking dilemma of protecting older relatives who need full-time care or rehabilitation.
Officials from King County, Washington, reported on Sunday that 29 coronavirus deaths had been linked to the house. As of Friday, the house confirmed 13 coronavirus deaths and said it was waiting for test results from 11 other people who died.
Nations around the world are concerned with protecting the elderly from the virus. There were two deaths and dozens of people in South Korea infected with a severe outbreak in a provincial nursing home. Nursing homes are also of concern in Europe, the new epicenter of the global crisis, as the number of new cases is declining in China, where older people are cared for more frequently at home.
In northern Italy, the virus has affected the older population, among other things in some nursing homes, but also in densely populated houses where many older people live. In the UK, some nursing homes have started blocking visitors as the government says older people may soon be asked to stay indoors. In Spain, where the virus is growing rapidly, the first group of infections focused on nursing homes in Madrid.
In the United States, infection control errors have long been a serious problem in the nursing home industry, where approximately 1.7 million seniors live. According to health data from the federal government, patients in nursing homes suffer between 1.6 and 3.8 million serious infections every year, leading to up to 380,000 deaths.
On Friday, a Trump administration official called on nursing homes at national level to restrict all visitors except for some "end of life" situations. President Donald Trump promised to speed up the distribution of the test kits – for the first time in recognition of the serious shortcoming.
Richard Mollott, executive director of the Long Term Care Community Coalition in New York, said the coronavirus epidemic has turned nursing home residents into "sedentary ducks."
"They can be very dangerous places to live in," he said. "The industry has had bad experiences with human safety."
The Life Care Center in Kirkland was led after a federal inspection in April 2019 for violating the infection control regulations. Such violations are widespread in the industry, said Charlene Harrington, an elder care specialist at the University of California, San Francisco. Disease control errors are partly due to chronic staff shortages in most facilities, Harrington said, noting that downsizing is one way to increase industry profits.
"National enforcement of nursing home standards has been pitiful," said Harrington, who testified in Congress about elderly care and wrote extensively about the regulation of nursing homes.
The American Health Care Association, a group in the elderly care industry, said such criticism was not helpful in a pandemic. The organization recognized challenges in infection control in nursing homes, including due to government underfunding and the nationwide lack of nurses.
"We can always do more to improve infection control," said David Gifford, the organization's chief medical officer, in a statement. "This pandemic shows that as a nation we all have to improve our way of working to prevent infections, including in nursing homes."
The Cleveland, Tennessee-based Life Care Centers of America Inc., which operates the home in Kirkland, are among the largest players in US nursing home care, with more than 200 retirement homes in 28 states. The company announced last week that it would take stringent infection control measures across all facilities to protect itself against coronaviruses.
Leigh Atherton, a company spokeswoman, declined to answer detailed Reuters questions about the company's response to the Kirkland outbreak. In previous press conferences, another spokesman, Tim Killian, described an overwhelmed staff that acted heroically in the face of a cruel outbreak. By March 7, more than a third of the 180 employees were out of action on suspected coronavirus symptoms.
"This is an acute care facility that is used to treating patients with infectious diseases," said Killian that day. "But we're really dealing with an unprecedented level of outbreaks, a virus we know little about."
The response of the staff was initially "limited" due to the lack of test kits, although in the center patients without symptoms showed acute symptoms within an hour that required hospitalization.
"We let patients die relatively quickly under these circumstances," said Killian.
As of Sunday, the World Health Organization reported that more than 150,000 coronavirus cases with more than 5,700 deaths have been confirmed worldwide. The United States reported more than 3,800 cases and 69 deaths on Monday.
Waiting for exam
Spencer knew little about the risk of illness in nursing homes when she arrived at Life Care with her mother. But the day her mother asked to leave – two days before the house confirmed the outbreak – Spencer drove to the facility to remove her. A nurse reassured them and assured them that a broken buzzer on the bed had been repaired to call the staff. When no one reacted to the buzzer for two hours on the mother's first night there, she was finally forced to knock on her tray table to get the attention of someone who was helping her into the bathroom.
Spencer burst into tears when the nurse said he was also worried about her and asked how long both women had to deal with hospital stress before they came to Life Care.
Spencer had another dilemma: her mother had just had a blood clot surgery and was suffering from a severe stomach infection. She couldn't walk and couldn't return to her full-time age community nearby until she was mobile. She came to Life Care for rehabilitation.
"But I will live with this tantrum forever," said Spencer, "because I wanted to take her home that day."
The facility was confused after it first informed families of the outbreak on February 29, Spencer said. Officials said the facility was "locked" – no visitors allowed. In a heartbreaking daily ritual for many families with relatives, Spencer stood in front of the window of her mother's room, could see but not touch, and tried her best to be comfortable on the phone.
Life Care has never forbidden residents to leave the house, Killian said in a briefing on March 12. However, it became impossible for many families to move a relative. Hospitals would only accept those with acute symptoms, while other facilities would not accept patients from an outbreak facility. Many Life Care residents were too sick to be cared for at home.
"These patients cannot go anywhere else," said Killian.
Spencer couldn't bring her mother back to the old people's home where she had lived before her operation. "They needed a test that showed they didn't have the virus – but there were no tests," said Spencer. "It was massively confusing and poorly managed."
On March 8, the form was finally tested for coronavirus. The first batch of test kits – 45 in total, still not enough – had arrived at the facility three days earlier.
On March 10th, before receiving the test results, Shape woke up sick, like the beginning of a severe cold. She had a runny nose and chills.
Later that day, Spencer called the nurses' station for a full medical report. She asked about the coronavirus test – and found that the results had already been received, but no one had called her.
Shape's test was positive: it had signed Covid-19.
When did you know?
Spencer's guilt and fear of her mother's condition mix with the suspicion that Life Care knew that a powerful virus was sweeping through the facility when she housed her mother there on February 26 – but did not warn her.
Life Care Center officials said they had no idea of a coronavirus outbreak until they were informed of the first positive coronavirus test shortly after midnight on February 29.
"We had no medical reason to suspect COVID-19 at this time," Life Care's Killian said in a press conference. "At the beginning of February we had symptoms of respiratory problems in our facility. This is common in our facility … We see between three and seven deaths in a normal month."
Hours after the first test confirmed the coronavirus, almost all families with about 120 residents had been informed of the positive result. According to Life Care, 66 residents have been brought to hospitals since February 19.
Until March 13, 44 residents still lived there, according to Life Care. 26 have coronavirus, including Judie Shape, with tests on another nine that are either pending or incomplete.
Spencer speaks to her mother on the phone several times a day and usually looks at her through the window of her room. Form doesn't sleep much. She tries to stay optimistic. Her coronavirus symptoms have so far been less severe than many others of her age and health, which gave her and her family hope.
The mother struggled with isolation and loneliness before her hospital and nursing home remained. She has become more anxious and angry when she saw the television news about corona virus in her room.
"My mother is isolated at the end of her life," said Spencer. "She didn't deserve it."
(Except for the headline, this story was not edited by NDTV staff and published from a syndicated feed.)