Marc Perrusquia

Marc Perrusquia is the director of the Institute for Public Service Reporting at the University of Memphis, where graduate students learn investigative and explanatory journalism skills working alongside professionals. He has won numerous state and national awards for government watchdog, social justice and  political reporting.

‘There’s going to be more’ — Nursing home COVID-19 cases create stark choices for residents

By Updated: April 03, 2020 3:00 PM CT | Published: April 03, 2020 9:29 AM CT Exclusive

The manicured lawns and gated communities of East Memphis’ affluent Massey Hill area may not seem a likely setting for one of Shelby County’s first major COVID-19 strikes.

Yet strike it did – right at the heart of this neighborhood’s most vulnerable denizens.


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Six residents and staff members have tested positive for COVID at Carriage Court of Memphis, an exclusive senior assisted living home where one-bedroom apartments start at just under $35,000 a year.

Health Department Director Alisa Haushalter said this week she “applauds’’ Carriage Court for its efforts to quell the outbreak and for the “exemplary infection control practices’’ it maintained even before a health department “strike team’’ intervened over the weekend at the 125-bed facility.

But as the coronavirus threat heads toward an expected surge later this month that could overwhelm the county’s healthcare system, experts fear the potentially life-threatening outbreak at Carriage Court could be a bellwether for the county’s 58 licensed nursing homes and assisted care facilities, several situated in some of Memphis’ poorest communities.

 The Institute for Public Service Reporting is based at the University of Memphis and supported financially by U of M, private grants and donations made through the University Foundation. Its work is published by The Daily Memphian through a paid-use agreement. Follow the Institute on Facebook or Twitter @psr_memphis.

“It’s just the first of many. That’s the problem. What’s going on with them is potentially going to happen everywhere,’’ said Dr. Jeff Warren, a Memphis City Councilman, physician and member of the Memphis and Shelby County COVID-19 Task Force, a collection of health professionals, politicians, government planners and others assigned to contain the coronavirus threat here.

Members of the task force will hold a teleconference at noon today – Friday, April 3 – with nursing home administrators to plan for the surge. One of the difficult questions they will grapple with involves whether to keep virus-stricken residents in nursing homes rather than transfer them to hospitals, where their chances of survival may not increase.

“What we’re going to try to hope to do is to try to keep as many people as possible in the nursing homes,’’ Warren said.

“…They’re either going to make it or not in the nursing home. And sending them to the hospital to be on a ventilator may mean that someone who’s 20, 30 or 40 or 50 won’t be able to survive because we won’t have enough ventilators.’’

Though many of Shelby County’s long-term care facilities have been on lockdown for three or four weeks now, officials fear the advancing surge.

A “critical issue’’ involves a lack of personal protective equipment – PPE – such as masks, protective gowns and face shields, said Jesse Samples, executive director of the Tennessee Health Care Association, which represents nearly 400 long-term care facilities statewide.

“Availability of PPE is incredibly important for long-term care workers to protect both themselves and their residents,’’ Samples said in an email to the Institute for Public Service Reporting.

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Another major concern involves social distancing. Despite the lockdown that’s barred visitors from long-term care homes for weeks, authorities believe coronavirus is getting into these facilities through asymptomatic workers – some who may not have adhered to strict social distancing.

“The number of people who die in nursing homes and the number of people who are infected is going to be directly proportional to the degree that we did social distancing correctly,’’ Warren said. “It’s going to depend upon the number of people who are workers who get this virus and don’t know they have it.’’

The outbreak at Carriage Court

Haushalter said at a press briefing earlier this week that the first COVID-19 case at Carriage Court occurred a few weeks earlier. Though she could not give a precise date, that timeframe would place the first case around March 11.

“We worked closely with them as well as the state,’’ which dispatched an infection control expert to the facility, Haushalter said.

About two weeks later – roughly March 25 – Carriage Court reported a second case of COVID.

That second case triggered a “red flag’’ that caused the Health Department to send a strike team to the facility, Haushalter said.

“We’ve done much more intensive work with them (since),’’ she said. That includes conducting “significant testing” last weekend, March 28-29. That testing resulted in four positive results in addition to the earlier two, said Dr. Bruce Randolph, health officer for Shelby County. In all, the Health Department conducted 22 tests, producing four positive results and 16 negative. Two test results were incomplete, Randolph said.

A phone message left for Carriage Court administrator Lisa Bobal was not returned.

The outbreak has shattered the usual decorum at Carriage Court, a three-story facility at 1645 West Massey Road just down the street from International Paper’s corporate headquarters. Residents here enjoy the use of a private library, a beauty and barber shop, a large community room and an outdoor patio.


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Haushalter said she attempted to coax the facility’s management into making a public announcement but they declined to do so. The health director initially hesitated to name of the facility herself but eventually did so under mounting public pressure.

“I made a decision in partnership with input from the mayor and others that it was in the best interest of the public’s health to release that information yesterday evening and then to the media this morning,’’ Haushalter said earlier this week.

Others said they find it difficult to fault the facility. The wife of one 53-year-old disabled resident who asked not to be identified told the Institute that while she hasn’t seen her husband in weeks she believes Carriage Court couldn’t have done anything to prevent the outbreak.

Warren agrees.

“It has nothing to do with, you know, whether Carriage Court did anything right or wrong in this situation. They’re just the first one. And there’s going to be more.’’

The continuing threat

“Protecting that population is going to have to become a major focus of all of ours,’’ said Paige Brown, mayor of Gallatin, Tennessee. Brown has helped oversee the emergency response at the Gallatin Center for Rehabilitation and Healing, where 74 residents and nearly three dozen staff members tested positive for COVID. Four of the nursing home’s residents have died, according to The Tennessean newspaper in Nashville.

 “Nursing homes might be just a natural place for the virus to spread if extreme precautions aren’t taken,’’ said Brown, who believes all such facilities should be locked down and supplied with ample personal protective equipment. “That probably means protective gear for everybody in the facility.’’


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The Centers for Disease Control issued an advisory late last year for nursing homes and other long-term care facilities to develop comprehensive COVID-19 response plans that include rapid identification and management of an outbreak as well as obtaining proper supplies and training.

Still, some facilities have been overwhelmed.

A Seattle-area nursing home faces more than $600,000 in fines following a COVID-19 outbreak last month that led to three dozen deaths. In Georgia, meanwhile, Gov. Brian Kemp announced this week he will deploy National Guard troops to nursing homes and assisted living centers to help clean facilities and develop aggressive infectious control measures.

Though the state of preparedness among Memphis facilities remains uncertain, Haushalter agrees officials should expect more COVID infections.

“As we continue to have spread, you expect that you’re going to have spread into vulnerable populations and then what we would call mini outbreaks in different settings,’’ she said. “And so nursing homes as well as assisted living facilities are those kind of places where you have mini outbreaks.”  

COVID-19 in Memphis and Shelby County: April

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