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King County, Washington Nursing Home Harbors 9 of 10 New COVID-19 Infected Cases

First days at the heart of an outbreak: Life Care nursing home becomes national epicenter of coronavirus

March 3, 2020 at 6:00 am Updated March 3, 2020 at 6:02 pm

The four ambulances arrived in quick succession Monday morning, filing into the parking lot of the long-term care facility in Kirkland that has become a focal point in the United States' response to the novel coronavirus illness.

For Life Care Center, COVID-19 has brought seven resident deaths out of nine total in the state - and nation - by Tuesday evening. It has also brought a cluster of illnesses, a wave of questions from family members with relatives inside Life Care and scrutiny over how prepared the care facility and others are for an outbreak.

Health experts warn that nursing homes and other assisted living facilities are especially vulnerable, not only because they largely serve elderly residents, but also because many have been cited for health violations.

Ambulances have arrived each day at Life Care, with emergency workers wheeling away the sick on a stretcher. In some instances, a white sheet is held up to shield the patient from cameras. Of the 27 total COVID-19 cases to emerge statewide as of Tuesday evening, 14 have been linked to Life Care, according to officials. Some 50 people among the facility's 100-plus residents and 180 staff were being monitored for signs of the illness, officials said over the weekend.
"We don't really know what has led to this, but we know generally speaking that it's very common for nursing homes to have very lax systems for control in place," said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for residents of nursing homes and other assisted living centers.

Life Care said in a statement it was following all the proper protocols for dealing with the outbreak and stemming its spread. Visits from family members, volunteers and vendors were being halted as a precaution, Ellie Basham, the center's executive director, said in the statement.

"We are doing everything that the CDC [Centers for Disease Control and Prevention] and the State of Washington recommends and we are in regular contact with them," Basham wrote in a separate email to family members of its residents.

But even as the center halted visits, one family member of a patient told The Seattle Times in an interview she was allowed to walk right in Sunday evening to see her 89-year-old mother.

Kim Frey drove 230 miles from Twisp to visit her mother, who last month was hospitalized with a severe respiratory illness at nearby EvergreenHealth and nearly died. When she went to Life Care Sunday, the only thing on her mind, she said, was "What if she dies and she's in there all alone?"

Frey said she didn't anticipate being allowed into the facility, but an employee noticed her standing outside her mother's window and let her in. Frey made a sign to hold up to her mother. It read, "We can't come in, but Jesus can ... you're not alone! Drink a lot of water."

Staff at Life Care were caring for Frey's mother well, she said. They were "smiling and reacting to her pleasantly, not making me feel rushed at all. I was very encouraged by what I saw."

And the mood inside the facility was "actually pretty peaceful," she said, no buzzing alarms or people rushing around.

But now that she's out of the facility, Frey said, she questions whether visiting her mother was the right thing to do. Frey said she wore a mask when she saw her mother, and took a shower and washed her clothes. Still, she wonders whether she might be carrying the disease - and whether she may inadvertently pass it to her 88-year-old father.

The center declined to respond to questions about Frey's account of the visit.

Failures to follow requirements for preventing infections are the most commonly cited violations among nursing homes nationally, according to a Seattle Times analysis of inspection data from the federal Centers for Medicare and Medicaid Services. Such violations often consist of a staffer's failure to wash hands or properly dispose of sanitary gloves and don't affect a large number of patients.

In this regard, the Life Care Center in Kirkland was neither an exception nor an outlier. Health inspectors cited the facility last April for failures to prevent infections, the only such finding in recent years, the federal data shows. CMS rates the facility three out of five stars for health inspections, and five stars overall.

Authorities have cited other nursing homes more often for infection-prevention deficiencies.

At Life Care Center, though, the lapses by staff to guard against infections had the potential to affect many patients, according to state and federal records.

During a series of unannounced visits last March and April, investigators documented a range of infection-related concerns, from how staff treated wounds to a broken exhaust fan in the laundry room. In one case, inspectors said they saw a nurse go into resident's room without personal protective equipment, despite a sign outside warning staff and visitors to wear a mask, gown and gloves when entering. The resident had a suspected respiratory infection and was being kept in isolation. Investigators also noted that the resident's oxygen device was tangled with the bed sheet and socks, instead of being bagged to prevent infection.

