State investigates more than 25 long-term care centers
April 17, 2020
More than 25 long-term care facilities were under investigation by the state last week as coronavirus outbreaks kept rising, with now 25 deaths of residents and 335 positive cases. But officials are releasing few details.
The homes under investigation include Grace Skilled Nursing and Therapy in Norman, which has the state's largest outbreak, now with 10 residents' deaths, and Mangum Skilled Nursing and Therapy, where three residents died, according to an April 6 report by the Oklahoma State Department of Health, obtained by Oklahoma Watch, and agency data. Both facilities are owned at least in part by members of the same family.
Investigations are conducted at every facility that reported a positive case of COVID-19 among residents or staff or that has suspected cases, according to the state.
Another 17 investigations were resolved by the agency, the report said. As of publication, the state has not released reports for the resolved investigations requested by Oklahoma Watch, saying that they "cannot be released until they have been released to the facility."
Long-term care surveyors from the health department are conducting onsite investigations. Other state and county employees and public health professionals, including some from the University of Oklahoma's Health Science Center, are assisting in the efforts.
Investigators use the Centers for Medicare and Medicaid Services' infection control survey when reviewing facility compliance with federal standards. The survey requires checks for proper hand washing and use of protective equipment such as gloves and masks, cancellation of group activities and dining, and restricted visitor protocols.
Contact tracing is also a priority. The survey requires a count of residents and staff who have tested positive for COVID-19 or are showing symptoms. Investigators interview everyone who has tested positive and review their medical histories. Initial questions are focused on patients' contact with others going back days before the first symptoms occurred, to identify and notify anyone who may have been infected.
"Traditionally, health department epidemiologists have called each suspected associate of positive patients," state epidemiologist Aaron Wendelboe wrote in an email. "As the number of cases grows beyond our capacity to reach everyone in a timely manner, we are now using other means, such as emailing information with action steps for each person to take."
So far, no facilities have received citations as a result of an investigation, said health department spokeswoman Shelley Zumwalt. The focus has been on educating and assisting facilities on infection control, she said.
Grace Living Centers
Grace Skilled Nursing and Therapy in west Norman announced in late March that two residents had died and seven more had tested positive for the virus. By Monday, those numbers had risen to 10 deaths and 71 positive cases.
An outbreak team conducted an onsite investigation on March 25, according to the state investigation report. The report contained few details, except to say there was "appropriate infection control in place."
The facility refused requests for an interview but provided a statement that said in part: "Since this matter began, the facility has taken all steps recommended by the CDC, the Oklahoma State Department of Health, the office of the state epidemiologist and its own professional team in its attempts to address and mitigate the spread of COVID 19." It added that "while the facility continues to deal with the effects of this unprecedented pandemic, it is also hopeful that the efforts being put forth will ultimately achieve a favorable resolution for many involved. But the fight is by no means over."
Also under investigation is Mangum Skilled Nursing and Therapy. Its ownership is tied to members of the same family as the Norman nursing home, according to Centers for Medicare and Medicaid Services data on nursing homes. The state's report said that staff who were ill continued working at the facility. The report does not say whether any staff worked at the facility while suffering from COVID-19 symptoms. As of Monday, the facility had 37 cases of COVID-19 and three deaths.
The Mangum center declined to be interviewed but said in a statement that staff members are being screened daily "in accordance with the standards previously established by health officials." The statement said the facility "is unaware of any determination by the Oklahoma State Department of Health that the facility allowed an individual who was either known to have tested positive or displaying symptoms consistent with COVID 19 to provide care or otherwise work in the facility."
According to the federal Centers' online nursing-home data, the Norman nursing home is owned by a for-profit business, Security Health Care LLC, and its principal owner is Kenneth D. Greiner III Revocable Trust. It was formerly known as Grace Living Center-Norman.
The Mangum nursing home, formerly Grace Living Center-Mangum, is owned by Mangum Nursing Center LLC, with Don Greiner as a direct owner and Kenneth Greiner as an indirect owner, according to the federal site.
A third Grace facility, Grace Skilled Nursing and Therapy in Jenks, has reported one positive coronavirus case. The Jenks home is owned by Jenks Living Centers LLC, and owners listed in the federal data site are Kenneth Greiner and Don Greiner. The facility is not listed in the investigations report, which was completed before the Jenks case was confirmed.
The Greiners have ownership interests in at least 21 nursing homes across the state, according to the federal site.
Many of the facilities under investigation have at least one resident or staff who tested positive, with additional test results pending.
Among other listings in the report:
• Two people in an unidentified Cleveland County facility tested positive for the coronavirus but had no symptoms. They were tested "due to exposure to a positive nurse at a local hospital."
• At an Osage County facility, six residents and three staff tested positive, and others had respiratory illnesses, "including roommates of positive cases."
• An unidentified nursing home in Tulsa County had six residents and 16 staff members who tested positive.
• A Garfield County facility had 14 residents and seven staff reporting respiratory illness, but none were tested for COVID-19 because the "illnesses had resolved."
Calls for More Testing
Some families of nursing home residents are asking why their loved ones weren't tested sooner and why more residents aren't being tested.
Rebekah Newman's 65-year-old aunt is diabetic. She moved into Grace Skilled Nursing and Therapy in Norman late last year while recovering from a foot surgery and was expecting to move back home by March. But after three weeks on a ventilator in Norman Regional Hospital, Newman wonders if her aunt will ever return home.
Newman, who asked that her aunt's name not be used, said her aunt was taken to the hospital a few times in February and March for an additional surgery and complications from the procedures. Newman asked doctors to test her aunt for COVID-19 several times but they refused because she did not have common symptoms like a fever or dry cough, Newman said.
Four days after being put on a ventilator, Newman's aunt was tested for COVID-19, Newman said. Two days later, on March 25, her aunt was confirmed positive. Doctors put her on hydroxychloroquine, a drug that is commonly used to treat malaria and that a small study in China found sped up recovery of people mildly ill from the coronavirus. Newman said it hasn't helped.
"It was only after someone (else) at Grace was positive that she met the criteria and that's what made them finally decide to test her," Newman said. "I wish they had tested her sooner. They could have done the malaria mix sooner. Now, there's nothing we can do but wait."
Gary Webb, whose mother tested positive for COVID-19 at the Norman home, wants to know why the state isn't testing every resident at facilities that have a positive case.
"We should be testing every resident and going into every single nursing home," Webb said. "These are the most vulnerable people and their chances of dying are much higher, so we should be doing everything we can to protect them."
The state's weekday reports on long-term care facilities do not include the number of residents tested.
The Norman home would not say how many of its residents were tested but provided a statement that reads: "The facility requested early testing from the Department of Health and, when resources prevented public testing, worked with a private lab in Cleveland County to engage in exhaustive voluntarily testing of numerous residents."
The facility announced late last month that it used Norman-based IMMY laboratory for additional testing of residents but would not say how many were tested.
The state denied that it delayed or withheld testing from the Norman home, saying nursing home residents have always been a priority.
Regarding the Norman facility and family members' complaints about lack of testing, the state health department said in a statement: "Families who have loved ones in long term health facilities have seen the worst of this pandemic and their pursuit for factual information is understandable. Since the very start of the COVID-19 pandemic, committing resources to testing long term care facilities has been OSDH's highest priority. When OSDH was initially notified by Grace Living Center in Norman that they had a symptomatic individual at the facility, there was not just one, but multiple individuals including staff and residents who were symptomatic and after testing were found to be positive for COVID-19. The timetable from the initial call from Grace requesting testing and OSDH staff arriving onsite to test individuals was 24 hours."