KINGSPORT, Tenn. (WJHL) — Personal protective equipment littering the floor. Other trash overflowing as residents cry out for help that an overstretched staff couldn’t provide. And deaths that neared the two dozen mark.
That was the reality at Wexford House as the long-term care facility battled a COVID-19 outbreak that eventually caused 23 resident deaths and sickened more than 180 residents and staff combined.
Dr. Marta Wayt was among those who contracted COVID-19. With the outbreak several months in the rearview mirror, Wexford House’s medical director sat down with News Channel 11 to discuss the pandemic’s effects on long-term care.
“That was absolutely the most frustrating and challenging emotional event in my medical career,” Wayt said of the facility’s weeks-long battle that reached its nadir in December.
“I think we all banded together as much as we could,” she said.
Tennessee Department of Health (TDH) data show Wexford House suffered some of the highest COVID-19 case numbers and deaths in the region, but the facility was by no means an outlier.
“Up until the advent of the vaccine we were losing two to three people a day,” Sullivan County Regional Health Department Medical Director Dr. Stephen May said.
Between late August and mid-January, TDH reported 1,442 resident cases in the seven-county News Channel 11 viewing area of Northeast Tennessee. The resident death count from COVID-19 during that time was 258, and another 961 staff contracted COVID.
“From the beginning I knew it was going to come; I just wasn’t sure when it was going to hit us,” Wayt said. “The benefit that we have is just that we’re not a heavy populated area, and so because of that I think it probably just didn’t come on quite as quickly here.”
Those regionwide numbers roughly doubled from around Labor Day to mid-November, but Wexford House seemed to be largely containing a battle with COVID-19. Four resident and three staff cases were reported by TDH the week of Sept. 11 — the first to be reported.
Wexford House had developed some protocols based on Medicare guidelines, essentially shutting things down along with other area nursing homes.
“We really only allowed end-of-life visits, and that was extremely hard for the residents…and the family members and the staff even,” Wayt said. “But it protected us for a long time.”
The virus gains a foothold
Even after those initial cases came in, Wexford House managed to hold the line. One resident died of COVID-19, but by Veterans Day, the case count had risen to just 17 residents and nine staff.
But the weekly report of Nov. 20 showed in plain, sanitized numbers that things had taken a turn inside. The resident case count had more than tripled — to 56 — and the staff count had shot from nine to 33.
Case rates in the community were raging at that time, which May said made it extremely difficult for facilities to prevent surges inside.
“A lot of the disease we recognized came in with the staff and employees where they had community exposure (and) they became either asymptomatically ill or mildly ill and continued to work,” he said.
“And that was before we had the active screening that we do once, twice weekly now to pick it up early.”
Two weeks later on Dec. 4, the case counts had reached 101 residents and 59 staff. And that week had seen 13 more deaths to report.
“We were short nurses anyway, and then take about half of our staff down (out due to COVID),” Wayt said.
“The remaining staff had to work sometimes 18, 20 hours in a row then come back a day and a half later and work again that long. It was a war zone. I can tell you that.
“There were physical therapists who were changing briefs. There were administrative personnel that were handing out water, passing trays, doing everything that they could to step up, but at the end of the day, it was still absolutely a feeling of helplessness.”
By Christmas, case counts had flattened — three additional residents and 14 staff — but another nine deaths had been reported.
“We had a lot that we were learning,” May said. “We were learning what were the best infection control protocols. We were just getting widespread testing online. We were still in the process of developing good treatments for those who became so sick.”
Wexford House’s 23 deaths reported is the second-highest total reported in Northeast Tennessee and the fourth-highest in the News Channel 11 viewing area. Those four nursing homes alone reported 117 resident deaths.
All of them at Wexford House were difficult to endure, Wayt said. But one group in particular hit her hardest — those who came to Wexford House for short-term rehabilitation.
“When our surge and our outbreak occurred here, for them not to survive — it was extremely challenging,” she said. “And a lot of those folks, I still treat their family members, and I still see how they’re suffering with the loss.
“Part of that suffering, I think, is really driven by the fact that they could not visit their loved one until the very end … They couldn’t comfort them or comfort themselves with their presence. So really, to this day, it’s still very challenging and very emotionally draining.”
It wasn’t just residents who bore the brunt of COVID-19’s severest effects. Wexford House’s 79 staff cases is the highest total of any Northeast Tennessee long term care facility, though a handful of others are close.
It was as those cases mounted that the “banding together” took place. Wayt said she and three of her nurse practitioners all contracted COVID — fortunately, she said, in kind of a staggered fashion.
Still, they had to conduct some patient checks virtually, and when Wayt returned after her own illness she saw that “war zone” she had described.
“To be able to look down the hall and see PPE everywhere on the floor, trash overflowing, residents crying out not being able to get the help that they needed.
“And the nurse is doing everything they could, the nurse’s aides doing everything they could to run from room to room and to help them as much as they could but still not being able to do that.”
A heavy psychic toll
That was the nadir for Wayt, who said her faith played a primary role in carrying her through. She remembers coming back from her own isolation period.
“I was the only provider in the building at that point, and I think we had about 70-80% of our patients who were positive at that time,” said said. “I’m just trying to come in the building and see the sickest of the sick and seeing the staff really beat down and worn down.”
She said medical school and residency couldn’t quite prepare her for those darkest days.
