As a contract physical therapist, Zach King crisscrosses the Puget Sound region working for whatever nursing home needs him that day. If anyone can claim to be at the frontline in the battle against COVID-19, it is him.
Last Thursday, the 29-year-old Seattle resident reported to work at a facility in Bellevue, just seven miles away from the Life Care Center in Kirkland, where 31 of the roughly 55 remaining residents have tested positive and 18 are known to have died.
King was going about his business when a full-time employee tipped him off: Two residents he was scheduled to treat were showing respiratory problems consistent with COVID-19. Normally cheerful and chatty, King was furious. No one in management had warned him.
“I wouldn’t see them," he said, "I just refused to do it.”
Three hours to the south, COVID-19 has crossed the river into Oregon. There have not been any fatalities in Oregon’s senior residential facilities -- in fact, there hasn’t yet been a single confirmed case in them, so far. But the hard truth for the 45,000 residents of the state’s senior residential facilities is that a Kirkland-like nightmare could play out here.
“Kirkland should be a wakeup call for all of us,” said U.S. Sen. Ron Wyden. “I have long been fearful about whether there are adequate protections for the elderly in a health care emergency or heaven forbid, a pandemic.”
COVID-19 has already challenged Oregon’s largest, wealthiest hospitals. With tighter budgets, less safety equipment and less training in how to use that equipment, the state’s senior residential facilities may be even more vulnerable.
Oregon officials aimed to address that Tuesday, announcing a series of emergency policies they hope will better protect residents at long-term care facilities, including limiting and screening visitors, documenting who has visited and reducing residents’ community outings.
Washington introduced similar rules on Monday requiring that all nursing home visitors and employees get screened for the virus. It also will require facilities to isolate any resident who tests positively for COVID-19.
In Oregon, regulators are also taking steps to make sure their new and existing laws are enforced.
They announced Monday an ambitious plan to visit every senior living facility in the state and review their illness prevention plans. All residential care facilities need to have such a plan to receive a state license. State officials said the new reviews will focus on pandemic response plans and infection control procedures.
The state’s Office of Aging and People with Disabilities, which has regulatory oversight of long-term care providers in Oregon, has assembled a team of 70 people to conduct reviews of about 670 facilities statewide. In the process of doing reviews, the team will provide technical assistance on infection control and emergency planning if it is determined that is needed.
"We are dedicated to doing everything possible to work in partnership with care providers to protect vulnerable Oregonians," said Department of Human Services Director Fariborz Pakseresht.
How significant is the risk? At noon Tuesday, Pakseresht’s agency told all of its employees to immediately “refrain from entering any long-term care facility.”
The state requires that senior living facilities adopt emergency response protocols for fires, bombs, natural disasters and “pandemics.” At many facilities, the protocols emphasize basic hygiene -- more and better handwashing and coughing into one’s elbow. The disease protocols also encourage the use of personal protective equipment like face masks, hoods and full body suits.
Yet that equipment is in short supply in some facilities and training in how to use them is scattershot. Plus, some operators worry that masks, face shields and other equipment will frighten residents.
“One of our key principles is to operate a home-like environment to the extent possible,” said Michael DeShane, president of Concepts in Community Living. “It becomes an issue to have people running around with those weird looking helmet gizmos. While we don’t want to underreact, we also don’t want to overreact such that communities begin to look like hospitals. It is a tricky issue.”
But DeShane and others in the industry say they are prepared.
The virus “has all our attention,” said Tom Stanley, co-founder of Cascade Living Group, which has 15 senior living operations in Oregon. “This is a unique virus in the sense that it’s brand new and we don’t fully understand all of its characteristics. But all responsible providers have good solid infection control measures in place.”
Another factor operators keep in mind: Some predicted killer viruses have fizzled. “We have been through so many different issues that I have become inured,” DeShane said. Still, he said his company is taking COVID-19 seriously. In a recent letter to residents and their families, the company said it has emergency supplies in each of its facilities, including sufficient food to feed residents and staff “for an extended period of time.” It also has increased cleaning and disinfecting procedures as well as screening visitors for possible illness.
The industry’s response protocol also mentions isolation, another tried and true strategy to control the spread of disease. Ideally, a facility could place an infected resident into a separate room with negative air flow to prevent the spread of contaminants, experts said. Short of that, facilities should improvise and move the resident away from others.
But many senior facilities don’t have isolation chambers with negative air flow technology. Many don’t have a dedicated isolation room at all. For those facilities, industry guidelines suggest operators attempt to maintain six feet of separation between sick residents and healthy ones.
Staffing is another vital issue. If caregivers themselves get sick or quit due to concerns about the virus, that could be devastating to the residents.
"Facilities have infectious disease protocols -- and its important these are being followed,” said Jake Cornett, executive director of Disability Rights Oregon. “But if you're a person with a disability or an older adult who needs support, what happens if your support worker is exposed or quarantined? Your need for care doesn't go away because your support worker catches the virus.”
With some nursing home workers barely making minimum wage, they can’t afford not to work. Some get little -- if any -- paid time off, which raises the specter of sick workers unknowingly spreading COVID-19 to vulnerable seniors.
“The staffing challenges are real,” said Melissa Unger, executive director of the Service Employees International Union in Oregon. “The Centers for Disease Control guidelines state that if you are sick you stay home. But if you literally can’t afford to stay home, that’s a problem.”
SEIU represents 3,500 nursing home employees and many more home health workers.
Even without a highly contagious virus on the loose, it’s never been easy to fill all the 85,000 jobs in Oregon’s senior centers. The strong economy and low unemployment has made it even harder.
“Turnover is already huge,” said Rosie Ward, senior vice president of strategy for the Oregon Health Care Association.
DeShane, the senior care center operator agrees, saying one-third of his workforce is perpetually in flux.
King, the Seattle-area physical therapist, is just hoping the predictions of pandemic prove overblown and that some normalcy can be restored.
While some of his co-workers have quit – worried they’ll get sick and infect their families – King doesn’t feel like he’s in physical danger. He’s young enough and healthy enough to survive the disease.
But he is worried about the financial risk. As a contract employee, he gets paid more than some of his peers who work fulltime for a single facility. But he has to buy his own health insurance and he only has five days of paid time off a year.
“What if I can’t work?” he wonders. “I don’t have a plan for if I get sick.”
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