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https://www.washingtonpost.com/coronavirus/

Coronavirus pandemic

Marvin Joseph

Caitlin Evans can pinpoint the first day she and other nurses believe they exposed residents of Sagepoint Senior Living Services to the novel <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a>.

The 26-year-old nurse spent a half-hour on March 27 preparing a man with a bad cough to go to a hospital for a medical procedure.

Neither she nor other nurses who helped him to the ambulance wore masks or other protective gear. Despite their pleas, they said, managers told them that such protections were unnecessary.

Former and current employees at Sagepoint and six other nursing homes in Maryland say the virus spread rapidly as their facilities struggled with shortages of staff, testing and personal protective equipment. At several nursing homes, employees said, managers played down the severity of outbreaks and did not provide masks and gowns until patients had tested positive.

Staffing is so limited at one Silver Spring facility that the administrator sometimes sleeps there overnight. A nurse at a skilled-nursing facility in Rockville said there are coronavirus-positive patients “all over” the building, even though managers say those patients have been isolated.

Gov. Larry Hogan (R) <a href="https://www.washingtonpost.com/local/maryland-orders-coronavirus-tests-for-all-patients-staff-at-nursing-homes-where-471-have-died-so-far/2020/04/29/735ba1c2-8a1f-11ea-9dfd-990f9dcc71fc_story.html" title="www.washingtonpost.com">last week ordered</a> universal testing for nursing home residents and employees in Maryland and signed a contract for 260 medical professionals to assist with staffing. But a top nursing home executive told Maryland lawmakers Wednesday that the testing has not yet materialized. And nursing home employees said the additional staffing won’t cover yawning gaps at the state’s 226 facilities.

At Sagepoint, when Evans learned that the man with the cough had tested positive for the coronavirus, she thought of all the residents she might in turn have exposed in the three days since tending to him. She asked to be sent home but says her manager told her to finish her shift.

Evans began quarantining the next day. She developed a chickenpox-like rash that has been associated with the virus, but says her doctor told her she did not have enough other symptoms to get tested.

As of Wednesday, according to <a href="https://coronavirus.maryland.gov/pages/hcf-resources" target="_blank" title="coronavirus.maryland.gov">state data</a>, the 165-bed facility in La Plata, Md., had recorded 35 fatalities attributed to covid-19, the illness caused by the novel coronavirus. Among the dead: the man with the cough.

The death toll at Sagepoint is the highest among nursing homes in Maryland, where long-term-care facilities accounted for more than 6,000 of the state’s coronavirus infections as of Wednesday and 804 confirmed covid-19 deaths. More than <a href="https://coronavirus.maryland.gov/pages/hcf-resources" title="coronavirus.maryland.gov">1,900 employees</a> of such facilities had contracted the virus, according to <a href="https://coronavirus.maryland.gov/pages/hcf-resources" target="_blank" title="coronavirus.maryland.gov">a state database</a>.

Some employees at Sagepoint have resigned over the coronavirus response, adding to staffing problems. Others remain, working double shifts. A longtime nursing assistant died of covid-19.

Sagepoint spokeswoman Joyce Riggs said in a statement that the nursing home followed guidelines issued by the federal Centers for Disease Control and Prevention, which said on <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/guidance-retirement-response.html" title="www.cdc.gov">March 20</a> that only staffers working with patients who had tested positive for the coronavirus were required to wear masks. On <a href="https://www.cms.gov/files/document/4220-covid-19-long-term-care-facility-guidance.pdf" title="www.cms.gov">April 2</a>, the agency mandated that all staffers wear masks in long-term-care facilities.

“The dedication was there — we tried the best we could,” said Evans, who resigned from her job April 20. “But there were so many things that could have been done to prevent this that weren’t done.”

[Hundreds of nursing homes with cases of coronavirus have violated federal infection-control rules in recent years]

While the number of deaths at Sagepoint is an outlier, the conditions its staff described are not, according to interviews with eight current and former employees at six facilities.

An employee at Potomac Valley Rehabilitation and Healthcare in Rockville, who spoke on the condition of anonymity to avoid retribution, said staffers pleaded with administrators for protective equipment throughout March, to no avail. Documents obtained by The Washington Post show a supervisor telling staffers that such equipment was in short supply at Potomac Valley and across the nation, and that they could bring in their own equipment if they wanted to do that.

Potomac Valley administrators did not respond to multiple requests for information about the conditions at the 175-bed facility before the initial publication of this article. On Thursday, after the article appeared online and in print, Potomac Valley’s parent company, Vita Healthcare, issued a statement.

“Residents are currently being isolated on designated units and our staff are equipped appropriately with PPE and are adhering to the CDC recommendations,” said the statement from Vita Healthcare regional director Gregory Strite.

According to state data, 33 residents and 19 staffers had tested positive for the novel coronavirus as of Wednesday, and six residents had died. Montgomery County Health Department spokeswoman Mary Anderson said a seventh death had been reported to the county but was not yet in the state database.

Residents who have or are believed to have the virus are supposed to be isolated in a separate wing, and the facility informed patient families in letters dated April 21 and April 30 — also obtained by The Post — that there is a “designated unit and dedicated staff” taking care of infected residents.

