How California nursing homes became coronavirus hot spots
The toll is grim at the Redwood Springs Healthcare Center in Visalia, site of California's deadliest coronavirus outbreak in a nursing home. As of Thursday, 115 residents had tested positive for COVID-19, 61 staff were infected and 26 residents were dead.
At Huntington Valley Healthcare Center in Orange County, 64 patients and 36 staff were ill. Six had died.
At Canyon Springs Post-Acute in Santa Clara County, 69 patients and 30 staff had tested positive, and six residents are dead.
"We weren't prepared," said a Redwood Springs nurse who has tested positive. "We lost control of the situation because we weren't talking about it."
All three facilities share the same parent company: Plum Healthcare Group, a California entity that controls about 50 skilled nursing facilities in the state. Plum is emblematic of the state's nursing home industry overall - corporate chains with murky ownership structures, lax state oversight, overworked and underpaid employees and a mixed record of complying with infection control requirements, such as workers washing their hands.
Plum declined to comment on specifics of the outbreak, other than to say it maintains high standards and has been "meticulous" with infection control, including adding new protocols in March.
"The safety and well-being of our clients and their efforts to care as well as protect patients and caretakers are our highest priorities during this national emergency," said Plum spokesman David Oates in an emailed statement.
But patient advocates say operators such as Plum may create conditions where infections can quickly spread undetected, with few repercussions because of infrequent state inspections. Of the 192 skilled nursing facilities with outbreaks in California, a Los Angeles Times review of records found at least 13 connected to Plum, accounting for at least 500 cases of COVID-19 and 43 deaths. Other chains also have multiple outbreaks.
Nationwide, about 380,000 people in skilled nursing and assisted living facilities die each year from infections, according to the Centers for Disease Control and Prevention.
"Nursing homes would like the public to think this just happened to them, but it didn't," said UC San Francisco professor emeritus Charlene Harrington, who studies skilled nursing facilities. "The chains were bad to begin with, and then they were just not prepared for this pandemic."
The nursing home industry once comprised small operators, locally owned and managed, and often nonprofit. But the industry has morphed into a network of sophisticated chains, with a strong lobbying presence in Sacramento and Washington, D.C. For weeks, the industry has been pressuring Gov. Gavin Newsom to shield them from potential liability, arguing they could be forced to close under a wave of lawsuits, taking away beds needed to relieve pressure on hospitals.
These chains are often owned by investors who obscure their roles through limited liability companies, or LLCs, and amass dozens of properties that draw hundreds of millions in Medicare and Medicaid funds. The industry brings in more than $10 billion in annual revenue in California, mostly from state and federal government payments for about 119,000 beds in about 1,200 facilities.
Harrington said her own research and that of others has found that facilities owned by for-profit chains have lower staffing and more regulatory problems than nonprofits or state-run facilities - often including lapses in basic hygiene. Nearly 90% of California's nursing homes are privately owned, and in a 2015 study, Harrington found that about 75% of California facilities were owned by chains - one of the highest percentages of any state.
Industry officials say there are benefits to chain operation, including better management, the ability to lower costs and higher industry standards. However, they contend, in the face of the fast-moving coronavirus pandemic, little could be done to mitigate its effects on an elderly and vulnerable population.
"It's really beyond the worst-case scenarios that I think anyone could reasonably prepare for," said Mark Parkinson, president and chief executive of the American Health Care Assn. and the National Center for Assisted Living, an industry trade group.
Overall, at least 663 residents and 11 staff at California nursing homes have died from COVID-19 - about 31 percent of the deaths in the state - according to health officials, though a Los Angeles Times review has found multiple errors in state data. Thursday, the state reported that nearly 2,700 staff members and 4,700 residents have tested positive for the coronavirus in skilled nursing facilities.