Just as the COVID-19 outbreak at Brighton Rehabilitation and Wellness Center was flourishing in early April, Shelby Dille, a nursing assistant and co-president of the union representing the building’s in-house workers, expressed a common refrain among staff: It was inevitable that COVID-19 would enter the building.
“It’s everywhere,” she said on April 9 at the nursing home in Beaver County. “Obviously, every nursing home has it or is going to have it.”
Even though the virus has moved into more nursing homes since then, it hasn’t gotten into all of them: 263, or 38% of Pennsylvania’s 693 nursing homes have reported no positive cases among residents, according to state data as of Oct. 13, the most recent available. Another 78, or 11%, have reported having just one to four positive cases.
And 352 nursing homes, nearly 51%, report they have not had one resident die from COVID-19. Ninety-one nursing homes still had not reported any data to the state, and it was not known publicly whether they have had any COVID-19 cases or deaths.
One nursing home that did take action was Rochester Manor, just 3 miles from Brighton. It took quick action, as did other nursing homes the PG contacted whose infection and death rates were low.
During the third week of February, Kristin Goldstrom Oeder, Rochester Manor’s executive director and nursing home administrator, began staff training sessions about what COVID-19 was, how it was transmitted, and what the home was going to do to protect staff and residents. She also began ordering more personal protective equipment.
“Our preparation started with lots of work in February, ahead of government guidance,” she said. “I kept reading about what was happening out West, in Washington and California, and trying to learn from that about what we could do to mitigate this.”
By March, visits to Rochester Manor were being discouraged, unless they were absolutely necessary. If they did come, visitors were screened for illness and asked whether they had been anywhere recently where there was an outbreak. They were given a mask and told to socially distance from those they were visiting.
Even before the federal government mandated the move on April 2, Rochester’s staff began wearing masks full time.
Rochester Manor’s nursing home — it also has an independent living unit — is about a sixth the size of Brighton, with 81 residents when the outbreak began.
When Rochester had its first positive case among residents in early April, Ms. Goldstrom Oeder and the facility’s medical director took what may have seemed like a drastic step — they moved into the unit where the resident was isolated, as did the two staff members who helped care for the resident. The goal was to prevent anyone who came in contact with the resident from transmitting it to anyone else.
“I stayed there for two weeks,” Ms. Goldstrom Oeder said. “I missed Easter with my kids. But a lot of people here made sacrifices like that.”
The resident recovered and Rochester has had two other residents test positive — but those may have been false positives because the residents had no symptoms, and follow-up tests were immediately negative, she said. Five staff members have tested positive.
Ms. Goldstrom Oeder is aware of Brighton’s problems.
“It’s a tale of two facilities for sure,” she said.
Brighton officials told the Post-Gazette that by “early March” they had begun efforts to prevent COVID-19 from spreading, including screening visitors and staff, though they would not provide specific dates when those steps were implemented.
In an email response to questions about preparations before the government-mandated lockdown March 12, Brighton officials also said they began “preparing for the COVID-19 pandemic in January 2020 as cases of the virus began to spread through community transmission across the world and in the U.S.
“During that time, we reviewed all protocols and guidance issued by [the Centers for Medicare & Medicaid Services] and government health officials, and ensured our staff was fully trained and aware of how best to implement all guidance related to COVID-19. This included constant reminders and self-audits regarding proper infection control practices, including strict hand-washing practices for everyone at the facility, as well as constant disinfection of high-touch areas.”
Pressed for details about the screening of visitors or staff put in place before March 12, Brighton officials wrote that they "instituted a variety of screening protocols at entrances to the facility for both staff and visitors in early March prior to state-mandated lockdowns.”
“These screenings included surveys of staff and visitors about any symptoms they may be experiencing, contact that may have had with anyone who was COVID-19-positive, and mandated hand sanitizing prior to entering the facility. On March 11, Brighton enforced mask mandates and began temperature taking for all staff and visitors.”
Asked to provide documents or emails that showed how the home screened visitors and staff before March 12, Brighton responded in an email: “These protocols were conveyed to staff daily through verbal communication and CDC-issued literature and posters shared prominently in staff areas and other common areas.”
But staff, volunteers and residents’ families say that despite concerns in early March that COVID-19 was starting to course through the massive building, no protocols -- including screening visitors or staff -- were changed until March 12.
“No one was really concerned before that,” said Tristan Adams, a former certified nursing assistant who worked at Brighton as a temporary, or agency, worker for two years until July.
Connie Sluzynsky was so concerned about the care her mother, Billie Namath, 83, was receiving at Brighton the first week in March that she made a round of calls to nurses and the building administrator.
