Maricopa County has marked a grim milestone as more than 100 residents of long-term care facilities have died to date of COVID-19 complications.
The number of residents with confirmed cases of COVID 19 in the state's largest county has more than doubled since mid April to 735 residents. Of those, about 25 percent have been hospitalized and 103 have died, according to the county's latest figures released Saturday.
Much as the nation's first major outbreak of the disease centered on a nursing home, the outbreaks in Arizona may reveal nursing homes to be the single deadliest setting for the pandemic within the state. Residents of long-term care facilities account for 64 percent of the county's total 159 COVID-19 deaths.
Even as some parts of the state's economy move to reopen, nursing-home deaths continue to mount, as facilities struggle with shortages of staff and personal protective equipment.
And though health officials this weekend launched a testing "blitz" to sample tens of thousands more people, universal testing for every long-term care resident is not available.
Dr. Rebecca Sunenshine, medical director of Maricopa County Public Health, said this week that health officials have known since the beginning of the COVID-19 outbreak that residents of nursing home and assisted-living facilities are at the highest risk of severe complications. They often have other health conditions.
"As long as COVID-19 is circulating and health-care workers are exposed, we will continue to see some cases," she said.
County health officials check with the facilities weekly, she said, to see how many COVID-19 cases they have, if any, and how many residents are experiencing respiratory illnesses. Those residents who exhibit COVID-19 symptoms are immediately offered testing, she said. The goal is to identify cases as quickly as possible and make sure confirmed patients are isolated.
Sunenshine said while universal testing for all long-term care residents in the county is not available, county officials are in discussions with partners about the topic. But there is currently not enough testing available.
"If we were to start testing individuals broadly, the first place we are looking is long-term care residents," she said.
Maricopa County has more than 500 long-term care facilities, an umbrella term that includes skilled nursing homes, assisted living, rehab and hospice facilities. As of May 1, 112 of these facilities reported at least one confirmed case of COVID-19.
While long-term care facilities are among the most significant outbreaks, state and health officials have refused to release the names of the facilities and the number of outbreaks at each facility, citing patient privacy.
Instead, information about outbreaks has emerged through media reports or when homes voluntarily confirm the cases.
MORE: Republic analysis reveals ZIP codes with nursing homes show spike in cases
Last week, a spokeswoman for Pennington Gardens, an assisted living facility in Chandler, said a total of 29 people had tested positive for the virus and 13 of them had died.
Since then, letters to families of residents indicate the positive cases have grown to 41 with three more resident deaths. The outbreak, once confined to the assisted-living part of the facility, has now spread into the memory care portion. A spokeswoman said they are in daily communication with families but declined comment on any specifics.
On Friday, Desert Cove Nursing Center in Chandler confirmed 53 residents and staffers have tested positive for COVID-19 and, of those, four residents have died.
Desert Cove's executive director, Tim Bouseman, said in a statement that 40 residents and 13 staffers have tested positive. Seven residents are hospitalized, and the rest are isolated and being cared for by staff.
INVESTIGATION: More than half of nursing homes were cited for infection-control violations
Deaths also climbing in Pima County
As in Maricopa County, more than half the total COVID-19 deaths in Pima County have been at long-term care facilities.
The county reported 280 cases of COVID-19 with 38 deaths as April 23, the most recent figures available.
"As we feared, they are a particularly vulnerable place," said Dr. Bob England, interim director of Pima County Health Department.
Chronic health conditions require a lot of care and close contact with staffers: feeding, bathing, turning them over in the bed
"People in those facilities work really hard to try to not spread things around," he said. "But it honestly is a difficult setting for any infectious disease."
Many facilities don't have enough personal protective equipment and are having to stretch their supplies.
"They've truly been struggling," he said.
At latest count, 60 residents of Sapphire Nursing Home and Rehab have been infected along with 30 staff members, according to a spokeswoman. One employee has told The Arizona Republic that at least 20 residents have died during the outbreak, many or all with COVID-19 symptoms.
Harder to sue nursing homes
A Good Samaritan executive order signed in April by Arizona Gov. Doug Ducey makes it harder to sue long-term care facilities during the COVID-19 outbreak.
Attorneys and health care experts who examined Ducey's executive order at the request of The Arizona Republic said it sets a higher bar for civil lawsuits related to COVID-19 care, raising the bar from negligence to "gross negligence or reckless or willful misconduct."
In other words, families who sue would have to prove nursing homes weren't merely failing to use reasonable care. They would have to prove that administrators or employees knowingly and voluntarily disregarded reasonable care standards or were recklessly indifferent to the result or the rights and safety of others.
Brian Lee, executive director of Families For Better Care, a nonprofit group advocating for nursing home residents, said he understands concerns that nursing homes will be inundated with lawsuits as large numbers of residents die from COVID-19 complications. But, he said, families "have a constitutional right to have due process."
But David Cohen, a Phoenix attorney who defends nursing homes against lawsuits and served as a consultant to the Arizona Health Care Association on the executive order, said while frivolous lawsuits will either not be filed or will be dismissed by a judge "the lawsuits with merit will still go forward."
Even before Ducey's executive order, Arizona families faced hurdles when trying to sue nursing homes.
Several years ago, a series of tort reforms created a more favorable legal environment for Arizona nursing homes. The statute of limitations for filing lawsuits has been lowered from seven to two years.
Proponents of the reform argued successfully to Arizona lawmakers that without the reforms, nursing homes faced a legal and financial crisis because of excessive lawsuit verdicts and settlements. They were paying higher insurance premiums to defend lawsuits, which was less money they could put toward patient care.
Legal and health-care experts say lawsuits against nursing homes related to COVID-19 are inevitable because of the large number of deaths. The Associated Press recently reported as many as 11,000 deaths have occurred at long-term care facilities in the U.S. since the coronavirus outbreak began.
A life lost
To the many families whose loved ones have died from COVID-19, they are much more than just a number.
Ali Morse lost her cousin, William Downs, to COVID-19.
Downs lived for 25 years at Rainbow Acres, a residential community for adults with disabilities in Camp Verde. He thrived there, taking art lessons and painting vibrant-colored pictures. When his mother died in 1983, Morse became his medical power of attorney.
As Downs aged, and could no longer care for himself, Morse moved him first into assisted living and then to Handmaker Home for the Aging in Tucson, where he had been living for the last two years.
She last saw her cousin on March 11 before the nursing home, like others across the country, banned nearly all visitors to protect residents from the virus.
Morse received an email on March 31 from Handmaker, informing her that a resident of the nursing home had tested positive for the virus. This was the facility's first reported case, the email said. Tom Hines, an administrator for the facility, declined comment to The Arizona Republic.
Not long after the email, Downs became ill with a 102-degree fever and high heart rate, Morse said. He was tested for COVID-19 on April 4. But before the test results came back, his condition went downhill. He died April 7. One day later, his test came back positive, she said.
Her cousin was a happy, kind soul, who will be missed by many, she said.
He would have turned 79 on Monday.
Have you heard reports of Arizona nursing homes or assisted-living facilities with cases of COVID-19? Contact reporter Anne Ryman with your tips at: anne.ryman@arizonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman.
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