DAYS OF HEARTBREAK
Inside Austin’s deadliest nursing home
Maria Ortega cradled a phone to her ear — her children and grandchildren huddled around her — as she choked out a few final words to her 74-year-old mother, Rachel Luna.
Luna was in an ICU bed across town, in and out of consciousness, dying from the coronavirus. She slipped away just after midnight on April 15.
The next day, 86-year-old Barbara Gardner, who lived down the hall from Luna at the West Oaks Nursing and Rehabilitation Center, succumbed to the virus alone in her room.
On the third consecutive day of heartbreak at the tan-brick facility in South Austin, 51-year-old Maurice Dotson, a beloved nursing assistant who tended to patients there for a quarter century, became the first health care worker in the city to die from COVID-19.
“My heart breaks for everyone there,” said Dotson’s mother, Florence. “I pray about it every day.”
Since the outbreak began in late March, the virus has stalked the West Oaks hallways, spreading from room to room, patient to patient. West Oaks has averaged at least two deaths a week. More than half of its 125 patients have been diagnosed with the virus. Fifteen have died. Two dozen staff members have tested positive.
What happened there the week of April 12 offers a snapshot of the grim toll the coronavirus has exacted at facilities that house some of the nation’s most vulnerable populations.
Leaders there say they have been in a constant battle to save lives by isolating the sick from the healthy. Terrified employees have raced to prevent further loss while trying to protect themselves after losing a friend and colleague.
The experiences of family members with loved ones at West Oaks mirrors the devastation and anxiety of thousands of families across the nation.
Elderly parents and grandparents who could no longer care for themselves sit sequestered in nursing homes and similar facilities. Children and grandchildren have grappled with the helpless reality that they can’t see family members and must put faith in often overwhelmed facility staff who they hope are abiding by protocols and providing proper care. Nationwide, an estimated 24,000 residents and staff have died of the virus.
West Oaks operators say they have taken an array of steps to stop the spread of COVID-19. They have suspended gatherings, closed dining halls and quarantined residents in their rooms. They have made sure workers have protective gear and given lessons on how to wear and discard it. They have mandated daily temperature checks for patients and staff alike.
“As we navigate through this unprecedented crisis, our top priority is keeping our patients healthy and safe,” Larry Deering, CEO of West Oaks’ parent company, wrote in a letter to families.
But that is cold comfort for families who have stood by helplessly as their loved ones died alone.
“I don’t want to say I blame them because they were good to my mom,” Ortega said. “But I wonder, ‘Why her? Why my mom?’”
‘She was happy there’
Rachel Luna, once a feisty tournament-winning pool player, moved into West Oaks, a sprawling facility nestled among Texas oaks, four years ago.
She had lived with her daughter in their North Austin duplex for years, but when dementia took hold, she became a danger to herself. After accidentally overdosing on medication, doctors and social workers told Ortega and her brother that they should consider 24-hour nursing care.
West Oaks was the only facility in Austin that had an opening and could offer the level of care Luna needed.
“Miss Luna” quickly settled into Room 114 and got to know residents and staff, who doted on her. Her mother could be demanding, but workers treated her kindly, Ortega said.
“My mom was old school,” Ortega said. “And she would let them know, ‘You get my check to take care of me, so you are going to take care of me.’”
But Luna appreciated the community, which became a hub of social activity for the family.
At Christmastime, gold tinsel decorated the doorway to Luna’s room, a wreath hung in the middle of the door and a stocking dangled under her nameplate.
They sang along when a resident or visitor played the piano next to the vending machines in the common area and shared snacks in the “West Oaks Bistro.”
“She was happy there,” Ortega said.
Long-term care facilities hit hard
Nursing homes and long-term care facilities like West Oaks have been hit hard in the COVID-19 pandemic. Estimates by The New York Times and others found that long-term care facilities have, as of Thursday, accounted for about one-fourth of the more than 75,000 deaths nationally.
In New York, for instance, officials reported that the number of nursing home residents who died after testing positive or were presumed to be positive since March 1 reached nearly 5,000 by May 3, accounting for about one-fifth of the state’s deaths.
Texas officials reported this week that 395 people had died of the virus at nursing homes, about 45% of all virus-related deaths in the state. The toll has rapidly escalated since April 13, when the state reported 47 fatalities at nursing homes and senior care centers.
In Austin, nursing home fatalities make up about half of the city’s total COVID-19 deaths. At least 29 of the deaths in Travis County were residents at nursing homes or other long-term care centers. As of late this week, 335 of the county’s estimated 2,000 COVID-19 cases were nursing home patients or staff.
Experts from the Centers for Disease Control and Prevention have tried to understand nursing home clusters since the first U.S. outbreak in King County, Wash., in February.
Older adults are more susceptible because of their age and underlying health conditions, researchers say. And, nursing homes pose a greater risk because of the “congregate nature,” which experts say routinely contributes to outbreaks of flu, stomach viruses and other maladies.
Research into nursing home outbreaks has also highlighted a troubling aspect of the virus that applies to the population at large, according to the CDC.
“Residents with COVID-19 may not report typical symptoms such as fever or respiratory symptoms,” the agency said. The CDC says patients infected with the virus may have no symptoms and could spread it without knowing.
Officials in Austin and Travis County have issued several orders to try to curb the spread at nursing homes. Officials said in an April 22 directive that facilities must not admit any new residents if two or more patients test positive; that a facility must make all staff available for COVID-19 testing if requested by public health authorities; and that operations must notify next-of-kin of all residents if a patient tests COVID-19 positive.
