LA's Nursing Homes Serving Black And Brown Patients Are Hardest Hit By Coronavirus. What's Going On?
Every night after walking a mile home from her job as a certified nursing assistant in East Los Angeles, Alma Lara-Garcia would strip off most of her clothes before she went in the house.
"I didn't care if the neighbors saw," she said. "I would take off my overshirt, down to my camisole and take off my shoes and pants before I'd go in."
Only then did she feel it was safe to enter the home she shares with her four teenage children. She knew the coronavirus was circulating at the nursing home where she worked, Buena Ventura Post Acute Care Center. But she had no idea it would kill so many of the elderly residents she cared for, or that she would become one of dozens of staff members to fall horribly ill.
Lara-Garcia is Latina. Most of the residents at the 100-bed Buena Ventura facility are also Latino. An increasing volume of evidence shows that COVID-19 is taking a disproportionate toll on people of color. A collaboration between KPCC/LAist, The New York Times, The Baltimore Sun and The Southern Illinoisan has found the same pattern in nursing homes. This is true even though all nursing homes, by nature, care for people with underlying health conditions that make them especially vulnerable to the disease.
MORE FROM THE COLLABORATION
- The Striking Racial Divide in How COVID-19 Has Hit Nursing Homes (NYT, LAist, Baltimore Sun, Southern Illinoisan
- Maryland shows higher risk for and wide racial disparity in nursing home coronavirus outbreaks, analysis finds (Baltimore Sun)
In the 22 hardest-hit states for which data was available, plus the District of Columbia, nursing homes with many black and Latino residents were twice as likely to have at least one case than those with mostly white residents, according to a New York Times data analysis.
Race and Latino origin turned out to be a major predictor of whether a nursing home has a COVID-19 outbreak, the analysis found, even after accounting for a facility's location, federal quality ratings, size and infection rate in the surrounding community.
Buena Ventura has an overall rating of five stars — the highest rating on the Centers for Medicare and Medicaid Services' website — although it has just two stars for staffing, a measure of hours spent with each resident by nurses and aides.
Buena Ventura Post Acute Care Center is among the 20 worst-hit homes in a county where nursing facilities have been devastated, according to public health data. So far, 59 of Buena Ventura's residents and 24 of its staff have confirmed cases of COVID-19.
Twelve people at the nursing home have died of COVID-19, according to the county health department.
The map below shows nursing homes with at least 25 reported cases of COVID-19 (red) and homes with no reported cases (blue) as of May 15, 2020.
Source: The New York Times; Los Angeles County Department of Public Health; California Department of Public Health.
Overall, the county has reported 990 COVID-19 deaths at institutional facilities, most of them at nursing homes, according to L.A. County Public Health Director Barbara Ferrer.
Despite Lara-Garcia's intimate role as a caregiver — spooning food into the mouths of fragile residents, carefully bathing them and communicating with family members about their well-being — she said the severity of the outbreak at Buena Ventura was never fully explained to her and her colleagues in the rank-and-file staff. She said supervisors didn't walk her or colleagues through the thought process behind infection control or keep them updated on the number of residents and staff who became infected.
The lack of information communicated to her and fellow certified nursing assistants, who are generally among the lowest paid health workers, felt disrespectful, she said — she knew the residents and their families better than almost anyone.
"CNAs, you know how they say, we wipe butts only," Lara-Garcia said. "We do more than that, you know. We have the right to know what goes on."
Lara-Garcia said her incomplete understanding, and the lack of communication in the early days of the outbreak was potentially dangerous, as the virus spread unseen, eventually infecting even her.
KPCC/LAist and The New York Times made multiple requests to interview the managers and administrators of Buena Ventura but none made themselves available.
Buena Ventura administrator Tiana Thompson emailed a written statement that said in part:
"Our healthcare center has worked closely with [California Department of Public Health] and L.A. County Public Health to assure compliance with the [Centers for Disease Control and Prevention] and Centers for Medicare & Medicaid Services evolving guidelines. As with all health care providers in the country, we have acted aggressively to acquire and provide the recommended [personal protective equipment] for our staff and have been able to do so in compliance with the CDC's recommendations."
