Georgia Today: Why 1 in 3 COVID-19 Deaths Is In A Long-Term Care Home
The coronavirus pandemic has been especially deadly in nursing homes and assisted living facilities. On Georgia Today, Atlanta Journal-Constitution investigative reporter Carrie Teegardin discusses why facilities caring for the elderly have been so vulnerable to the virus, and how the pandemic has laid bare the state’s inadequate oversight. Then, Washington Post contributor Sidnee King tells us how the virus decimated the staff and residents of one facility in the heart of historic Atlanta.
Steve Fennessy: This is Georgia Today, a production of Georgia Public Broadcasting. I'm Steve Fennessy. It's Friday, Oct. 9th, 2020. The coronavirus pandemic has been especially deadly in nursing homes and assisted living facilities. Today, Carrie Teegardin, an investigative reporter at the Atlanta Journal-Constitution, on why facilities caring for the elderly have been so vulnerable to the virus, and how the pandemic has laid bare the state's inadequate oversight. And later, a contributor to The Washington Post on how the virus decimated the staff and residents of one facility in the heart of historic Atlanta. Carrie, we've heard a lot of talk about how ill-prepared our nation was to face a pandemic, and certainly nursing homes were especially caught off guard by this. But in Georgia, the situation's been especially bad. Why is that?
Carrie Teegardin: We've had concerns about this state's oversight of long-term care facilities way before the pandemic. Last year, my colleague Brad Schrade and I spent over a year on the assisted living and personal care home industry in the state's oversight of that industry and found a lot of weaknesses in the oversight. And we've continued to see that. Georgia stands out for not inspecting as often as they're supposed to under the federal requirements. They have — almost half of their surveyor or inspector positions from nursing homes are not filled and that's been the case for quite some time. One in four Georgia nursing homes is a one-star rating that's the lowest in the federal rating system. So we're kind of starting from a position that's not strong.
Steve Fennessy: So a weak oversight system and then the pandemic hits. What does it look like from within a home?
Carrie Teegardin: Very early on in the pandemic, we were in touch with a facility called Westbury, which is in Jackson, Georgia. And they seemed really well prepared. It was a very highly rated facility. And somehow the virus got in and they had a very difficult time controlling it when it did. In part, that was because the time that that happened, they could not get tests. I mean, I was talking to their facility owner and their director. They were calling anyone they could possibly think of who might have some kind of connection to China to get PPE. You know, driving to the airport to get an overpriced test, just a handful, whatever they could get. And at that point, everything was going to hospitals, you know, and they really couldn't get what they needed to figure out who had it, who didn't and to protect people. And they were very open and really stayed in close touch with their families. But their director, Jennifer Vasil, was — also expressed to us how difficult this was on their staff. They were losing residents that they'd known for years and a lot of their own staff members and colleagues, many of whom had worked together for years, were also getting sick.
Jennifer Vasil: And it's very difficult for the grief, these — having the deaths that we had to just really stick and that they have 40-plus years. One of our nurses had been here nearly 45. We have someone at the business office who's been here over 50. And just — it’s truly — it's been tough for them. But with the community rallying around us, supporting us and with the support of God, we have you know, we're surviving each and every day and staying strong through this very difficult process.
Steve Fennessy: So, Carrie, as we talk today, there's just over 7,000 Georgians who have died from COVID-19, and more than one in three of those are people who were living in nursing homes or assisted living facilities. What is it about this virus that affects the elderly, and especially the elderly who are living in nursing homes, so disproportionately?
Carrie Teegardin: I think, you know, it's the nature of nursing homes that you have people living in very close quarters and you also have caregivers who are touching them and next to them, a lot. And those caregivers are coming and going from the outside world. And even though these nursing homes were put in lockdown essentially by federal officials, Gov. Kemp as well, the workers are still coming in and out. And we've seen that throughout the pandemic, big outbreaks, lots of deaths in these facilities every month.
Family: Got you a card! It’s your birthday.
Newscast: For families at this Georgia nursing home, window visits are as close as they can get.
Steve Fennessy: Right, so we have family members who were on the other side of glass outside windows just communicating to their loved ones via phone while they're looking at them through glass.
Carrie Teegardin: Yes. The window visits, I mean, that have taken place. You know, all these things that have come up outside of windows, even at Westbury, a grandson that sort of reenacted his wedding with his new bride outside of his grandmother's window. But some of these places you can not get to a window to really check.
Steve Fennessy: Yeah.