Austin officials also created a strike team of additional doctors, nurses and other medical staff who may supplement facility staffing during an outbreak and remain until it has subsided.
A week of heartbreak
The week of April 12, the outbreak was in full swing at West Oaks.
A couple of weeks earlier, staff had called Ortega to alert her that two patients had tested positive for the virus. A week later, she was relieved when nurses called again to say that her mother had tested negative.
But about 10 days after that, West Oaks staff called once again to report that Luna wasn’t herself and appeared dehydrated. Two days later, she was admitted into the hospital, where doctors again tested her for the virus.
This time, the test was positive. A doctor told Ortega her mother’s prospects were grim.
“He told me that in her condition, she was probably not going to survive,” Ortega said. “I didn’t want to hear that.”
One week later, on April 14, the family made that final tearful call to their matriarch.
“For her to die the way she did, that’s what really, really hurts,” said Ortega, a school food service worker, crying as she sat on a rusted folding chair in her front lawn. “She deserved to have everybody around her.”
Debbie Cullins’ father called her on April 11 to say her mother, Barbara Gardner, had tested positive for COVID-19.
West Oaks had become a center of family life for 86-year-old Gardner and her husband.
Cullins said her mother suffered seizures that left her unable to speak. She was referred to the facility four years ago by the staff of a rehab center where Gardner was a patient.
Each day, Gardner’s 85-year-old husband, John, made the 4½ mile trip from his home to the facility to feed his wife lunch and dinner, his daughters said.
For her to die the way she did, that’s what really, really hurts. She deserved to have everybody around her.
“My dad said there were a lot of people who didn’t have anybody who would visit them, and he felt sorry for them,” said Cullins, who lives outside of Dallas. “He would go and talk to them and do different things with them.”
The family got its first wrenching blow when John Gardner learned he could no longer visit his wife after West Oaks closed its doors to outside visitors in mid-March.
In early April, Cullins’ father called to say that the virus had arrived at West Oaks.
Despite the positive test nearly two weeks later, her mother had no obvious symptoms, Cullins said. Family members prayed she had a mild case and would bounce back. Then her fever spiked, and she died the following day, April 16, one day after Luna.
“Not being able to be there for your mom, who is so frail and so vulnerable, it is horrible,” said Sandy Millner, another of the Gardners’ daughters. “She didn’t deserve that. It’s a nightmare.”
Cullins said she now fears for her father, who not only lost his wife of 63 years, but possibly other friends who died that he doesn’t yet know about.
“He is afraid of which of his friends he has lost,” she said.
Devoted caretaker lost
While the families of Luna and Gardner anguished over the suffering of their loved ones, Maurice Dotson, one of the staff who had cared for them in those final years, was fighting his own battle with COVID-19.
The devoted caretaker who always put residents first — never completing a shift without going room-to-room to see if they needed anything — was taken by ambulance to the hospital April 9.
Dotson had told friends that he was worried about contracting the virus, but felt as though he would be abandoning his family if he didn’t go to work.
On April 17, the day after Gardner died, COVID-19 took Dotson, too.
West Oaks officials in a statement said they grieved for Dotson’s loss and that “our dedicated staff put patients first before themselves everyday.”
Company officials said in a statement that they said they are following protocols recommended by doctors who are advising them, Austin Public Health and the CDC.
In the April 28 letter to families, Regency Healthcare, which operates West Oaks, said it has designated specific staff to work only with COVID-19 patients and established isolation spaces “with physical barriers” for those patients. They also have increased housekeeping responsibilities, ensuring that “touchpoints” are routinely cleaned.
“We are committed to addressing every challenge this pandemic brings,” the letter said.
Resident beats death
On April 17, the same day Dotson died, Diana George called her father from her room at West Oaks. The 50-year-old multiple sclerosis patient was upset. She felt ill and feared she had contracted the coronavirus.
Three days later, John George got another call from West Oaks. His daughter was unresponsive, en route to the hospital in an ambulance.
“Her immune system is compromised to start with,” John George said, his voice cracking. “And you think, it’s got to be a death sentence.”
But his daughter had a track record of beating death.
Diana George confronted a stream of medical woes for more than a decade. After being diagnosed with MS, her mobility gradually eroded until she required a wheelchair.
A series of infections forced doctors to amputate both of her legs.
“She weathered it better than we did,” said John George, a retired pool builder in Austin and Dallas. “It was not a problem for her, but she’s very positive.”
Fearing she would become a burden to her five adult children, Diana George moved to Texas from Missouri about 10 years ago, eventually settling in at West Oaks.
The last time most of her family — her mother, father, stepmother and children — saw her was more than two months ago. They gathered at West Oaks on Feb. 22 to celebrate her 50th birthday, snapping pictures of Diana George smiling brightly from under a rainbow-colored decorative hat.
Her parents had barely heard of the coronavirus then.
But John George said his fears deepened in mid-March when he learned that West Oaks was closing to visitors. A few days later, the facility informed him that a resident had tested positive for COVID-19.
Trying to gauge his daughter’s risk, he pressed for more details about which patients were sick. He got nothing until that terrifying call from his daughter.
But as she had before, Diana George proved herself stronger than the disease that attacked her body.
In the past three weeks, she has steadily improved. She remains hospitalized as officials search for a place where she can continue to recover before possibly returning to West Oaks.
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