Before the federal government banned most visitors from nursing homes on March 13, Sally Palmer and her daughter spent many hours by her disabled son’s side at Durham Nursing and Rehabilitation Center.
Once shut out, Palmer struggled to maintain contact with staff, a frightening time since she intended to remove her immunocompromised son if coronavirus reached the facility.
The virus did strike, but Palmer did not know until after her son was rushed to the hospital following seizures that two doctors later told her were likely linked to COVID-19 illness, she said.
Justin ended up on a ventilator at Duke Hospital for 11 days.
Nursing homes have been the epicenter of Durham County’s lethal COVID-19 cases. Deaths at three facilities account for almost 72% of the 68 COVID-19 fatalities in Durham County to date. Statewide COVID-19 cases linked to nursing homes account for 46.3% of deaths.
That tragic statistic doesn’t convey all the suffering related to the outbreaks.
The 9th Street Journal talked to three women — a mother, a granddaughter, and a daughter — who said they were cut off from loved ones in Durham Nursing and Rehabilitation and Treyburn Rehabilitation Center after COVID-19 first struck these facilities.
Palmer’s 39-year-old son, Justin, is blind, immunocompromised and has cognitive impairments from a traumatic brain injury.
Palmer was ready to pull Justin from Durham Nursing and Rehabilitation if the coronavirus struck there because she was dissatisfied with his care before the pandemic, she said. Due to his medical conditions, he chokes very easily if he is not monitored during meals.
“He started being taken to the hospital every three weeks or so because no one was able to watch him,” said Palmer.
Immediately following the ban on visitors, Palmer and her daughter, Brooke, called the facility every day to check whether there were any signs that coronavirus had reached the home. In the week prior to Justin’s hospitalization, Palmer called four times to ask an administrator and nurses if there were any signs the virus was present. Both times employees told her all was well, she said.
On April 9, Justin was rushed to Duke Hospital after suffering four seizures in 24 hours, his mother said. Five days later, Durham County Public Health Department reported 54 positive coronavirus cases at Durham Nursing and Rehabilitation.
A few days after Justin was admitted, he seemed to be improving despite testing positive for COVID-19. But then he started to struggle to breathe and was put on a ventilator for 11 days, his mother said. Two doctors told Palmer his seizures were a side effect of COVID-19, the coronavirus illness, she said.
“He couldn’t breathe on his own for a while and there were days there where I thought he wasn’t gonna make it but he did. He did, he did, he did,” she said.
Michelle Baldwin, the executive director of Durham Nursing and Rehabilitation, declined to comment about Palmer’s recounting of events when reached by phone. Maximus Healthcare Group, the owners of Durham Nursing and Rehabilitation, did not respond to multiple requests for comment by phone and email.
As of July 10, 17 deaths and 111 coronavirus infections have been reported at Durham Nursing and Rehabilitation, which is licensed to 126 beds, according to the North Carolina Department of Health and Human Services. The facility was taken off the list of ongoing outbreaks on June 30.
Justin did not return to Durham Nursing and Rehabilitation. After his hospitalization, he stayed with his sister until they found a new facility home for him, a specialized home for patients with traumatic brain injuries in Johnston County, about 60 miles from Durham Nursing and Rehabilitation. For now, he’s at his sister’s home.
In mid March, Kayla Driver’s grandmother, Mary, checked into Treyburn Rehabilitation Center for what was supposed to be two weeks of physical and occupational therapy. One day, therapists stopped coming to her room, which she was not allowed to leave, her granddaughter said. Neither woman was told why, Driver told 9th Street.
After the granddaughter called asking about coronavirus, her grandmother asked a staff member if the virus was in the facility. She was told people who tested positive were in rooms on a different hall, Driver said.
Her expected two-week stay turned into three and a half weeks. “She was upset because she had wanted to come home and they weren’t helping her get where she needed to be,” said Driver.
Luckily, Driver’s grandmother left on April 10 without contracting the virus, just four days before Durham County reported Treyburn’s first four cases.
Treyburn Rehabilitation Center reported 105 cases and 22 deaths at its 132 bed facility as of July 10, according to the North Carolina Department of Health and Human Services. Treyburn’s cases continued to rise this week: The number of resident cases increased by four from a July 7 state update.
Since the start of the outbreak, staff at Treyburn took pains to keep residents informed about the ways coronavirus was changing operations inside the facility, said Susan Kaar, vice president of compliance and quality management at Southern Healthcare Management, which manages Treyburn.