FACING THE VIRUS WITH POOL GOGGLES
Buena Ventura sits on a residential street half a block away from the I-5. The neighborhood is 98% Latino, according to census data. The rooms at Buena Ventura, which house up to four residents each, surround a grassy courtyard with a small, Spanish-style fountain.
Lara-Garcia, who speaks Spanish and English, said she liked working there because she shares the same culture and language with many of the residents.
"It felt like home," she said.
But in mid-March, when federal health authorities released new guidelines for nursing homes to combat the coronavirus, Lara-Garcia said the atmosphere became tense. Administrators ordered staff to feed residents in their rooms, rather than in the communal dining room, and suspended all group activities, Lara-Garcia said. Family members were no longer allowed to visit.
Months later, Lara-Garcia cried recalling how family members of residents begged her through the windows to take care of their loved ones.
"They would say 'Alma, take care of my mom,'" she recalled. "'I leave my mom in your hands.'"
Lara Garcia said staff had their temperatures checked at the beginning and end of their shifts. She said they were not given masks, gloves or any other gear designed to prevent the spread of infection, what's known as personal protective equipment, or PPE.
"The only thing they were asking of us was to wipe the door handles, the controls to the TV, the controls to the bed," she said.
Lara-Garcia said she and other staff didn't know the new measures were due to the coronavirus until she and a few others started asking questions. As one of the few bilingual staff members, Lara-Garcia said she often acted as an interpreter between the mainly English-speaking nursing home administrators and the largely Spanish-speaking nursing home staff.
"I started asking, what was the reason? You know, and they said that the state had implemented that law that no one could go out, or no one could come in, only the workers," she said.
Soon after, it became clear the virus had made its way into Buena Ventura.
One morning in early April, Lara-Garcia said, administrators gathered the staff in the dining room and told them that two people had tested positive for COVID-19, one staff member and one resident. Lara-Garcia had noticed that some of her patients had been moved from their rooms, without explanation.
On April 9, the Los Angeles County Department of Public Health reported that there was at least one confirmed case of COVID-19 at Buena Ventura Post Acute Care Center.
Even so, Lara-Garcia said it wasn't until the second week of April that she and fellow staff members were given surgical masks and gloves and told to wear them at all times. She said she and other staff members were given a paper lunch bag and told to put their surgical masks in the bags after their shift and reuse them for three days. This is in line with CDC guidelines when critical protective equipment is scarce.
Lara-Garcia said her supervisor also gave her bright orange pool goggles to wear while working, to try to keep her from getting infected with the virus. At first, she thought it was a joke.
"Why are we wearing this? They're not even 99 cents," she remembered thinking.
The goggles didn't fit under her glasses, so she didn't wear them. Administrators told her that they wanted to order medical grade goggles and masks, but suppliers were out.
A week later, Lara-Garcia said, the situation at Buena Ventura deteriorated. She described how one nursing station was converted into a makeshift isolation area. More and more of the residents Lara-Garcia cared for were moved into it. And she observed more and more of her coworkers becoming ill.
Lara-Garcia said she and other staff members were not told there was a risk that staff and residents could transmit the virus even if they didn't have symptoms, something the county health department began cautioning the public about at the beginning of April.
Lara-Garcia said the confusion took a toll on her mental health. She sometimes met a fellow CNA in the bathroom and they cried together, away from residents, whom they didn't want to upset.
"We were scared, we didn't know what was happening," she said.
FEW PROTECTIONS FOR NURSING HOME WORKERS
More than half of all reported COVID-19 deaths in L.A. County have been among residents and staff of what local public health officials call "residential congregate settings," mostly nursing homes. Two-thirds of the health care workers who have died of the disease in L.A. County — 20 out of 26 people — worked in nursing homes, according to county health officials.
April Verrett, president of SEIU Local 2015, which represents nursing home employees, including Buena Ventura staff, said some workers have sent photos of themselves wearing rain ponchos and garbage bags because they lacked protective gowns. Others were using plastic bags on their hands instead of gloves.
Certified nursing assistants like Lara-Garcia often make minimum wage, or close to it, despite being the backbone of care at nursing homes. (Lara-Garcia said she made $15 an hour at Buena Ventura; minimum wage in the City of Los Angeles is $14.25 for employees of for-profit companies with more than 25 workers.)
