Judy Daniel, 72, first saw the new residents in the smoking area. About two dozen people had abruptly moved from Attalla Health and Rehab to Trussville Health and Rehab in middle of July.
“We didn’t have any COVID for months,” Daniel said. “After they came here, COVID started spreading like wildfire. I mean, it spread fast.”
Daniel didn’t know why so many new people arrived at once at the nursing home where she lived. Later she would discover, and federal records would show, they had been evacuated after an outbreak of coronavirus at the nursing home in Attalla.
Residents at Trussville Health and Rehab watched as cases exploded after the move, going from one in mid-July to 25 two months later.
Mike Curtin, 75, has lived at Trussville Health and Rehab for more than three years. Like most residents, Curtin has disabilities that require help with daily tasks. Many of his neighbors couldn’t understand what was happening. From his room at Trussville Health and Rehab, he decided to look for answers.
Curtin called the Alabama Department of Public Health and the long-term care ombudsman. Why did the evacuees move to Trussville Health and Rehab, he asked, and did the nursing home do enough to keep residents safe? Curtin found himself frustrated at the lack of information.
“No one wants to end up in a place like this,” Curtin said. “A lot of the people here are dying, and nobody wants to talk about that. Nobody really wants to think about people like us. But we’re here, and we deserve answers and dignity.”
An uncontrolled outbreak
The coronavirus outbreak at Attalla Healthcare and Rehab hit a tipping point on July 10. The number of cases inside the nursing home jumped from two early that week to 79, including 42 among staff members, according to the Centers for Medicare and Medicaid Services.
Fear gripped the facility. Staff members who had been infected couldn’t return to work and many who hadn’t simply refused.
All of a sudden, the nursing home faced a dangerous shortage of nurses and caregivers for its 119 residents, said David Lester, CEO of Pro Health Group, the company that owns Trussville Health and Rehab. Attalla’s administrators activated its evacuation plan. The owners of Attalla Health and Rehab did not respond to requests for comment.
Nursing home evacuations are rare and risky for the fragile residents uprooted and moved far from friends and family. During the pandemic, they have also spread coronavirus from one nursing home to another. Despite those risks, conditions at Attalla Health and Rehab became so dangerous the nursing home had to evacuate.
Some residents moved to the local hospital, Lester said. Others who didn’t appear affected by COVID-19 traveled by ambulance to Gadsden Health and Rehab and Trussville Health and Rehab, whose owners had previously agreed to take residents in the event of an emergency evacuation.
David Grabowski, a professor of health care policy at Harvard Medical School, said evacuations before the pandemic usually happened during natural disasters or power outages.
“Evacuation would be a really extreme measure,” Grabowski said. “Moving older adults, many of whom have dementia or other cognitive issues, can be a really traumatic event.”
The owners of Attalla Health and Rehab and Trussville Health and Rehab announced the transfers in July. Some COVID-positive residents remained at Attalla health and Rehab with a reduced staff. Although several nursing homes have been hit hard by coronavirus, Attalla Health and Rehab is the only one in Alabama to publicly announce an evacuation due to an outbreak.
A race to save lives
Lester said his employees tried to prevent cross-contamination during the evacuation. Gadsden Regional Medical Center loaned his nurses a rapid COVID testing machine to check each resident before the move.
“We only accepted residents who tested negative that evening,” Lester said.
They didn’t have time to conduct more sensitive PCR tests, which typically take several days to process, Lester said. Staff from the two ProHealth nursing homes worked from Friday night to Sunday morning moving patients out of the understaffed Attalla Health and Rehab.
“We moved patients that were already inside those buildings into other halls and isolated the Attalla patients on a single hall at each facility,” Lester said. “And Attalla patients were cohorted together. So, two negative patients from Attalla would share a room. And to the extent possible, we tried to keep people who were roommates together at Attalla as roommates in the new facility.”
At the time, Lester said medical experts didn’t know that a person could test negative several days after exposure before testing positive, which is exactly what happened with the residents from Attalla. Even though they kept the new residents on an isolation wing, the virus still spread throughout the facility, where it also infected 12 staff members.
“Now I think it’s widely accepted that someone could have been exposed and not tested positive for five days,” Lester. “At that point, the general line of thinking was they would test positive within 48 hours.”
Judy Daniel said her roommate, Annie Early, developed a bad cough soon after the newcomers moved in and administrators announced the first positive cases.
“I kept telling them there was something wrong with her,” Daniel said. “I would go over to her bed. And I would pray with her. Or pray for her. And I would pat her hand. I’d tell her I love her.”