The employee, however, said there are covid-19-positive patients “all over the facility.” Documents obtained by The Post say residents who have the virus and residents suspected of having the illness it causes are being housed in all four of the facility’s wings.

“It’s taking a lot for us right now to not just call family members and say, ‘Please come get your parents,’ ” the employee said.  “Because they’re not safe with us. They’re not.”

Kim Peyser, whose mother has lived at Potomac Valley for 25 years, said the facility has declined to tell her how many residents have contracted the virus or whether the staff attending to her mother have been tested. She has sent two emails to an administrator and left one voice mail, none of which received a response, she said.

When Claudia Andino visited Potomac Valley on Friday, staffers seemed harried and there was trash lining the halls, she said. Her husband Nelson Silva, 31, had been brought there a day earlier following multiple surgeries for a brain tumor.

Andino said she called the facility repeatedly trying to get updates on Silva. When she was told his heart rate was dangerously high, she went there and learned from paramedics who were leaving the building that her husband had just died.

The paramedics gave Andino one of their own yellow suits, a mask and goggles and accompanied her into the building, she said. Silva’s body was in a hot, musty room, dressed in the same clothes in which he had arrived as a patient the day before. Next to him was used medical gauze and cotton swabs, she said.

On Saturday, Silva’s brother retrieved his belongings, which were in a trash bag, Andino said. Medical records and used napkins were mixed in with Silva’s clothes and rosaries from his 8-year-old son, Jayden.

“I know people are overwhelmed, but that’s no excuse for this kind of neglect,” said Andino, who detailed her complaints about the facility in an email to the Joint Commission, an organization that accredits health-care agencies nationwide. She shared the email with The Post.

“I can’t get him back,” she added, sobbing. “But what happened is not okay.”

Montgomery health officials say they have been in contact with all 34 nursing homes in the county but because of the pandemic, they have not conducted in-person compliance visits. The federal Centers for Medicare and Medicaid Services <a href="https://www.cms.gov/medicare/quality-safety-oversight-general-information/coronavirus" title="www.cms.gov">suspended non-emergency inspections</a> March 4.

“At this point, we’re taking their word for it,” Enrico Lachica, a clinical nurse administrator at the county Department of Health and Human Services, said last week when asked how Montgomery County is ensuring that facilities are abiding by regulations. He said the state had sent inspectors to 10 long-term-care facilities in the county. But some nursing homes had declined the visits, Lachica said. Hogan’s <a href="https://governor.maryland.gov/wp-content/uploads/2020/04/Nursing-Homes-Amended-4.29.20.pdf" target="_blank" title="governor.maryland.gov">April 29 order</a> made compliance mandatory.

Maryland Deputy Secretary for Public Health Fran Phillips said there may have been a pause in state inspections while inspectors were provided the correct protective gear. The state is sending one of its “strike teams” to Potomac Valley because of a “significant increase in symptomatic residents,” said Anderson, the Montgomery spokeswoman.

Riggs said state regulators visited Sagepoint last week.

Employees and spokespeople at five other facilities in Maryland said they are still rationing masks and gowns, more than a month after Hogan announced that all nursing staff would be given adequate personal protective gear.

Brian Witte

At two locations, nurses are wearing rain ponchos and trash bags, said employees who spoke on the condition of anonymity, citing a fear of retribution. They said some nurses reuse masks and gowns for more than a week.

Multiple facilities are also struggling with staffing, employees say. On a recent shift at Potomac Valley, the employee said, she arrived to find multiple patients in wet diapers, their beds soaked with urine.

At Althea Woodland, a 50-bed nursing home in Silver Spring, owner Philip Meyer said the facility’s administrator is staying overnight and filling various roles at all hours. Five staffers and nine residents have contracted the virus, according to state data, and three residents have died.

“[Hogan] says we have to adequately staff the building. Okay, but where do we get that?” said Meyer, who said he has approached six staffing agencies, only one of which has been able to supply workers. “Even one nurse, one nurse would be a huge help. Please send them.”

Meyer said he has not been able to procure tests for staff and residents, a concern echoed by the head of Maryland’s association of nursing home facilities, who said facilities across the state have requested tests from their local health departments, only to be told there are not enough.

“They don’t exist,” Joseph DeMattos Jr., president and CEO of the Health Facilities Association of Maryland, told a panel of state lawmakers Wednesday. “It’s one thing for the state to order testing,” Mattos said. “But to order testing in an environment where testing is not available is a problem.”

[Maryland orders coronavirus tests for all patients, staff at nursing homes, where hundreds have died]

Hogan said the state has done a survey of all the nursing homes and is beginning to launch universal testing. “It’s not going to be done overnight because we have 24,000 patients in nursing homes,” the governor said, adding that the state is beginning with the facilities with the “biggest problems and working our way down the list.”

Phillips said medical personnel from the state’s “bridge teams” have been dispatched to some nursing homes and will increasingly be utilized. The state hopes to redirect health-care workers from overflow sites to nursing homes, she said, because some hospital overflow sites have not been needed.