If the workers get sick or may have been exposed, Verrett said, "they cannot afford to miss a shift, let alone two weeks." Two weeks is the length of time that health officials recommend quarantine for people who may have been exposed to COVID-19.
Nursing home staff are often undertrained and responsible for too many patients with complex challenges, said Steven Wallace, who teaches public health at UCLA. They often have to rush from room to room, sometimes skipping essential steps like thorough hand-washing, he said.
At the start of the coronavirus outbreak, public health officials prioritized getting hospitals prepared with staff and equipment, fearing they could be quickly overrun with COVID-19 patients. Nursing homes were an afterthought.
"That then changed as they were seeing outbreaks in nursing homes and realizing that in nursing homes, once an outbreak occurs, it's really hard to manage," Wallace said.
Federal, state and local guidelines for nursing homes evolved rapidly — and still are.
"It would be difficult for an administrator because every day you open your mail and there's a potential for changing protocols. But you know, that's your job as an administrator, to make sure the protocols are followed."
Like hospitals, nursing homes have struggled with a lack of personal protective equipment. But unlike doctors and nurses, less-skilled workers at nursing homes, including nursing aides, janitors and kitchen staff, may not be trained to handle a virus outbreak.
Also, because they are low-paid, nursing aides frequently work at multiple locations to make ends meet, meaning they could transport COVID-19 from one facility to another.
A CDC investigation into one of the first COVID-19 outbreaks at a U.S. nursing home, in Kirkland, Washington, found that the virus's spread was likely aided by inadequate infection control, staff members who continued to work while they had symptoms, and staff who worked at multiple facilities, among other factors.
FAMILY MEMBERS IN THE DARK
In mid-April the Los Angeles County Department of Public Health began listing nursing homes with confirmed COVID-19 cases on the department's website. But it didn't report the actual number of cases and deaths at first. That left people like Sylvia, whose mother is a patient at Buena Ventura, reliant on the scraps of information they received from nursing home administrators. Sylvia asked us not to use her last name because she fears speaking out could cause her mother to lose her spot at the facility.
Sylvia's 73-year-old mother, who is partially paralyzed and has dementia, has lived at Buena Ventura for about six years.
She and her sister would visit their mother daily before Buena Ventura was locked down. Their mother also had a cell phone they could call, but it went missing just before COVID-19 cases started showing up at the facility.
They were frantic for information from the nursing home's administrators.
"My sister is, you know, is literally going insane, calling them every single day, three times a day," she said.
Eventually they got word that their mother had been moved to a new room, with three new roommates. One day, Sylvia went to stand in the parking lot where she could look through the window of her mother's room and talk to her on a replacement cell phone a sympathetic nurse had brought into the facility.
Sylvia was surprised to see someone else's purse on the nightstand, and pictures of strangers hanging in her mother's new space. In the rush to contain the COVID-19 outbreak at Buena Ventura, Sylvia suspects that aides hadn't had a chance to remove the former patient's personal belongings.
On April 21, the county health department reported that nine residents and two staff members at Buena Ventura had confirmed cases of COVID-19.
Just two days later, on April 23, county health officials reported the first death at Buena Ventura. The number of COVID-19 cases at the facility had ballooned to 13 residents and eight staff members, according to county data.
In May, Sylvia said administrators told her family that her mother had tested negative for the coronavirus. But Sylvia would like proof. She's glad her mother was moved to a room where she can see her through the window, but she cried recently describing the loneliness she sees her mother enduring, without much human interaction, and without the homemade food they used to bring her.
"She's already lost a lot of weight," Sylvia said. "She will not eat their food if it looks gross, if she doesn't know what it is, if she doesn't like the taste, she'll return it," she said.
Sylvia feels like she doesn't know what is going on at Buena Ventura, even though it's just a few minutes from her house. She's frustrated by the lack of communication from nursing home administrators.
"Nobody wants to meet with us. Nobody has attempted to talk to us. Everybody's busy, they're short-staffed, they're overwhelmed with all this COVID contamination in their facility," she said.