Separately, the investigators observed a kitchen employee use the same gloves to load dirty dishes into the dishwasher and then stack clean dishes.

There were two influenza outbreaks on the facility's infection-control report that month, and at least 17 residents and seven caregivers fell ill, according to the investigators. The facility said it trained staff and corrected the mistakes. When investigators conducted a follow-up visit in June, they found the facility was in compliance.



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By Mary Hudetz, Katherine Khashimova Long, Daniel Gilbert and Asia Fields
Seattle Times staff reporters

Workers outside the entrance to the Life Care Center of Kirkland long-term care facility on Monday unload supplies, including Purell sanitation stations. (Steve Ringman / The Seattle Times)

The Life Care Center in Kirkland. (Greg Gilbert / The Seattle Times)

Monday, March 2, 2020 King County Executive Dow Constantine addressing the press on immediate actions and updates along with the update of 6 deaths. 213198

Monday, March 2, 2020. Workers outside the entrance to the LifeC Care Center nursing home unload supplies including Purell sanitation stations.

1 of 3 | Workers outside the entrance to the Life Care Center of Kirkland long-term care facility on Monday unload supplies, including... (Steve Ringman / The Seattle Times)

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2020-03-04 King County Public Health Confirmed List of 31 coronavirus cases 04.Mar.2020 14:34

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A large number of the cases so far stem from an outbreak at Life Care Center of Kirkland, according to health officials.

The list includes 10 new cases:

A female in her 60s, Life Care resident, hospitalized at EvergreenHealth
A male in his 50s, associated with Life Care, not hospitalized
A male in his 60s, Life Care resident, hospitalized at EvergreenHealth
A female in her 70s, Life Care resident, hospitalized at EvergreenHealth
A male in his 60s, Life Care resident, hospitalized at Evergreen
A female in her 90s, Life Care resident, was hospitalized at Evergreen and died on 3/3/20
A female in her 70s, Life Care resident, hospitalized at EvergreenHealth
A male in his 30s, no known exposure, not hospitalized
A female in her teens, associated with Life Care, not hospitalized
A male in his 80s, a resident of Life Care, hospitalized at EvergreenHealth
No other details about the 10 cases reported Wednesday are available currently.

The other 21 cases, already reported earlier by Public Health, include:

A female in her 40s, worked at LifeCare, never hospitalized and is recovering at home
A female in her 60s, family member of a confirmed case of COVID-19, not hospitalized
A male in his 70s, a frequent visitor of LifeCare, hospitalization status unknown currently
A male in his 20s, unknown exposure, hospitalized at Swedish Issaquah
A male in his 20s, unknown exposure, hospitalized at Swedish Issaquah
A female in her 80s, resident of LifeCare, never hospitalized, died on 2/26/20
A male in his 50s, resident of LifeCare, hospitalized at Harborview Medical Center and died on 2/26/20
A male in his 50s, hospitalized at Highline Hospital. No known exposures. He is in stable but critical condition. He had no underlying health conditions.
A male in his 70s, a resident of LifeCare, hospitalized at EvergreenHealth in Kirkland. The man had underlying health conditions, and died 3/1/20
A female in her 70s, a resident of LifeCare, hospitalized at EvergreenHealth in Kirkland. The woman had underlying health conditions, and died 3/1/20
A female in her 80s, a resident of LifeCare, was hospitalized at EvergreenHealth. She is in critical condition.
A female in her 80s, hospitalized at EvergreenHealth in Kirkland. This person died on 3/1/20.
A female in her 90s, hospitalized at EvergreenHealth in Kirkland.
A male in his 70s, hospitalized at EvergreenHealth in Kirkland. The man has underlying health conditions, and is in critical condition
A male in his 70s was hospitalized at EvergreenHealth. He had underlying health conditions and died on 2/29/20.
A man in his 60s, hospitalized at Valley Medical Center in Renton.
A man in 60s, hospitalized at Virginia Mason Medical Center.
A woman in her 50s, who had traveled to South Korea; recovering at home
A woman in her 70s, who was a resident of LifeCare in Kirkland, hospitalized at EvergreenHealth and died on 3/2/20
A woman in her 40s, employed by LifeCare, who is hospitalized at Overlake Medical Center
A man in his 50s, who was hospitalized and died 2/28/20 at EvergreenHealth