Carrie Teegardin: Some folks don't have phones or aren't able to speak because dementia is so common in these facilities. The folks under the restrictions haven't even been able to have interactions among themselves. They're not even going down to the dining room and eating together. And I started a hearing several months ago from some folks in the industry, very worried about what they were seeing, folks with who maybe you've had limited dementia when this all started progressed dramatically. And so there are very serious problems with oversight. A family can't provide its own oversight, right? If they can't even get the person on the phone, let alone lay eyes on them. They don't have their own advocate there to make sure that they're OK.
Steve Fennessy: So in some cases, and I guess, in many cases, there are family members who haven't seen their loved ones or, even in some cases, talked to them since March, right?
Carrie Teegardin: Yes. And I think some of the most heartbreaking cases are, you know, I haven't seen my parents, elderly parents since March or really being able to communicate with them. And then the person dies. You know, it's a very tough way to lose a parent, and I think the grief process will be very difficult because there's so much wrapped up in all that. And I worry about so many people who have lost family members during this time. You know, it's over 2,500 hundred deaths in Georgia right now from long-term care facilities from coronavirus. And that's at least, you know — that's the ones we know have been counted.
Steve Fennessy: So I have a question about reporting. Are we hearing just from facilities with a certain minimum number of beds? Do we know figures from others?
Carrie Teegardin: We really don't. In Georgia, you know, we have nursing homes which are, you know, the skilled nursing facilities that actually provide medical care. Then we have assisted livings, which are generally 25 beds and over, and those all have to report. And then personal care homes, we have lots of those throughout this state. But the only ones that have to report are the ones that have 25 beds or more. Well, we have lots of 20-bed personal care homes. I mean, there are quite a few like ten- and five-bed personal care homes. And we really don't have a good sense of what's going on in those. So I think this speaks to the issues around oversight that there really hasn't haven't been many eyes on these facilities. And when this outbreak of the pandemic began, these facilities at a certain point had to start reporting their numbers to the state. But state inspectors were not going in. They said, "We don't have the PPE. We're not even going to go in these facilities. We're going to call."
Steve Fennessy: Let's talk about staffing and how well-prepared and outfitted the staff is to combat the coronavirus. What have you seen?
Carrie Teegardin: You know, when an outbreak happens, I've been told by operators that, a lot of times, staff will stop showing up. They don't want to carry it home once they know the whole facility’s, you know, in a giant outbreak. And just having enough caregivers in every long-term care setting has been a giant problem because you combine people not showing up with people who have to sit out because they have tested positive. You know, if you think, “Wow, over 7000 workers in long-term are tested positive,” that means they haven't been able to work, you know.
Steve Fennessy: Yeah.
Carrie Teegardin: These are not high-paid workers. And for the most part, you know, people work in assisted living. Nursing homes often make 10 or 12 dollars an hour. They're often working double jobs. So they might even be working at two facilities. And, you know, they were out in the community, you know, going to the grocery store, doing — living their lives. And the chance of exposure was just greater.
Steve Fennessy: You'd mentioned that the state had suspended its inspections of facilities such as these. Have they resumed?
Carrie Teegardin: They've started finally going in and the federal government ordered them to go back in. I mean, one of these facilities, it's in Dunwoody in suburban Atlanta that we wrote about, there were just issues with not doing proper infection control. This was a facility that was reporting that it had no cases for months. And then all of a sudden it recorded — it went from like zero to 63 positive residents being reported in one day. And then it's now up to 180, I believe, with 28 deaths. There was a family member who called concerned about the facility and the state went in to do an inspection and checked around and said everything looks fine here and they found nothing. The feds sent them back in and did a more in-depth inspection and they turned out finding extremely serious breakdowns in infection control. And so think about that. And they have told them they're going to hit them with a big fine. So they found the highest level of violations when they started looking more closely. And I think that raised all sorts of questions in our minds: How could someone go in — one inspection say everything looks good, come back and find that they had the most serious level violation that they can get?
Steve Fennessy: So what's — what's the answer to that? Explain the discrepancy there.
Carrie Teegardin: We don't really know the answer to that. I would say Georgia's Department of Community Health is a very difficult agency to get information from. I've been a reporter in the Atlanta Journal-Constitution for 30 years and dealing with that agency in terms of its response to the public and providing information is just — it's very frustrating.
Steve Fennessy: Brian Kemp, of course, is the governor. What's he said about this?
