Texas allows nursing homes to voluntarily accept COVID-positive patients from hospitals and other nursing homes. But there are no additional safeguards for the people sent there, and some of the facilities have a history of breaking rules.
John Wayne McDermett used to manage nursing homes. Now he lives in one.
After serving 12 years as a rural county judge and working a stint as a disc jockey at a country radio station, the Texas native switched careers and started managing nursing homes stretching from West Texas to North Texas. For two decades, he hired, fired, and even mopped the floors when the janitor was out. Now, after a series of strokes forced him into an early retirement, he lives at the Munday Nursing Center, the only nursing home in Munday, a town of 1,300 an hour north of Abilene.
McDermett, 69, says he likes living here. The staff is friendly. The food is decent. He has a desktop computer in his room where he can read the news and communicate with his two daughters via Facebook. McDermett takes pride in the fact that he’s something of a spring chicken at the facility; he’s the youngest male resident here. So even though he uses a wheelchair and has diabetes, blackouts, and seizures, passing his days at Munday Nursing Center hasn’t been too bad. That is, until mid-July, when McDermett was told that he and 20 other residents had tested positive for COVID-19.
Munday’s small, 61-bed facility didn’t have the room to properly isolate all of its COVID-positive residents, so based on state guidance, leaders decided to send some of their infected residents to another facility that was, in theory, specially equipped to handle them. So McDermett and the others packed up three days’ worth of clothes and loaded into a caravan of cars to make the trip to Coronado Nursing & Rehabilitation Center, a 188-bed facility in Abilene that had opened a separate wing for COVID patients three months before.
Sending COVID-postive patients to dedicated facilities seemed logical: Since the coronavirus started sweeping the nation this spring, nursing homes had been hit especially hard. In rural areas, many small facilities simply weren’t equipped to handle outbreaks. But many of the nursing homes residents were sent to are chronically understaffed, making it difficult for nurses to properly care for an influx of new residents. The state health department didn’t create any new safeguards for facilities that accepted sick patients, despite the already spotty inspection records at some. The result appears to be a migration of elderly, sick people into nursing homes that were unprepared, and in some cases, unscrupulous.
For some of the sick Munday residents, the trip would be their last—the decision to send residents away set in motion a chain of events that staff, family members, and residents say led to medical neglect of residents and at least two deaths.
An investigation conducted by a Texas Health and Human Services Commission (HHSC) inspector in August turned up no deficiencies at Coronado. Senior Living Properties, the company that operates Coronado along with 36 other nursing homes in Texas and Oklahoma, says it has taken “extraordinary” precautions in caring for residents during the pandemic. “Nothing is more important than the safety and well-being of our employees and all those who live and are cared for at Coronado Nursing & Rehabilitation,” a spokesperson told the Observer.
Roughly 50 nursing homes have dedicated COVID-19 units, according to an HHSC spokesperson, with six dedicated entirely to COVID-positive residents. Most of them are concentrated in Dallas, San Antonio, and Houston. Administrators at these facilities say that they’re opening their doors to COVID-positive residents as a community service that will prevent further spread in other nursing homes.
But some nursing homes aren’t equipped to handle the influx of very sick people. For example, hospital patients in El Paso have been sent to the 139-bed Mountain View Health and Rehabilitation since July, despite allegations that the facility was putting workers and residents at risk by failing to provide sufficient protective gear. Workers told state regulators that administrators denied them access to PPE, going so far as to hide masks from employees, triggering a state investigation. As of October 13, 119 residents had tested positive for COVID-19, according to the most recent state data.
Elsewhere in Texas, residents and their families expressed concern that facility operators were intentionally bringing sick people into their fold instead of isolating them where they were living at the time of infection. Family members of residents at a Plano nursing home told WFAA in September that they were alarmed to learn the facility was taking in COVID patients from a local hospital. “I was appalled. Absolutely horrified,” the granddaughter of a 98-year-old woman told the TV station. Nursing homes aren’t required to get the approval of residents or family members before opening a COVID unit onsite.
As the coronavirus spread across New York in March, overloading the state’s hospital capacity, Governor Anthony Cuomo began requiring nursing homes to accept COVID patients from hospitals to free up space. “Early on in the pandemic, there was this thought that we need to get all the COVID-19 residents and get them out away from the negative people,” says George Linial, the president and CEO of LeadingAge Texas, an advocacy group for nursing home residents. The plan backfired—death rates started to skyrocket in New York nursing homes that had accepted hospital patients; the order was rescinded. Linial says that despite the inherent difficulty of creating COVID-specific wings inside nursing homes, “that seems to be working better than trying to ship everyone off to a COVID-positive facility.”
Despite the lessons learned in New York, Texas has continued to transfer COVID-positive patients. The state has few safeguards to protect such a vulnerable population as it’s moved from one place to another. There are no special requirements nursing home operators must meet before setting up such units, and the state conducts no additional inspections. The lack of oversight allows even facilities with histories of violations and deficiencies to take on high-risk residents.
