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Lancaster County nursing home has seen the highest COVID-19 death toll in Pa. and answers are needed

Intelligencer Journal - 6/29/2020

THE ISSUE

As LNP | LancasterOnline’s Hurubie Meko and Gillian McGoldrick reported Friday, Conestoga View Nursing & Rehabilitation in Lancaster Township has had the most nursing home deaths in Pennsylvania — that is, the highest actual death toll. “Once the virus got inside Conestoga View, the 446-bed facility was hit hard,” they wrote. “By May 23, there had been 74 deaths; one more was recorded by June 12, according to Lancaster County Coroner Dr. Stephen Diamantoni and the latest reporting from the state Department of Health.” Medicare.gov gives Conestoga View just one star, rating it as “much below average.”

The opening description in LNP | LancasterOnline’s report Friday was striking: “The only thing separating Conestoga View roommates from each other — and from a deadly, infectious, airborne virus spread when someone coughs or sneezes — was a thin curtain,” Meko and McGoldrick wrote.

A thin curtain separating three to four residents in a crowded room? In a pandemic?

And then this: “A Mount Joy resident, whose sister-in-law lives in the nursing facility, said two people in her relative’s room had COVID-19 — one of them died April 15.”

The Mount Joy woman said it took two weeks for the room to get a deep cleaning, and her sister-in-law wasn’t tested for the novel coronavirus until two months later: June 17.

How could this possibly be?

Lancaster County Commissioner Josh Parsons — touting the county’s success in battling COVID-19 — tweeted Friday that the county has made deep-cleaning teams available to all county nursing homes. While taking care to point out that such measures are “totally” the responsibility of the Pennsylvania Department of Health, Parsons added: “We are also testing nursing home residents & staff more aggressively than most other places.”

But the situation at Conestoga View is clearly terrible.

As Meko and McGoldrick noted, the death count at the nursing home has surpassed that of Brighton Rehabilitation and Wellness Center in Beaver County, after that facility adjusted its death numbers last week.

The 75 deaths that have occurred at Conestoga View are more than there are beds on a single floor of the facility.

Seeking answers

Shamefully, the parent company of Conestoga View — Complete HealthCare Resources-Eastern Inc. in Montgomery County — did not respond to multiple requests for information from Meko and McGoldrick.

The administrators at Conestoga View, however, say the death toll owes to a combination of factors: a lack of COVID-19 testing and personal protective equipment; and guidance from the Pennsylvania Department of Health that conflicted with that from the Centers for Disease Control and Prevention.

A state Health Department spokesman said Conestoga View administrators should have reached out for answers to any questions they had about state guidance.

We agreed they should have. But it would have helped significantly if the state guidance had been clear in the first place.

Moreover, Conestoga View should have been on the state Department of Health’s radar — the facility was cited three times for serious issues from 2018 through 2019.

As recently as February, the state Department of Health found supervision that was inadequate to prevent accidents, and a patterned lack of infection-control procedures at Conestoga View.

Howard Hay, executive director of Conestoga View, told LNP | LancasterOnline that the facility had made plans to create a COVID-19 unit before its first case was confirmed. But he said epidemiologists from the state Health Department told administrators that they should consider everyone in a unit to be positive after a case was identified, and that moving residents would create a higher risk of infection than leaving a patient with roommates.

In an email, Hay said this was contrary to CDC guidance. He said the state Health Department has changed its position about grouping residents several times.

More troubling assertions from Hay:

— When Conestoga View turned to the Department of Health for testing materials, it received only 20 tests for the facility of more than 400 residents.

— The facility was forced to buy its face shields from a company in Pittsburgh and local hardware stores.

— It resorted to buying cow-birthing gloves to give staff an extra layer of protection when its gown stockpile was depleted.

The good, the awful

We have supported Gov. Tom Wolf’s aggressive measures to curtail the spread of COVID-19 in the commonwealth — and looking at what’s now happening in states such as Arizona, Florida and Texas, we are glad that tough statewide measures were implemented here in March.

But we are at a loss to explain how the residents of Conestoga View have been failed so completely.

Karen Buck, executive director of the Philadelphia-based Senior Law Center, told LNP | LancasterOnline that facilities that are “in crisis” with known infection-control problems or staffing issues are the ones the state Department of Health should be assisting with funds, resources and supplies.

We couldn’t agree more.

We also wonder where county officials have been — and how the presence of a county health department might have helped.

We know the county sold Conestoga View to Complete HealthCare Resources in 2005. But its residents are citizens of Lancaster County. So, too, are the facility’s staff members, who have worked through one heartrending loss after another of residents with whom they’d grown close.

Their welfare should be the concern of county as well as state government.

Poor and vulnerable

The story told by Sheila Bair to LNP | LancasterOnline is heartbreaking.

The New Providence resident said she called Conestoga View the morning of April 21 to check on her 90-year-old mother-in-law, Frances Bair. She had been told the night before her mother-in-law had a fever and had been put on oxygen. When she called at 6:40 a.m., she was given the impression that her mother-in-law was fine.

Thirty minutes later, a physician at Conestoga View called her to say her mother-in-law was dead. The cause? Probable COVID-19.

Bair, who worked at a local nursing home for 25 years, told LNP | LancasterOnline that she suspects her mother-in-law was not monitored appropriately throughout the night.

Had she known her mother-in-law might have been infected with COVID-19, she said she would have asked for her to be tested.

It’s appalling that she was not tested before her death.

Bair said her mother-in-law had limited financial resources.

Most Conestoga View residents rely on Medicaid to pay toward their housing.

Which points to the more fundamental issue raised by the reporting of Meko and McGoldrick: how we as a society care for economically disadvantaged and vulnerable people.

The picture painted by their reporting is not pretty.

As Lisa McCracken, a Lancaster County-based director of senior living research and development at an investment bank, told Meko, a facility’s ability to separate residents into private rooms — which may help to limit a virus’s spread — is often directly correlated to how many residents are able to pay out of pocket.

“We’re seeing a greater vulnerability amongst the economically challenged,” McCracken said. “You don’t see private pay residents sharing a room.”

The anger over the state directive that nursing homes had to accept COVID-19 patients is certainly justified. But in the case of Conestoga View residents, where else might they have gone? As its executive director noted, it remains the county’s “safety-net facility.”

How we ensure the health and well-being of the least advantaged among us needs to be addressed more squarely moving forward.

Because as Buck of the Senior Law Center said, “People are dying every day. This pandemic is not over, and the crisis in long-term care facilities is not over.”

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