Carrie Teegardin: He said that protecting the state's most vulnerable has been a big priority.
Gov. Brian Kemp: One of the most critical battlegrounds in our fight against this virus remains in our long-term care facilities, specifically nursing homes. This is a top priority for us as we continue to work around the clock to protect our most vulnerable. And we will continue to do everything in our power to keep these Georgians safe.
Carrie Teegardin: But I think some in the industry and the families have wondered where the help is. I mean, early on — not just in Georgia, but elsewhere — The long-term care industry was kinda not the priority. They you know, everyone agrees that they had great trouble getting PPE and testing. And so without that, it was very difficult to combat the virus. But I think, you know, he's in charge of the departments that could provide more assistance. And I just think it's the oversight and holding the facilities accountable — we’re just not, you know, we're not seeing them cite many facilities for violations.
Steve Fennessy: Just ahead, how one nursing home in Atlanta's Sweet Auburn neighborhood saw 70 percent of its residents come down with the coronavirus. That's ahead. This is Georgia Today.
Steve Fennessy: This is Georgia Today. I'm Steve Fennessy. Before the break, I spoke with reporter Carrie Teegardin of the Atlanta Journal-Constitution. She's been tracking nursing home care across the state. Now let's hear from Sidnee King, who examined one facility in particular called Legacy Transitional Care and Rehabilitation. So, Sidnee, you're a graduate student at Northwestern University's Medill School of Journalism. And in early September, you reported a story that ran in The Washington Post on a nursing home on Auburn Avenue here in downtown Atlanta. So how did you come to examine that particular nursing home?
Sidnee King: Yes. So The Washington Post team, which I was working with, had been taking a look at nursing homes nationwide for several months. And in May, I started taking a closer look at homes in Georgia, which at the time was amongst the states with the highest percentage of nursing home outbreaks in the country. And Legacy Transitional Care and Rehabilitation Center at the time was one of the largest outbreaks in the state. It still is. And I became particularly interested in that facility because, through speaking with experts, I learned that most of the residents and staff who live and work in the facility are African-American.
Train Overhead Announcement: This is the Sweet Auburn Curb Market stop.
Sidnee King: The Sweet Auburn neighborhood has this really rich historic legacy in terms of civil rights, in terms of African-American business ownership. Roberta Phillips, who's Chief Docent at the Herndon home in Atlanta, recalled Auburn Avenue's past in an episode of Georgia State University's Georgia Detours.
Roberta Phillips: Auburn Avenue itself was a street of Black businesspeople back in the day. You had funeral homes, cafeterias … newspaper right next door to us. But we had churches and restaurants in any place that you can name. We already had those kinds of things in our community there.
Sidnee King: The street that Legacy sits on, Auburn Avenue was once dubbed by Fortune Magazine, the richest Negro street in the country.
Steve Fennessy: Sidnee, as part of your reporting, you and your colleagues at The Washington Post look for patterns in code cases and deaths from nursing homes all across the country, not just Georgia. What did you find?
Sidnee King: I found that one of the greatest tragedies of this time is what's going on in these nursing homes. What we found is that nursing homes with majority Black residents had a higher death rate nationwide — 20% higher than nursing homes for majority white residents. And there's a number of factors that — that play into this. A big one is location. Nursing homes with a lot of black residents tend to be in urban centers, which tend to be more densely populated. And so Black residents are more susceptible to contracting the virus from administrators and nurses who are, you know, kind of out and about maybe taking public transportation and maybe living in more densely populated neighborhoods, things of that nature.
Steve Fennessy: Back to Legacy Transitional Care and Rehabilitation — and that's the full name of the facility. Tell us a little about — how big is it? How many people live there?
Sidnee King: The facility has 186 beds. The Georgia Department of Public Health has reported. In surveying resident cases out there, about 150 or more residents currently in the facility. Unfortunately, we found that 105 residents had contracted the virus. More than 10 people died from the pandemic. And over a dozen staff members also fell ill. So nearly everyone in the facility felt the impact of this virus. Legacy staff and administrators are not entirely sure how the first case came into the nursing home.
Steve Fennessy: Okay.
Sidnee King: But I did speak to one of the nurses who is one of the main characters in the story. Her name is Crystal Wright, who fell ill first. She's an infection control nurse at the facility and she was out for over 30 days because she tested positive for the virus twice.
Steve Fennessy: Oh, wow. Okay. Does she know if she contracted it at the facility or was it somewhere else?