In San Antonio, Bexar County officials decided this summer to consolidate all of the city’s COVID-positive nursing home residents inside the 92-bed River City Care Center. Some county officials opposed the decision, calling the site “horrible” due to its spotty inspection record. A San Antonio Express-News article published in November 2019 reported instances of abuse and neglect inside the facility, including the choking death of one resident. Other nursing homes started sending their infected to River City anyway. Since then, 14 people who had tested positive for COVID-19 have died; some of those deaths were possibly related to high temperatures inside the facility and the distribution of the wrong medication, the city’s NBC affiliate reports.
Abilene’s Coronado Nursing & Rehabilitation Center has had its own problems in the past. In its December inspection by the U.S. Centers for Medicaid & Medicare (CMS), the facility was cited for four deficiencies, the most serious of which put a resident in “immediate jeopardy.” In that incident, a resident with dementia was able to leave the facility and walk two miles away on a 48-degree night, the inspection report shows. He was gone for two hours before anyone on staff realized he had left. CMS gives Coronado an overall rating of two out of five stars: below average.
Still, Coronado opted in April to take on sick people “to help fill a need in the community,” spokesperson Taylor Pittman says. As of September, the facility had accepted 72 COVID-positive residents. McDermett, the former nursing home administrator, was one of them.
McDermett says he didn’t shower because he saw what appeared to be feces on the shower walls and floor. Worse still, McDermett says he wasn’t regularly given the litany of medications he takes to prevent blackouts and seizures. He says he wasn’t treated with prescription eyedrops for glaucoma; not using the drops can worsen the condition and cause vision loss. He wanted to call his family and his doctor to let them know what was happening, but he doesn’t own a cellphone. There was no landline in his room.
Ruby Walling, a 94-year-old woman with dementia, also had a bad experience at Coronado, her daughter Barbara says. Ruby arrived at the facility in late June after testing positive for COVID-19. Barbara gave her mother a cellphone and showed her how to use it so they could keep in touch. Her mother started calling her, hysterical and sobbing. “She said she would kill herself if I didn’t get her out of there,” Barbara says. When she went to remove Ruby from the facility, she observed that her mother was “filthy,” as if she hadn’t been bathed during her stay there.
Nursing facilities in Texas typically have fewer employees than they need, and Coronado is no exception. Even before the influx of new residents, CMS rated Coronado’s staffing as “much below average.” Licensed nurses at Coronado spend one hour and four minutes with each resident per day, 30 minutes less than the national average. Staffing is one of the most important ways to measure quality of care at a nursing home, experts say. “I don’t think they were prepared for us,” McDermett says. Pittman, the facility’s spokesperson, says Coronado has added seven full-time direct-care employees to its roster since the pandemic began.
“It was a bad experience. I’m just hoping I can get over it one of these days,” McDermett says.
Despite McDermett and Walling’s harrowing experiences, they were luckier than some of their peers who were also transferred to Coronado. Gene Thompson, a 100-year-old World War II veteran and cotton farmer from Munday, was among the residents who tested positive for the virus in July. On the day he was sent to Coronado, Gene was in high spirits, says his grandson Tyler Thomspon. Gene thought a change of scenery might be nice. After a few days at Coronado, Tyler became worried about his grandfather. Gene wasn’t able to get out of bed. He couldn’t talk. Tyler went to Coronado and confronted staff, telling them he wanted to remove Gene from the facility. Tyler carried him to his car. He didn’t appear to have been bathed; instead staff had put him in an adult diaper, Tyler says. Gene, a diabetic, appeared to have low blood sugar and was dehydrated. They picked up a bottle of orange juice and after drinking it, Gene perked back up.
Tyler took Gene back to the Munday Nursing Center, which had at that point set up its own small isolation wing. Tyler says he cherished the one-hour drive with Gene. “We hadn’t been able to see him for months. I was lucky,” he says. Neither of them knew that Gene had contracted pneumonia. Back in Munday, Gene began having trouble breathing; he was sent by ambulance to a hospital emergency room in Wichita Falls, an hour north. Tyler and other family members rushed to see Gene in the hospital, but he died soon after arriving.
At least one other Munday Nursing Center resident died from COVID-19 complications after being sent to Coronado. Pittman says her company “strongly disputes” the allegations made by McDermett, Tyler Thompson, and Barbara Walling, pointing to the state investigation that turned up no deficiencies at Coronado.
At the Munday Nursing Center, life is slowly improving. In September, the facility was able to open its dining room to residents for the first time since March. The isolation wing is gone. Sunday church services resumed. Governor Greg Abbott eased some restrictions on family visitations at nursing homes last month, which allowed limited visitations in Munday. Though he’d love to see them, McDermett isn’t allowing family members to visit him just yet—he doesn’t want to risk giving them the virus or spreading it to his new granddaughter, who was born the day before he was sent to Coronado.
For now, he’s focused on making it through the pandemic, he says. “That’s the bottom line: to stay alive.”
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline.
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