UPPER PROVIDENCE — Only one other nursing home in all of Pennsylvania has seen more deaths from the coronavirus than Parkhouse Nursing and Rehabilitation Center, according to new data released by the state.
With 48 deaths listed, Parkhouse was second only to Brighton Rehabilitation & Wellness Center in Beaver County, which had 76 deaths, according to the state's figures.
Kelli Campbell, the administrator at the 467-bed facility on Black Rock Road, replied late Wednesday that "we grieve the loss of all our residents, who will always be members of our family, from this deadly virus. We continue to strive to provide care in keeping with best practices, including maintaining a dedicated unit solely for COVID+ patients, as part of our comprehensive efforts to limit the risk of transmission."
She concluded, "the health and safety of our residents, as always, remains our top priority."
The death statistic that put Parkhouse in the headlines is just one data point in a constant flood of ever-shifting figures.
But it is emblematic of a larger trend which shows that in all three categories measured — cases among residents, cases among staff, and deaths from the virus — facilities in just five counties surrounding Philadelphia account for more than half of the ten hardest hit facilities.
'This Virus Has Wreaked Absolute Havoc'
Nursing homes and personal care homes have struggled for months to contain the virus, with residents of the facilities accounting for more than two-thirds of the state’s overall death toll of 4,624 — a higher proportion than in most other states.
“There is no question, in Pennsylvania and all across the world, long-term care facilities have been places where this virus has wreaked absolute havoc," Gov. Tom Wolf said in a recent video news conference.
And much of that havoc is centered in continuing care homes in Berks, Bucks, Chester, Delaware and Montgomery counties, according to the data which tracks coronavirus statistics in nursing homes from March 6 to May 19.
As MediaNews Group reported last week, as of May 15, the vast majority of COVID-19 deaths in the region are occurring in these facilities.
- 85 percent of Chester County's COVID-19 deaths have occurred in 38 different care homes;
- 83 percent of Montgomery County's COVID-19 deaths have occurred in 88 different care facilities;
- 81 percent of Delaware County's COVID-19 deaths have occurred in 39 facilities there, and
- 67 percent of Berks County's COVID-19 deaths have occurred in 25 facilities there.
The Wolf administration has faced criticism that it didn’t do enough, soon enough, to keep the virus from spreading among some of Pennsylvania's most vulnerable residents.
"We keep trying to figure out what we can do better as we move along in this pandemic," Wolf said. “I think in hindsight there are a lot of things that maybe we’ll learn, and I hope we do, that we can do better."
“COVID-19 is a particularly challenging situation for these settings as they care for residents with serious medical conditions," Rachel Levine, Pennsylvania's Secretary of Health, said in a statement that accompanied the release of the data. "We will continue to work to ensure the safety and wellbeing of residents through education, resources and testing.”
Testing has been a problem since the pandemic began and the state's promise to test all nursing home residents remains unfulfilled.
According to the Department of Health, a pilot study of two facilities is currently underway to test all residents and staff at the facility.
Additionally, the department, working with commercial laboratories, has been coordinating with facilities that are implementing universal testing.
"We are receiving test swabs from the federal government to ensure our facilities have an adequate supply. In addition, the Pennsylvania National Guard is mobilizing to provide a mobile testing option for facilities that may not be able to test on their own," according to the state's press release.
The state also has faced criticism that it fueled the outbreak in nursing homes by allowing coronavirus-positive nursing home residents to be readmitted from the hospital.
However, guidance from the U.S. Centers for Disease Control and Prevention never discouraged such a practice, and advised nursing homes to create a plan for managing readmissions of residents who contracted the virus and admissions of new residents who were infected, The Associated Press reported.
Nursing homes were told to place those residents in a single-person room or in a separate observation area to be monitored for evidence of the virus. The practice of admitting virus-positive patients to nursing homes appeared to be routine across states, according to AP.
Despite those precautions, public health officials say nursing homes largely lacked the trained staff, testing supplies and personal protective equipment to contain outbreaks.
'Calls for Investigation'
“This COVID-19 crisis has drastically worsened problems that have existed in these nursing facilities for years," state Sen. Katie Muth, D-44th Dist., said after hearing testimony May 4 about the situation at nursing homes.
"When you combine such a vulnerable population with a workforce that is under-protected, understaffed and underpaid — you are inviting the kind of dangerous and deadly scenario that is currently playing out,” Muth said.
"There’s no excuse for what’s going on," particularly in terms of adequate testing and PPE for staff, state Sen. Andrew Dinniman,D-19th Dist., said during the May 4 hearings. "The Department of Health failed our nursing homes."
Both state senators represent portions of Chester County.
Of the 274 confirmed or probable COVID-19 deaths reported to the Chester County Coroner's office, 229 were residents of long-term care facilities, The Daily Local News reported Tuesday, the same day the state released its data.
There are 75 licensed long-term care and personal care homes in Chester County, with nearly half of them experiencing a coronavirus outbreak.
The state’s chief fiscal watchdog, Auditor General Eugene DePasquale, has been publicly urging greater transparency in releasing nursing home data.
