November 05, 2020
On November 1, 2020, 60 Minutes featured an investigation of the Life Care Center’s Kirkland Care Center. From what I can remember, this was the first segment of the shows that specifically focused on a long-term care facility. Much to my surprise, the episode was a supportive feature that included interviews with staff about the technical assistance provided by the Washington State Department of Health or by the Centers for Medicare and Medicaid (CMS).
The segment identified that the Life Care Center of Kirkland was the first known long-term care facility to encounter residents with fevers, cough, and rapid respiratory distress requiring hospitalization, which was later identified as COVID-19. They noted that the first of many residents developed symptoms on February 12, 2020. At that time, the only testing for COVID-19 was available through the Centers for Disease Control and Prevention (CDC) and was only permitted for individuals who had traveled to China or who had contacted with an infected person confirmed to have the virus. Since none of the residents of the Kirkland facility met those requirements, the building had no access to testing.
Once testing kits were shipped to Kirkland, the tests were found to be defective. At the same time, researchers at the University of Washington School of Medicine’s testing processes were prohibited by the Food and Drug Administration (FDA). Testing for COVID-19 was provided through the public health department on February 28, 2020.
Bill Whitaker, the 60 Minutes correspondent, toured the facility and noted 38 resident deaths, and said that the medical director and 67 staff members became ill from COVID-19. The facility no longer has any cases of the virus, but at the height of the pandemic, the staff at the nursing home were unable to tell who had the virus or what symptoms would be apparent. The staff purchased oversized men’s shirt to wrap around as dresses in order to improvise personal protective equipment (PPE) that could not be purchased using normal channels.
The director of the public health agency, Dr Jeffrey Duchin, was trained in public health outbreaks, but still was overwhelmed by the COVID-19 outbreak because of the rapid development and spread of the virus. Dr Duchin asked the CDC for a team of epidemiologists to be sent to Kirkland to manage the control of the contagion. The facility wrote to the Department of Health for a strike team to help because of the desperate staffing situation. It took 5 days for help to arrive but in the interim, CMS arrived to perform a survey. It was estimated that 400 staff hours were used to fulfill CMS’ requests for document production from a staff already severely limited by their own illnesses.
Instead of the government attempting to address the issues on the ground, efforts were focused on citing the facility for their lack of preparedness, and CMS cited the facility in excess of $600,000 for the nursing home’s failure to protect its residents during the outbreak. In a 48-page 2567, CMS cited the Kirkland facility at the “Immediate Jeopardy” level. CMS Director, Seema Verma, was asked to comment about the circumstances of the deficiencies and the role of the federal government in managing the crisis in the Life Care Center’s facility, however she declined to answer 60 Minutes’ inquiries. State officials also cited the nursing home for issues similar to those identified in the federal survey.
There were no government protections, insufficient PPE, no available testing, and a complete lack of understanding about the nature of the virus. In January and February of this year, hospitals did not have access to these interventions, let alone long-term care facilities. The corporate official that was interviewed by Bill Whitaker voiced her opinion and said that the nursing home was used as a scapegoat for the spread of COVID-19.
Life Care Centers appealed the findings of the state and federal inspections. A federal judge sided with the nursing home operator and concluded that the facility did not neglect the residents. The federal case is still pending.
To date, 80,000 of the 230,000 US deaths from COVID-19 occurred in long-term care residents. There is a need for an effective public health response, however, inspections and citations during a health care crisis are not the kind of response nursing homes need to battle the pandemic.
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society.