“They said they were prepared,” said Ms. Sluzynsky, of Monaca. “But you didn’t see anything change.”
One of the protocols implemented March 12 required all staff to enter through the main entrance to be screened.
“I wouldn’t say [the government lockdown] was very successful at first,” said a former full-time employee who left at the end of March. “For a couple of weeks, some employees were using their keys to go in the side doors of the building rather than come through the main entrance and be temperature checked and screened. It wasn’t until later that they tightened that down.”
Dr. Dave Thimons, Brighton’s medical director since 2012, said in an interview in late March that he was increasingly concerned about what was happening. With few labs testing for COVID-19 by then, and the labs that were testing already at capacity, he was frustrated by his inability to find one to provide testing services that could help confirm what everyone suspected.
On March 18, to draw attention to the problem, he began posting on the Facebook page of his Aliquippa-based company, Personal Care Medical Associates, which provides medical services by contract to Brighton and other nursing homes.
Our President and CEO, Dr. Dave Thimons, DO, CMD, makes an appeal for more Coronavirus Tests, The Washington Post. https://youtu.be/tmKfPApaXzAPosted by Personal Care Medical Associates on Sunday, March 22, 2020
Dr. Thimons wrote about a nursing home resident — he did not say where the resident lived — who had COVID-19 symptoms but was not tested for it when sent to a hospital and was, instead, sent back to the home. Posting his email address and cellphone number, the doctor called for help in providing more testing for nursing homes.
That Facebook post led to calls from reporters. Dr. Thimons sounded prophetic when he told WPXI-TV on March 18, “We don’t know what to do. Right now we’re … sending patients back to nursing homes with suspected coronavirus where they could infect 100 other people there, where mortality rates in nursing homes may be 10 to 20%. We’re looking at massive amounts of deaths and a huge tragedy.”
Dr. Thimons’ prediction would prove to be an underestimate for Brighton: The mortality rate there — at least 82 residents eventually dying from among the 332 who tested positive — was 25%.
Brighton says by its own count, only 73 residents have died from COVID-19. In late June, it removed nine residents from its self-reported data given to the state each week.
To do that, Brighton used a disputed state definition of who could be classified as a COVID-19-related death.
The state definition allowed nursing homes not to count someone who died after contracting COVID-19 if they had met criteria for having “recovered” before they died.
The state said that was based on the federal Centers for Disease Control and Prevention’s definition of recovered. But the CDC said the designation was not intended to to be applied to COVID-19-related deaths, just to whether a person with the disease could be removed from isolation.
Brighton’s actual COVID-19 death count may be even higher than 82. Three families told the Post-Gazette they had loved ones die of what was listed as “pneumonia” on their death certificates. The families said their relatives were never tested for COVID-19, even though they had symptoms and others who lived in their rooms or unit had tested positive.
Three more families said the deaths of their relatives, who also had symptoms or were in rooms where others tested positive, were recorded as “dementia” or “Alzheimer’s.”
Those six residents could have died from the causes listed on the death certificates, but all of the families said they were told that the victims had symptoms similar to COVID-19 — such as a fever or shortness of breath — but were not tested.
It is unclear exactly how many people have died without being tested, and Brighton would not provide a figure when asked.
Brighton reported its population at the beginning of April as 460, and the state said Brighton voluntarily stopped taking new residents in early April. By the time the state declared June 10 that 82 people had died, Brighton said the building’s population was just 334 — 126 fewer in just 10 weeks. That means 44 other residents either died or left the building during that time.
Families say they were told that as many as 20 residents were moved out as the outbreak swept through the buildings.
But exactly how many of those 44 residents were moved, died of COVID-19 or died from some other cause could not be determined. Brighton would not provide a breakdown when the Post-Gazette asked specifically for that information.
Ala Mazzocca, 91, a five-year resident of Brighton originally from Aliquippa, was one of those who died but was not tested.
On April 8, nurses said Mrs. Mazzocca had bedsores — a problem Brighton had been cited for in the past and that nursing home experts say is a sign of an overwhelmed staff that could not attend to her properly — and her dementia was worsening. Five days later, a staff member called to say that she had died of “respiratory distress” overnight on April 13. On her death certificate, signed by Dr. Laura Mantine, a physician working for Dr. Thimons’ practice, the cause was listed as pneumonia.
It was a stunning conclusion, said her grandson, Andrew Macurak of Washington, D.C. The family had not heard of any respiratory issues before that. “You don’t suddenly get pneumonia overnight,” he said.
The family said in her obituary that she was a victim of the coronavirus.
“It was obvious what she died of,” Mr. Macurak said.
Next: “Everyone’s sick.”
Sean D. Hamill
Laura Malt Schneiderman