A son's nightmare: Elderly mother's COVID-19 diagnosis brings treatment challenges to light

Apr. 12--A Tobyhanna man's claim that his elderly mother was denied proper treatment at her Nazareth nursing home during the COVID-19 pandemic has raised questions about patient safety at long-term care living facilities in Pennsylvania.

It was March 11 when Jose Abrew received a letter from Gracedale Nursing Home informing him that the facility was suspending visitations due to the "very real potential" for asymptomatic COVID-19 carriers to infect patients and staff. Being that Abrew's 87-year-old mother Luz lived at the nursing home, he was concerned that he could not visit with her, though he appreciated the safety measure.

On March 27, however, Abrew received another letter, this one denoting that a staff member at Gracedale had tested positive for coronavirus. Three days later, another letter revealed that a patient at the facility had tested positive as well.

"That same day, or the day after, I received a phone call telling me that my mom had a high fever," Abrew said. "She was taken up to the ICU on the 10th floor, and they were going to do some x-rays."

Abrew said he called the facility and requested for his mother to be transferred to a hospital, only to be told that they could not do that, as she was not exhibiting symptoms of COVID-19. Abrew argued that his mother's 101.5 degree fever was reason enough to take her, though he said that a nurse explained that as she was drinking and eating on her own, and therefore she was "OK."

A doctor later called and gave Abrew the same message, he said, and later he received a message that the chest x-ray revealed nothing out of order.

"The next day they called me and tell me a test came back positive for COVID-19," Abrew said. "I was like, 'What are we going to do?' And (the nurse) said, 'She's still not showing symptoms, we're just going to keep up the care and comfort,' stuff like that. I said, 'She needs to get to a doctor. She needs to get to a hospital.'"

But the medical staff allegedly continued to advise against hospitalization, Abrew said, even when he stressed "something's not right."

Finally, on April 7, Abrew said he received a message from a supervisor that his "wish had come true," and not 10 minutes later, his mother was transported to St. Luke's Anderson campus in Easton.

"When she got there, she came in with a 101.5 fever and she was dehydrated, completely dehydrated," Abrew said. "They ran some tests on her the next day in the morning, the doctor told me that my mother had kidney failure, she had double pneumonia, and she was very dehydrated."

According to Abrew, his mother was put on breathing treatments. Despite the fact that she is diagnosed with diabetes, dementia and mild kidney issues, as of a month ago, Abrew said his mother was in relatively good health. Now, he worries about what could happen next.

Even though the supervisor finally arranged the hospital transfer, Abrew felt that he was lied to by doctors and nurse who claimed they were "doing everything they could" to help his mother.

Staff followed protocol

Gracedale Nursing Home administrator Jennifer Stewart-King, B.S., NHA, said on Thursday that there was more to the story, though due to the privacy elements of the Health Insurance Portability and Accountability Act (HIPAA), she would not comment on courses of action for specific patients. One thing she did confirm, however, is that Abrew's mother was in no way denied care.

"There was no reluctancy to get her to the hospital," Stewart-King said on Friday. "We followed all CDC/DOH guidelines in managing patients, and did everything we needed to during that time."

According to Stewart-King, staff at Gracedale follow those protocols to a T in order to protect their patients, especially in light of the pandemic.

"The Department of Health looks at all of our positive cases, so they actually monitor all positive cases and look for everything to make sure that everything was done correctly," Stewart-King said.

Patients can be effectively treated for COVID-19 at Gracedale, Stewart-King noted, and the staff are on high alert to monitor for any signs and symptoms that could suggest infection.

"We are ahead of the game," Stewart-King said. "We do have an isolation unit set up for COVID-positive residents, we have two containment areas with negative pressure, so they're isolated from the rest of the population. We get testing done as soon we see signs or symptoms. Sometimes the tests take longer as you know from the news, but as soon as we see signs or symptoms, they are sent up to that isolation unit."

Nursing homes in Pa. face unique challenges

Concern for elderly or otherwise vulnerable patients in long-term care living facilities like Gracedale -- which has seen three residents and 10 employees test positive for COVID-19, along with one death associated with the virus as of this week -- is a hot-button issue, with Secretary of Health Dr. Rachel Levine noting that about 6% of the Commonwealth's coronavirus cases have been situated in such facilities.

"Approximately 1,209 of our total cases are in 181 long-term care living facilities, which includes nursing homes and personal care facilities," Levine said during Friday's coronavirus update.

As with many other workers on the front line, employees at long-term care living facilities run a significant risk of contracting COVID-19 due to the fact that their jobs often require close contact with residents. Those same residents could potentially pick up the virus from workers, or pass it on to them if they have become infected themselves from visitors or other sources.

Some facilities, like the Brighton Rehabilitation and Wellness Center in Beaver, have taken to operating under the presumption that all residents and staff are infected with COVID-19.

On March 13, Getz Personal Care Home in Jonas opted to advise against any unnecessary visitations to their facility, on top of canceling outings and any unnecessary medical appointments for residents. Any changes in health would necessitate a trip to the emergency room, according to a letter from administrator Erin Hnat.

"Our primary concern at this time is the health and well-being of our residents and staff," Hnat's letter reads. "We have educated our residents and staff on what is going on at this time and how we are handling this pandemic. We have supplied our staff with the appropriate protective equipment to be used immediately if necessary and have plans in place if in fact a case would appear in our facility, which at this time we don not have any cases in our facility."

Despite the plans and protocols provided by facility administrators, Abrew is still adamant that at the end of the day, his mother was prevented from proper care, and that prompter action would have made for a more successful treatment.

When asked about the standards for treatment that are applied to long-term care living facilities in the midst of the COVID-19 pandemic, Levine noted that there are numerous protocols in place, along with a hotline for concerned loved ones to report suspected mistreatment. That hotline number is 1-800-490-8505.

"There are definitely protocols for the treatment of individuals in nursing homes and other long-term care living facilities," Levine said. "We have our own standards that we have put out, as well as the Department of Human Services for personal care homes, and there are standards through the centers for Medicare and Medicaid services. We actually have an anonymous complaint line where people who have any concerns about nursing homes can contact us about their concerns and then we will address them."

Abrew said that in the future, he may look into contacting an attorney to file a complaint, but for now, he is focused on the health of his mother, and that of others who he believes may not be receiving the best possible care in the wake of COVID-19.

"It was really tragic," Abrew said. "I'm still very distressed over what happened to my mom, and not only that, but how many other people has that happened to?"

For more COVID-19 information and resources for older Pennsylvanians, go to bit.ly/2xbkpwU.

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