“It prepares you for a lot of tragedy, and you learn how to compartmentalize, but even then those were very challenging days just to get through the day,” Wayt said.
“You were so exhausted by the end of the day. At least I was, and maybe the physical work wasn’t very hard. But the emotional drain on your system made it hard to want to come back the next day and the next day.”
May interacts with many nursing home medical directors in his public health role, and he also serves as one at a facility in Carter County. He said all folks could do was soldier on in the moment.
“You wish you could have done more, or picked it up earlier or done anything else with it but … we pick up the pieces and go on,” he said.
Wayt said she believes God simply gave her “a lot of fuel emotionally,” and that helped carry her through.
“I hope it’s been an example to those around me,” she said.
Example or not, Wayt said the psychic toll on staff has been immense. Wexford House is owned by Ballad Health, and she said Ballad’s employee assistance program for mental health is excellent — but as yet, people have hardly had time to look up.
“So when are they going to find time, and to do counseling on top of that, that’s really tough,” she said. “The best we can do in most circumstances is really try to support each other, and that’s hard when everyone’s tired.”
The trauma has certainly been real at Wexford House, where one of the facility’s nurse supervisors died from COVID-19 (TDH does not report staff deaths).
“His wife worked here as well,” Wayt said. “She has had a hard time coming back into the building because of it, and we don’t know that she’s going to return to work here with us.”
May said it wasn’t the only area facility that had a staff member die.
Wayt said the emotional toll is amplified because many people who gravitate to this specific area of patient care really bond with residents.
“There are deeper relationships with long-term care than acute care,” Wayt said. “I’m not saying that it’s not hard for anybody in health care to lose someone because it is challenging, but we’re like family here and most facilities will tell you the same thing.”
And while death is a fairly regular occurrence in normal times, the COVID-19 year has been in a league of its own.
“The most challenging part was, how many staff members were we going to lose to COVID?” Wayt asked. “Because we did. How many residents were we going to lose to COVID? How are those families going to respond? How many nurses would we actually see leaving the facility trying to get out of long-term care so they wouldn’t have to suffer that emotional challenge?”
COVID just fuel on fire of a stressed environment
Some didn’t stay, and Wayt said even before COVID-19 arrived, the nursing shortage was making the day-to-day difficult in long term care. She said accommodating the current census of patients is difficult and that taking new ones and providing a satisfactory level of care is tremendously difficult.
“The staff that’s there, they’re all working overtime,” she said. “We don’t know how to fix it.
“The health system is trying to recruit for the hospitals and to their long-term care facilities and to their offices. It’s everywhere.”
Ballad Health Chief Nurse Executive Lisa Smithgall said the system has increased pay for CNAs and other bedside staff at Wexford House and its other long term care facilities.
“We’ve had multiple adjustments recently trying to say, this is important to compete with the market and to meet the needs of the organization,” Smithgall said.
But COVID’s impacts blunted the success of that effort. Many typical recruits had been laid off from service jobs and pandemic unemployment paid more than a high stress nursing home job.
“So it became very very difficult for us to recruit during the last year for those unlicensed roles,” she said.
The prospect of a continued exodus is never far from Wayt’s mind.
“If there were folks on the fence maybe considering retirement, they retired early,” she said. “Some took jobs completely out of health care just to get away from this.”
The challenge may be universal in health care, but Wayt said long-term care as a sector is sometimes at the bottom of the heap. Asked whether American society supports long term care to a sufficient degree financially, or is even emotionally invested in the 2.5 million adults who live in nursing homes or assisted living, Wayt was emphatic:
“We’re beholden a lot to insurance reimbursement,” she said, adding that most revenue comes from Medicare and Medicaid insurance.
Nationally, taxpayer-funded Medicaid pays almost 60 percent of revenue nationally – Medicare another 14 percent. Wayt said that will cover room, board and what she called “minimum staffing.”
“So, if you really want great care, you have to charge more to get more staff in the building, and that’s a challenge,” she said. “I don’t know that we’ll fix it anytime soon.”
Wayt said the calling some people have to long-term care work may be one saving grace.
“I think that you have to have a heart for a long term care and that gets you through challenging times like this,” she said. “You know that if you leave those residents won’t have you anymore and they care about you. And you care about them.”
The importance of the ‘V’ word
Colleagues’ dedication and Wayt’s faith have been assets, but faith doesn’t get vaccine into arms.
By mid-March only 32 percent of Tennessee long term care staff were fully vaccinated according to a Center For Public Integrity report. Statistics like that concern Stephen May.
“The bulk of the disease was brought in primarily by the staff and that’s why now it’s so important we get healthcare facility worker staffs vaccinated,” May said. “Because that stops the bulk of the transmission into the facility.”
Just this week, the Centers for Medicare and Medicaid Services announced it will require long term care facilities to report resident and staff vaccination data weekly.
“We’re out of our initial surge and those folks aren’t protected anymore,” Wayt said. “We’ve had a fairly decent vaccination rate here at Wexford, but we can still have a second surge at any time so we can’t afford to be complacent.”
Regardless of society’s appetite for supporting long-term care or being emotionally invested in it, Wayt said it’s here to stay for the foreseeable future.
“In health care we always want our patients to be home surrounded by family, but long-term care facilities, they serve a purpose. Not everyone can be home.
“So we want to try to make it a good environment for them. But again, it’s going to be a big challenge to try to overcome all of the staffing shortages that we faced during this pandemic.”