Chester County Coroner Christina VandePol has called for an investigation into the high number of COVID-19-related deaths in nursing homes there.
Similarly, Pennsylvania’s top prosecutor, Attorney General Josh Shapiro, has opened criminal investigations into several nursing homes.
Impact on the Re-Opening Debate
Ironically, when Shapiro was Montgomery County Commissioners chairman, he oversaw the $41 million sale of the Parkhouse facility in 2014 into private ownership after 76 years of county management.
His replacement as chairperson of the county commissioners, Valerie Arkoosh, is a medical doctor and her daily briefings on the pandemic's local progress, and measures taken to fight it, have put her in the spotlight on the subject.
As such, she was put on the hot seat again May 5 when she testified before the Pennsylvania Senate Democratic Policy Committee, specifically on how the virus has impacted nursing homes.
"They are working so hard, they are really trying to do their best with the tools at their disposal," Arkoosh said of the staff in nursing homes in Montgomery County.
She said at first, the county was not specifically aware of how badly the virus was hitting nursing homes, in part because testing was infrequent and not consistent.
"We only became alerted to problems in the nursing homes when we got concerns about all the 911 phone calls," Arkoosh told the policy committee.
It is because of those 911 calls that Arkoosh has advised against a push to remove nursing home cases when calculating when the state can re-open and loosen business restrictions which are wreaking a different kind of havoc, on the economy, and are the subject of an increasingly vocal protest movement.
"First of all, I believe they should be counted. They are human beings, our parents, grandparents, brothers, sisters, aunts and uncles," Arkoosh testified. "I think it’s a problem if they’re not counted."
Secondly, Arkoosh testified, "when they get sick, they still go to the hospital and we’re trying to make sure the hospitals are not overrun."
"So that means the paramedic team, the hospital team and the home staff going home to their family," after being exposed, Arkoosh said. "Many of the workers live in different counties, trying to separate them out is difficult. The reporting data is a quagmire, but that's a subject for another day."
"We have to count them to make sure our hospitals don’t get overwhelmed, to keep our EMT teams safe," Akroosh advised. "Way too many people got caught up on the number, it’s just one of several factors" in determining when a region or county can re-open. "It needs to be looked at holistically. That number is not an island."
'Nobody Can Prepare for This'
And nursing homes in the region are not islands, although they can seem to be with isolation and shelter-in-place measures keeping out most family and visitors.
Neshaminy Manor, which bills itself as the fourth largest nursing home in Pennsylvania, is operated by Bucks County and ranks sixth in the state for the number of coronavirus deaths and number one for most cases among staff.
Bucks County spokesman Larry King said the facility prohibited visitors from the outset of the pandemic, takes employees' temperatures and has taken other preventive measures. All residents and staff have been tested for the virus, he said.
“It has an excellent reputation: if you look at the regular state inspections done at Neshaminy Manor, it gets top evaluations every time out,” he told the Associated Press.
But a disease like coronavirus has many vectors, Arkoosh testified.
"Nursing home staff may be asymptomatic and continue to work. Some need those paychecks, it is not a high-paying job, and if they have mild symptoms, they may come to work anyway," Arkoosh testified.
She noted that many nursing homes are owned by one or two corporations that own three, four or six different homes in several different counties.
"And they share staff, like occupational therapists, speech therapists, who go from facility to facility. Unwittingly, one individual could carry the disease from place to place," Arkoosh said.
Alex Metricarti, chief of marketing and public relations for Living Branches, which operates nursing homes in Souderton, Hatfield and Lansdale, testified to the policy committee that the non-profit's facilities began planning for the pandemic March 9.
"First, we planned to keep the virus out, because we were aware if it got in, it would be devastating," she told the committee.
Under the Living Branches plan, "no visitors were allowed; no non-essential personnel. Every employee was health screened every single day. If any were sick, they were sent home with pay," she said. "We had universal masking; all meals were served in residents' rooms and there were no in-person activities. You name it, we’ve done it."
But still, the virus got in. And it has been devastating.
"One nurse eventually tested positive," Metricarti testified. "We believe it was because she was crying so hard, she violated the seal on her face mask."
For the most part the virus has so far been successfully kept out of the Hatfield and Souderton locations, with only one asymptomatic staff member, who is now on leave, testing positive.
But by May 5, 54 percent of the 42 residents tested in the skilled nursing and memory care sections of at Dock Woods home in Lansdale had tested positive. There are, so far, no cases in the residential or personal care sections of those homes, said Metricarti.
In the skilled nursing facility, projections show that a minimum of 25 percent who contract the virus will pass away, Metricarti testified.
"Some of them have been with us for 20 years. One man was 101 and had been with us for many years," she said. "This is difficult for our staff."
Matricarti said planning can only go so far.
"Nobody can prepare for this. It’s just astonishing. We have enough money to purchase PPE, but it’s gotten more expensive. A surgical mask that used to cost 5 cents now costs $1.68," she testified.
Whatever results from the various investigations, hearings or new planning, it will likely be put to use in the future.
As Arkoosh told the policy committee, "there will be a next time, I promise you that."
The Associated Press and MediaNews Group Reporter Fran Maye contributed to this report.