Meyer said the state should focus on supporting, not punishing, nursing homes: “Don’t kick us when we’re down.”

Sagepoint, which opened in 1976, has a five-star rating from Medicare and a board that consists of a who’s-who of wealthy and politically connected residents of Southern Maryland. State Sen. Arthur Ellis (D-Charles County) described the facility’s reputation as “stellar.” He took notes on April 23 when he asked Riggs what help the facility needed.

“She said, ‘We have always had what we needed,’ ” he recalled.

Riggs said Sagepoint began buying additional personal protective gear in February and also has relied on supplemental gear supplied by the state. But current and former employees said staffers were refused protective gear when they requested it in March and were told not to wear masks because doing so would scare residents.

One of those who sought protective gear was Kamara David, who worked at both Sagepoint and a hospital where she treated covid-19 patients.

“I should never have been able to pass the front desk without a mask,” David said.

She quit after learning that the man taken to the hospital with the nagging cough had tested positive for the virus. “I knew then that this was going to run through the place like wildfire,” she said.

Riggs said all staffers were “issued full, appropriate PPE” after the nursing home received the man’s test results March 30. CDC guidelines, she noted, did not say employees should wear masks before then. Every patient at the facility was tested April 6, a day before the man was transferred back to Sagepoint.

Evans quarantined at home until April 10, which was the day Sagepoint received test results for all its residents. Chaos ensued, employees said, as they tried to move those who had tested positive to the first and second floors and those who were negative to the third and fourth floors.

Residents were not told the move would be a long-term one, said Joanne Dunlap, who would quit her job as a geriatric nursing assistant a week later. Some moved without bringing changes of clothing, Dunlap said; one woman wore the same outfit for a week.

Riggs said rooms were sanitized and visits from staffers were minimized to reduce the risk of exposure. But nurses said they were asked to move between the positive and negative wings frequently, raising the risk of spreading infection.

As of Wednesday, according to state data, 97 residents had tested positive, along with 32 staffers. Thirty-four residents and one longtime employee had died.

Tiffany Taylor, a nurse who has worked at Sagepoint for more than 20 years and is a manager, said the facility has done the best it can, given the rapidly changing guidelines. “It felt like things were changing every day, and sometimes twice a day,” she said.

Recently, she has been helping out on the floor, hoping to boost morale. She said that staffers have gear when they need it and that she has never considered leaving the job.

Dunlap said her breaking point came when her supervisor asked her to work a shift in the positive wing even though she was assigned to a wing of patients who had tested negative. She said she was worried that she would take the virus back to them. So she went to the bathroom, called her fiance, and told him she was going to quit.

“This is getting out of control,” she says she told him. As she spoke, she could hear a supervisor and two nurses arguing outside the bathroom door about PPE.

Evans said she was caring for as many as 25 patients, a load she called untenable. One night, she was responsible for treating a covid-19-positive patient on a floor full of negative patients. One patient was wandering. A third was dangerously low on oxygen.

Evans said she ran to the positive wing for oxygen tanks and stabilized the man struggling to breathe. She quit the next day, telling her managers she did not feel she could protect her patients.

Joyce Shorter, known to friends and family as “Cookie,” was a Sagepoint institution, having trained many nursing assistants over the course of a decade. Other employees called her “Grandma” and turned to her for advice.

After a double shift April 7, she arrived at home looking weak, said her husband, Theodore Shorter. A week later, she was struggling to breathe. She was diagnosed with covid-19, and died at the hospital April 17.

“I don’t know what happened at Sagepoint,” her husband said, his voice tearful. “But the house is cold and dark now, and I miss her.”

Most of the remaining Sagepoint staff have not yet been tested for the coronavirus, Riggs said, and the facility is awaiting tests from the state.

Phillips said that when nursing home employees are tested statewide, officials expect to find many asymptomatic carriers, which means even fewer people able to work.

[Do you work at a nursing home? Or, do you have a loved one at a long-term care facility?]

This article has been updated to reflect a statement from the parent company of Potomac Valley Rehabilitation and Healthcare. Erin Cox, Ovetta Wiggins and Paige Winfield Cunningham contributed to this report.


Dozens of cases, and 10 deaths. Inside the Pleasant View covid-19 outbreak.



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Hundreds of nursing homes with cases of coronavirus have violated federal infection-control rules in recent years


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2020 John Jay / H.F. Guggenheim Foundation fellowship in Criminal Justice Reporting

University of Pennsylvania, BA

Rebecca Tan is the Southeast Asia Bureau Chief, covering all 10 countries in ASEAN, Timor-Leste and the Rohingya refugee community in Bangladesh. She was previously on Local, covering government in D.C. and Maryland. She was part of the team that won the 2022 Pulitzer Prize in public service for coverage of the Jan. 6 attack on the U.S. Capitol. 

Rebecca Tan

2020 Pulitzer Prize for Breaking News Reporting, finalist 

Duke University 

Rachel Chason is The Washington Post's West Africa bureau chief. Before becoming a foreign correspondent in 2022, she was a reporter on the Local desk, focusing on politics and government in Prince George's County, Md. 