Sidnee King: She does not know. But she became sick before the first resident case was reported. We also spoke with another nurse who had worked at Legacy for years, loved her job, came to work every day with a bag of, you know, like, DumDum suckers in her purse for her favorite residents. But she has a husband and seven kids. And when people started getting sick, when she saw her coworkers going to the hospital, she quit her job. And, you know, she was — she was so scared that she could either pass the virus on to her residents that she loved and cared about or that she could pass the resident — the virus onto her family. But as the facility is kind of recouping, death rates are slowing down, she has come back and is working back at the facility again. The rates in nursing homes are very reflective of what's happening nationwide in the general population. You know, low access to affordable housing, low access to quality health care. You know, Black people tend to work these essential jobs where, you know, they don't have the resources to be able to stay at home. They have to go to work. They have to get on the bus. They have to get on the train. You know what I'm saying?
Sidnee King: And so in a nursing home like Legacy, where there's almost all Black residents, almost all Black staff who are in this time still concerned about paying their bills on time. You know what I'm saying? Like, you're having to take that step and go out even if they want to stay home. You're going to see those impacts of just being underserved, play out in a nursing home like Legacy.
Steve Fennessy: Right.
Protestor: We stand today because of Ahmaud Arbery! We stand today because of Breonna Taylor! We stand today because of George Floyd! We stand today for the Black people who never got a hashtag! Make some noise!
Steve Fennessy: You've mentioned in your story that I believe was after the Rayshard Brooks shooting. There were a number of protests in Atlanta and some went past the facility. And what effect did that have on the residents at Legacy?
Sidnee King: Yes. So really, what these — these residents are hoping for is, is just to return or just a semblance of normalcy even while the facility is shut down. And so to have that level of activity, to hear protesters outside of the window where, you know, see people marching down the street with posters or banners, you know, chanting Black Lives Matter. They said that, you know, it made them feel like they were a part of it. And I think it's really special because if you consider the legacy and the history of activism and resistance and fighting for, you know, equity for Black people that this neighborhood in Auburn Avenue represents just the symbolism of, you know, in a time where Black nursing home residents, Black elderly people are struggling so much, especially in the specific facility, to see, you know, people advocating for the lives of Black folk is really powerful and encouraging for them, even as they're as they're shut off from the world.
Steve Fennessy: Right. So it allowed them at least some way to, to — to witness, if not actually engage from —
Sidnee King: Yes.
Steve Fennessy: — from inside the facility.
Sidnee King: Absolutely.
Steve Fennessy: One of the other things you spoke about in your story was how well or how — how badly the government is tracking infections in nursing homes and specifically infections broken down by race in nursing homes. Can you tell me a little bit about what you found?
Sidnee King: Yeah. So first, you know, we — we looked at Georgia, what the state and county, what Fulton County are doing in terms of tracking nursing home deaths. And in both cases, nursing home deaths and cases are not broken down demographically. You know, we've asked why that's not the case and it comes down to resources and also cooperation with the nursing home facilities themselves. I mean, I just think that the takeaway from this — this reporting is that there should be a level of urgency to understand what's happening to Black nursing home residents. You know….
Steve Fennessy: Right.
Sidnee King: It's been reported that African-Americans are dying at a rate as high as two times the rate of their white peers nationwide and just overall, and it's alarming to see this same pattern persist in nursing homes. And so my hope is that there’d be a new level of just dedication to understanding what's going on. And we're seeing that a little bit with the Special Committee on Aging in the Senate and the hearings that they've had over the last four months, kind of hoping to begin addressing that issue. So, you know, we'll see what happens moving forward.
Steve Fennessy: Our thanks to Carrie Teegardin, an investigative reporter for the Atlanta Journal-Constitution. And to Sidnee King, a graduate student at Northwestern University's Medill School of Journalism. Last month, Georgia Gov. Brian Kemp loosened the restrictions on visitations to those facilities who have gone 28 days since a positive coronavirus case, a ban had been in place since March. I'm Steve Fennessy. This is Georgia Today, a production of Georgia Public Broadcasting. You can subscribe to our show at GPB.org/GeorgiaToday or anywhere you get podcasts. Please leave us a rating and review on Apple podcast. Have a story idea? Connect with us at GeorgiaToday@GPB.org. Our producers are Sean Powers and Pria Mahadevan. Our intern is Eva Rothenberg. Thanks for listening, we'll see you next week.
Transcript by Eva Rothenberg