Daniel would stay up late to keep watch over her roommate. Staff members sent Early to the hospital. Not long after, Daniel developed symptoms and went to Grandview Medical Center in Birmingham. She got sicker and stayed for two weeks. “I was out of it,” Daniel said.
When she got back to the nursing home, she went into quarantine for 17 days. When she emerged, she found out Early had died. Early and Daniel lived together for two years.
“Judy was heartbroken,” her sister, Betty Hicks, said. “They were just like sisters.”
During that time, Daniel watched over and protected her bed-bound roommate.
“It was just so important that I told her several times a day and at night that her daughter loved her,” Daniel said. “That you weren’t staying away from her on purpose. That there was a bad virus in here and we couldn’t have visitors. And I don’t know if she understood me or not. I hope she did.”
Michelle Weston, 50, pulled her father out of the facility after cases began cropping up. Soon after the transfer, the administrator called to tell her “some” of the new residents had tested positive, Weston said. They didn’t give her an exact number.
“By law they’re supposed to tell you,” Michelle Weston said. “Nobody had corona until they started moving people in. Then all of a sudden they had a lot.”
Her father, 80-year-old Elbert Weston, said the virus swept through the facility after the transfer.
Elderly at risk
The dangers of coronavirus outbreaks in nursing homes have been well-known to public health experts since the earliest days of the pandemic. One of the first outbreaks in the U.S. killed 37 residents at a nursing home in Washington.
The first wave of coronavirus cases in the U.S. devastated nursing homes in the northeast. A late March evacuation of St. Joseph’s Senior Home in Woodbridge, N.J. showed how such a drastic step could have devastating consequences. According to NJ.com, the evacuation not only spread virus to facilities that had previously been spared, it also caused residents grave harm as they hastily shifted from one home to the next.
Melissa O’Connor, an expert on healthcare for seniors at Villanova University, said she was surprised to see Alabama making the same decisions in July that led to disastrous consequences several months earlier in New Jersey.
“The East Coast had already had major, major issues that Alabama could have learned from,” O’Connor said. “I could defend the East Coast and give them a bit of a break because nobody really knew what we were dealing with at the beginning. But by July, we knew what could happen.”
Some states have adopted strategies aimed at keeping residents in one place during staffing shortages. At least ten of them have created special strike teams that can flood nursing homes with staff and supplies during coronavirus outbreaks. Others have mobilized National Guard units.
Alabama health officials took a more hands-off approach when Attalla Health and Rehab became overwhelmed in July, assisting over the phone while staff tried to coordinate the care and relocation of dozens of residents, Lester said. Dr. Karen Landers, area health officer for the Alabama Department of Public Health, said the department can call for volunteer nurses, but does not have the capacity to create a team.
“We really do not have the staff to do that,” Landers said. “Most of our nurses are fully engaged in other aspects of our COVID response.”
Jamie Harding, spokeswoman for the AARP of Alabama, said the transfer and subsequent outbreaks reveal shortcomings in the state’s approach to COVID-19 in nursing homes. The AARP has asked state leaders to help facilities improve staffing and care. They’ve also requested more up-to-date information about nursing home outbreaks.
Officials with the Alabama Department of Public Health have refused to release details about its nursing home coronavirus plan. And it is one of just a handful of states not releasing data on nursing home cases.
“I think again, we have seen so little transparency from our state leadership, and this is just another instance of it,” Harding said. “We know nursing homes were not overstaffed before we had COVID and now they are really struggling. What we really want to see is a strategic plan for how these facilities are going to operate safely.”
The end of the road
Phyllis Meek, 82, lost her husband William Meek at the beginning of September. Meek was 83 and suffered from dementia. Still, he remained physically strong, wearing out the soles of his shoes as he paced the long corridors. William Meek lived at Trussville Health and Rehab for two years, she said.
When coronavirus arrived at the nursing home, Meek had to stay in his room. That was hard, said his wife.
“He would call and beg me to take him home,” Phyllis Meek said. “He was so unhappy there because he wanted his freedom like he always had.”
In late August, Meek said staff members said her husband went to the hospital, where he tested positive for coronavirus. Within days, he was placed on a ventilator. William Meek is one of six residents who died from coronavirus at the facility, according to the Centers for Medicare and Medicaid Services.
“That virus ravaged him unmercifully,” Meek said. “It attacked the kidney, the heart, the lungs. He was on so many machines, my kids said they couldn’t get near his bed.”
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