The facility was split up into three sections. They included an observation unit where new patients and suspected cases stay for two weeks in single rooms, a COVID-19 unit where people with confirmed infections also stay in single rooms, and the rest of the residents, Kaar said.
Staff are assigned to one wing only “so you don’t have staff going from one section of a building to another section of a building,” Karr said.
Rodney Lowe did not survive COVID-19 after the coronavirus reached Durham Nursing and Rehabilitation Center.
Lowe, 64, has been a resident of Durham Nursing and Rehabilitation since August 2017, following a stroke in which he lost mobility in his right side and the ability to speak well.
Lowe was one of the 54 people at Durham Nursing and Rehabilitation whose positive coronavirus test results were announced by Durham County on April 14, according to Lowe’s daughter, Wendy Lowe Bouda. But Lowe Bouda did not know, she said, until 10 days later when a staff member, she said, called to say he had a fever and was dehydrated.
On April 24, Lowe Bouda, a pediatric nurse who lives in Jacksonville, Florida, called and asked a facility employee whether her father had the new coronavirus, she said. The staff member said she knew nothing about that, according to Lowe Bouda. At this point, Durham Nursing and Rehabilitation had reported 111 cases of coronavirus, according to Durham County.
A few hours later, a facility nurse practitioner called Lowe Bouda, she said, and said her father had tested positive for COVID-19. In fact, Lowe Bouda said, her father was among the 54 people from the facility who the county reported had tested positive on April 14.
Two days after Rodney’s family found out he was infected, he died at Durham Nursing and Rehabilitation Center.
“I could have made my dad more comfortable sooner if I had known it was not just a dehydration issue and it was COVID,” she said.
Lowe Bouda later learned from the family of her late father’s roommate at the facility that the roommate died of COVID-19 too, the day before Lowe Boutda was notified that her father tested positive with the virus.
9th Street asked to speak with Baldwin, the Durham Nursing and Rehabilitation executive director, about Rodney Lowe specifically when reaching out by phone and email. But Baldwin did not respond.
The Centers for Medicare and Medicaid Services (CMS) did not direct nursing homes to report coronavirus cases to the Centers for Disease Control and Prevention, residents or families until May 6, 68 days after the first major nursing home outbreak occurred in the U.S.case was confirmed inside a U.S. nursing home.
In a memo that went into effect on May 6, the federal agency officially started requiring the facilities to report cases to the Center for Disease Control and Prevention (CDC) and family members, in addition to the state and local health departments these facilities were already required to report to.
The memo noted that CMS did “not expect facilities to make individual telephone calls to each resident’s family or responsible party to inform them that a resident in the facility has laboratory-confirmed COVID-19.” It also stated: “However, we expect facilities to take reasonable efforts to make it easy for residents, their representatives, and families to obtain the information facilities are required to provide.”
Not all long term health care facilities in Durham County have had coronavirus outbreaks, according to county records. Since the virus struck Durham, five out of 10 Medicare and Medicaid-certified homes here have reported them. Two had only one death between them.
Durham Nursing and Rehabilitation and Treyburn, were the only homes among the five with outbreaks to receive the lowest possible ranking of l out of five stars, during recent inspections by Centers for Medicare and Medicaid Services inspections, in June of 2019 and February 2020.
Treyburn has followed all federal guidance on required disclosures, including complying with the within-a-calendar-day deadline for disclosing to family members after a single virus infection was confirmed or three or more residents or staff developed respiratory symptoms within the same 72 hours, said Kaar, the Southern Healthcare Management vice president.
Changes in normal programming made within facilities to prevent or reduce the risk of spreading the coronavirus must be disclosed to patients too, she said.
Being disconnected from family during a COVID-19 outbreak can have serious consequences for vulnerable residents in any long term care facility, said Lynn Friss Feinberg, a senior strategic policy advisor at AARP, the national nonprofit that advocates for older Americans.
She and a colleague published an article in the “Journal of Aging and Social Policy” in April noting how family members give the most practical support to older adults with serious health conditions.
“Family members of people living in nursing cares provide vital support for their loved ones in these nursing homes, ” Feinberg told 9th Street. “They’re really the eyes and ears of the comfort and safety of their loved ones.”
9th Street Journal reporter Victoria Eavis can be reached at firstname.lastname@example.org
At top: The late Rodney Lowe, a former Durham Nursing and Rehabilitation resident who died from COVID-19. Photo used with permission from Wendy Lowe Bouda