She'd like to know when her mother will be tested again for COVID-19, and if, like Silvia and her sister suspect, their mother has been routinely exposed to the coronavirus.
"They should be able to provide this information openly and transparently, without having the family members, you know, wondering or asking about it," she said.
A CALL FOR REINFORCEMENTS
On April 24, L.A. County public health director Dr. Barbara Ferrer announced a shift in strategy to fight outbreaks at nursing homes: All residents and staff would be tested for the virus, regardless of whether they exhibited symptoms.
A spokesperson for the public health department did not respond to a request for details on when Buena Ventura staff and residents would be tested.
On the same day, Gov. Gavin Newsom announced that the California National Guard would be deployed to hard-hit nursing homes to boost staffing and help with infection control and testing. Buena Ventura received a team of eight health care workers, according to a National Guard spokesperson.
On April 28, L.A. County health officials reported that 41 residents and 15 staff members at Buena Ventura had contracted COVID-19. Four people from the facility had died of the disease.
At one point the state health department also sent a 'strike team' to Buena Ventura to help manage the outbreak, including isolating residents and assessing exposures.
But by the time reinforcements were sent in, Lara-Garcia said she had already gotten sick.
'I JUST FELT LIKE I WAS GONNA DIE'
As more and more residents became ill in the first weeks of April, Lara-Garcia said she came down with a cough. She said she told her bosses, but that they told her she should keep working since her temperature wasn't over 100 degrees.
The Centers for Disease Control and Prevention state that workers who have a fever — defined as a temperature over 100 degrees — or other symptoms of COVID-19, like coughing and shortness of breath, should leave the workplace and be prioritized for testing.
Lara-Garcia said it wasn't until about a week later, when she told her supervisor she had a sore throat and uncontrollable coughing that she was sent home. Later, she said her supervisor sent her an email with a link to the county's website where she could schedule a coronavirus test.
In her emailed statement, Tiana Thompson, the administrator at Buena Ventura, disputed Lara-Garcia's account. Thompson wrote: "At no time has Buena Ventura Post Acute Care Center asked any employee who reported experiencing COVID related symptoms to report to work. To the contrary, staff who showed symptoms of COVID were sent home and referred for testing."
Thompson said she was unable to provide details about Lara-Garcia because of federal health privacy regulations. But she said Lara-Garcia "was never told to come to work when feeling ill."
Lara-Garcia said she got tested at East Los Angeles College, the closest site to her home, on April 15. Two days later, she said, she got the results: She had COVID-19.
She said a supervisor offered her access to a hotel room so that she could isolate herself, but Lara-Garcia declined.
"Who will take care of me, or look after my kids if I'm in a hotel?" she asked.
Instead, she had her kids move two of the mattresses out of the master bedroom that she normally shares with them into the living room. The kids slept on the mattresses on the floor for the next two weeks so that she could stay alone in the room.
"You know, it was really bad because I didn't have the attention that you will usually get even at the hospitals," Lara-Garcia said, recalling her physical pain. "I just sat in bed and cried. I just felt like I was gonna die because it's unbearable, especially my stomach. I developed some kind of rash on my body. I didn't know the agony," she said.
At one point, she said she contemplated suicide.
"Honest to God, I wanted to go to the kitchen and grab the knife," she said. "That's how bad it was. And then knowing on the other side of the door that my kids were not being cared for. It was really awful."
On April 29, exactly 14 days after Lara-Garcia tested positive for COVID-19, the director of staff development at Buena Ventura texted her, asking if her symptoms had subsided.
Lara-Garcia texted back that the fever was gone but she still had a "dry cough." The director of staff development replied: "if you have no fever and the cough is dry, you are allowed to come back," which is within CDC guidelines for returning health workers.
Lara-Garcia said she still hasn't gone back to work at Buena Ventura. She's angry. She feels like they played with her health, and that she wasn't given the information needed to keep safe.
But she said she needs to start making money again soon to support her family. She's considering going to another, nearby nursing home, where her friend told her they pay $24 an hour — a huge increase from the $15 an hour she said she was making at Buena Ventura.
But there's a catch: She'd have to work with COVID-19 patients. She said if they give her the right equipment to protect her from the virus, she'd probably take the job.
Elly Yu contributed reporting.