Many of the country's nursing homes were already understaffed and frequently cited for lax infection control before coronavirus began to spread. Now staff are risking their own health and often lacking access to the supplies and testing they need as they care for a population at high risk of dying from the disease.
State long-term care ombudsmen, who are tasked with protecting residents, told CNN there are not enough eyes on these facilities at a time when oversight is needed the most.
Routine health and safety inspections have been suspended by the federal government to protect against any additional exposure to workers and residents. A CNN review of more than 100 inspection reports documenting visits still taking place, and complaint information gathered from state ombudsmen, provides a snapshot of serious problems during this pandemic — including unacceptable care and failures to take steps to stem spreading infections.
Families, who are often the ones keeping tabs on their loved ones' care and in some cases even supplementing that care, have been restricted from visiting facilities in an attempt to slow the spread. CNN spoke with family members of nursing home residents in four different states who said they had struggled to get them tested for the virus or receive any updates about their conditions — and in some cases facility officials had kept vital information from them. One woman said she resorted to calling 911 herself to get her very sick father, who she said tested positive for coronavirus, admitted to the hospital — where she said he remained as of Thursday in critical condition.
On Sunday, the federal government announced a new rule requiring nursing homes to report Covid-19 cases to residents and their families and the CDC. Ombudsmen say it remains to be seen how — and how aggressively — this will be enforced by state inspectors. And even when facilities are cited for severe violations, critics have long argued that government penalties are too low to discourage the worst behavior.
"I'm concerned about neglect, poor care, rights being violated and abuse right now," said Patricia Hunter, the long-term care ombudsman for Washington state, where the first nursing home outbreak publicly unfolded.
More than a week before the Andover Subacute and Rehab Center II in New Jersey made headlines with the discovery of 17 bodies in the facility's morgue on April 13, there were signs of a deepening crisis, according to police reports obtained by CNN.
Repeated calls to police were made. There were calls about patients with symptoms such as a high fever or respiratory distress. One resident was taken to the hospital, reports show; another call was cancelled even though the patient had been in "full code" -- meaning they were in need of resuscitation. It's unclear if a third ever made it to the hospital. Police also responded to a fire alarm there, but when they arrived, the report states, they were told it was a false alarm and that maintenance had it under control.
And three days before the bodies were found, reports show county health officials told police they had been fielding complaints about understaffing, a lack of protective equipment and patient neglect — including allegations that some residents weren't being fed.
Even after the police discovered the extent of deaths at the facility (which they said at the time weren't necessarily all linked to Covid-19), frantic calls to police continued. A resident said he wasn't being allowed to call his family, though staff claimed to police it was because it was after hours. Other callers said the facility was in desperate need of more protective gowns and body bags, and a state senator reported there was no staff at the facility. One resident was sent to the hospital with hypothermia when the facility's heat reportedly stopped working, a report shows, though staff later told police the heat was working. As public scrutiny intensified, a nurse reported receiving threats.