When Kate Mackley and her family began hearing news of the coronavirus pandemic, they worried for her mother, Karla Mackley, who was 93.
"You know, that worry did play out," Kate Mackley said. "She passed away from COVID, and she passed away actually very quickly."
Mackley's mother lived at Monticello West, a long-term care facility in Dallas. On Tuesday, Dallas County Health and Human Services reported 32 cases of COVID-19 among residents and staff there, along with nine deaths.
Before losing her mother, Mackley said she received email updates from Monticello West about the outbreak, but they left her with questions.
"They wouldn't say specifically what floor those cases were on," Mackley said, "and very early on, they reported two employees with COVID-19, and they said that those employees were staying home after they had tested positive."
Mackley wondered whether her mother had COVID-19 when her health started declining. She said Monticello West would not test her mother for the disease onsite. The family took her to an emergency room where she tested positive.
"Her oxygen level dropped enough that an E.R. visit became needed anyway," Mackley said, "but I was really surprised at how hard they pushed back on having her tested onsite at Monticello so we and the hospice nurses could decide what was the appropriate plan of care for her."
Mackley wonders whether having her mother tested sooner could have made a difference.
"By the time my mom actually got to the E.R., she declined so rapidly," Mackley said. "She went directly from the E.R. to hospice, and she passed two days later."
Mackley also questions whether staffers are adequately trained in preventing transmission. While visiting Monticello West, Mackley said she saw some workers leave the facility wearing cloth face coverings, which they tugged down and then tossed into their cars. Federal guidelines call for not touching the eyes, nose or mouth when taking off a cloth mask, and washing hands immediately after removal.
"I feel for these people, and I understand they're doing their best in a very hard situation, but they don't have the training, they don't have the supervision to understand how not to transmit this virus not only to other residents but to themselves," Mackley said.
Monticello West declined KERA's requests for an interview. An emailed statement from the facility states, "Monticello West has had residents testing positive despite our community following the latest guidance from state and federal health authorities. The highly contagious nature of COVID-19 has proven to be an incredible challenge for healthcare facilities across the country...."
The latest report from Dallas County health officials identified 197 cases of COVID-19 transmission that appear to be tied to long-term care facilities, more than 7% of cases countywide. Clusters of COVID-19 have shown just how vulnerable these settings can be to the spread of infectious diseases.
"You know, when there's a virus here that no one's immune system particularly recognizes, then our most vulnerable, our elders who are in the nursing homes with these multiple comorbidities, become a population that we become very very concerned about," said Dr. Sandra Petersen, a consultant at Pegasus Senior Living.
Petersen, who is helping lead the COVID-19 response at 37 facilities, said seniors in long-term care are likely to have existing health conditions that put them at a greater risk. There's also the fact that many caregivers work across multiple facilities.
"Because of the way the virus is spread, we have staff that may not realize that they're carrying the virus and may be totally asymptomatic," she said.
Petersen said Pegasus Senior Living is teaching staff to care for residents in isolation and use protective equipment properly. Without a vaccine for COVID-19, she doesn't see these enhanced safety measures going away any time soon. Petersen thinks the coronavirus pandemic will change approaches to senior care.
Some changes are already taking shape. The federal government is now requiring nursing homes to report COVID-19 cases to residents and their loved ones, as well as to the Centers for Disease Control and Prevention.
"That's the hope I have from this is that we learn better ways of caring for them and more efficient ways of doing things for the residents that promote their health and safety," Petersen said.