Bloomberg Businessweek - USA (2020-11-09)

onApril22,thediseasehadspread

widely. More than 45 out of about

300 testscamebackpositive.Inthecom­

ingweeks,morethan 100 additionalres­

identsandstaffwouldbeinfected.Six

woulddie,includingCharlesHorton,an

82 ­year­oldformerpoliceofficer.He’d

firstshowedsymptoms,includingshort­

nessofbreath,inmid­April.

Thefacilityhadpreviouslytoldhis

son,TimHorton,thathisdadwasneg­

ativeforthevirus.ButCharles’ssymp­

tomsworsened,andhewasrushedto

thehospitalinlateApril,wherehetested

positive.HediedonMay2. Timthinksif

managementhadtestedtheentirebuild­

ingsooner,hisdadmightstillbealive.

“Thesepeoplehaveshownneglect,”

saysTim,whoisn’tsurewhetherhisdad

wasactuallytestedearlier.He’shired

anattorneytopursuea lawsuitagainst

Trevecca’sowners.“Itain’tright.”

TreveccaisoneofnineTennessee

nursinghomesacquiredoverthepast

fouryearsbyCareRiteCentersLLC,a

chainbasedinEnglewoodCliffs,N.J.In

responsetoa detailedlistofquestions,

AshleyRomano,CareRite’schiefexperi­

enceofficer,saidina writtenstatement

thatthecompanyhas“workeddiligently

togoaboveandbeyondwhatis recom­

mendedbyregulatorybodiestoensure

thehealthandsafetyofourresidents

andstaff,”includingsettingupisolation

zones,discontinuingcommunaldining

and activities, and

supplyingprotective

equipment before

it was required.

Romano addedthat

CareRite’s facilities,

includingTrevecca,

passed infection­

control inspections

since the pandemic

began. “Our company

was founded by peo­

ple who care deeply

about our work and

the residents and

families we serve,”

she said.

Two of Tennessee’s

three largest out­

breaks at nursing

homestodatehavebeenatCareRite

homes,TreveccaandthenearbyGallatin

CenterforRehabilitation& Healing,and

twootherCareRitefacilitiesareamong

thetop 15 inCovidcasesstatewide.As

ofearlyOctober,thecompanyoperated

4%ofthestate’snursinghomebedsbut

accountedfor10%ofcasesand11%of

fatalities,or 71 deathsintotal.Thenum­

bersaresimilarlyelevatedwhencom­

paredwithfacilitiesaroundNashville,

a virushotspot.CareRite’sfivehomes

within 25 milesofthecitycentersuffered

aninfectionratemorethanthreetimes

thatofthemetroarea’s 26 otherhomes.

RomanosaysCareRitehasdetecteda

highnumberofcasesbecauseit proac­

tivelytestedresidentsandstaff“whether

ornottheyareshowingsymptoms.”She

adds:“Thesemeasuresundoubtedly

showcasedhighernumbersbutmost

importantlyallowedustoseparatethe

sickfromthewellandcelebratecount­

lessrecoveries.”

Butmanyemployeessaythesehigh

infectionrateswereentirelypredictable,

causedbya lackofsuppliesanda blin­

keredattitudeabouttherisksthevirus

posed.“Itwasa hotmess,”saysTika

Johnson,a 45­year­oldnursepractitioner

whoworkedasa contractoratTrevecca

andspentsevendaysinintensivecare

aftertestingpositiveonApril24.(She

stoppedworkinginCareRitehomesnot

longaftersherecovered.)“Theyweren’t

preparedforwhatwas

coming,”shesays.

Outbreaks at nursing

homes have become

achingly familiar across

the U.S., beginning with

the one in February in

Kirkland, Wash., that

killed 35 elderly residents

of the Life Care Center.

Only 0.6% of the total U.S.

population lives in nurs­

ing homes and assisted

living facilities, but they

account for 40% of Covid

fatalities, according to

data from the Kaiser

Family Foundation. Put

more simply: Residents

oflong­term­carefacilitiesareabout

100 timesmorelikelytodiefromCovid

thanmembersofthegeneralpopula­

tion.Morethan 450 nursinghomes,out

of15,000nationwide,havesufferedout­

breaksthatinfected 100 ormorepeople.

As industry executivespointout,

some ofthe reasons for thesehigh

deathrateshavenothingtodowith

the homes themselves. Old people

whobecomeinfectedwiththecorona­

virusaremuchmorelikelytodiefrom

it,andanyonewholivesinclosequar­

terswithothersis atgreaterriskofinfec­

tion.“Unfortunatelythisvirusdoesnot

discriminate,”saidRichardFeifer,chief

medicalofficerofGenesisHealthcare,

thenation’slargestnursinghomechain,

ina Mayinvestorcall.“Ithasimpacted

five­starandone­starcentersalike.”

Early research led by David

GrabowskiofHarvardMedicalSchool

seemedtosupporttheideathatnurs­

ing homes were powerless to stop

outbreaks.Grabowskifoundnoappar­

entcorrelationbetweenfacilitiesthat

becamevirushotspotsandthosethat

scoredlowontraditionalqualitymet­

rics,including pastinfection­control

violationsorwhetherthefacilitywas

ownedbya for­profitbusiness.Instead,

hefound,thetwomostcriticalfactors

werebeyondanyhome’scontrol:a facil­

ity’slocation(whetherthesurrounding

communityhasa highrateofinfection)

anditssize(thebiggerthebuilding,the

largerthestaff—andthehigherthelike­

lihoodsomeonewillcarrythevirus

inside). “It’s much more about where

youareandnotwhoyouare,”Grabowski

saidduringanonlineseminarinMay.

“Idon’tthinkthisis a bad­apple prob­

lem. This is a system problem.”

The research gave the industry

ammunition to argue that Covid deaths

weren’t its responsibility. “It’s been said

that blame is a person’s way of making

senseofchaos,”wroteNewYorknurs­

inghomelobbyistStephenHansein

anop­edintheBuffaloNewsinMay.

“OutbreaksofCovid­ 19 arenottheresult

ofinattentivenessorshortcomingsin

long­term care facilities.”

Meanwhile, some governors, such

as New York’s Andrew Cuomo, may

58

Bloomberg Businessweek November 9, 2020

Covid-19Casesper 100 Beds

◼Infections

◼Deaths

Tennessee

nursing homes

CareRite homes

in the state

1.7

12.7

31.4

4.7