When Annie Kynard-Hackworth came to say her final goodbyes to her husband Herman Hackworth on April 21, she had no idea he was suffering from COVID-19.
She knew his nursing facility, Bill Nichols State Veterans Home, had cases. A detachment from the Alabama National Guard had finished cleaning just days earlier. The guardsmen left behind gloves, masks and face shields, which she donned after her temperature was checked.
Then Kynard-Hackworth took the elevator up to the top floor, where her husband lived in a locked unit for dementia patients. She thought those doors had kept the virus out. But when she stepped into the hall, Kynard-Hackworth met a chorus of gasping and coughing.
“Everyone was struggling to breathe on that side of the hall,” she said. “Men were coughing everywhere. Even his roommate was struggling for air.”
‘Ticking time bomb’
At least 90 residents of Bill Nichols State Veterans Home in Alexander City have tested positive for COVID-19, and 22 have died, according to Bob Horton, spokesman for the Alabama Department of Veterans Affairs. Almost 40 employees also caught the virus, which has been particularly deadly for residents of nursing homes.
The virus first appeared in late March. Weeks earlier, doctors were already watching a hot spot develop in the ICU just down the highway in Opelika, a cluster that ignited across Chambers and Lee counties in early March and was only now seeming to reach Alexander City in Tallapoosa County.
A staff member reported to work with an elevated temperature and mild symptoms of the virus. Administrators at the home had already started screening all employees and visitors, so the worker was turned away and referred for testing. It came back positive on March 30.
Staff started taking residents’ temperatures twice a day and checking for coughs and shortness of breath. On April 3, they began testing those who had symptoms. The first positive hit came back April 8.
Once coronavirus gets a foothold inside nursing homes, it can spread with devastating speed. Kent Davis, commissioner of the Alabama Department of Veterans Affairs, knew the residents were particularly susceptible.
“The residents are mostly elderly and all of them have major health issues,” Davis said.
As more of them became sick, Davis said he realized he had a crisis on his hands. Davis said he wanted to test all the residents. But the state lab would only test those with symptoms such as fever and dry cough, leaving potentially infected but asymptomatic carriers mixed into the general population.
Cases began piling up. Finally, on April 17, Davis appealed directly to State Health Officer Dr. Scott Harris. “I had a long teleconference with him,” Davis said. “I said there’s got to be an exception for this. This is a ticking time bomb.”
Davis said testing is still a problem. Some states have made nursing homes a higher priority for COVID-19 tests, but not Alabama.
“If there is one thing that has been a little exasperating, it’s been the testing,” Davis said. “Because in Alabama, nursing home residents are still considered priority 2. The protocol has been that you can’t test someone until they are symptomatic and you have screened them for other illnesses. Flu and cold, something like that.”
Veterans homes under scrutiny
Bill Nichols isn’t the only home hit hard by COVID-19. More than 70 deaths have been linked to an outbreak in a New Jersey state veterans home. Officials are investigating the Holyoke Soldiers’ Home in Massachusetts, where at least 71 residents have died. Last week, a group of U.S. senators called for an investigation into the oversight of state veterans homes.
Alabama has four state veterans homes owned by the state and operated by a contractor, HMR Alabama. The contractor provides all the staff for the homes, including doctors, nurses therapists, custodians and foodservice. They received $52 million last year from the state for their services.
Heyward Hilliard, vice president of HMR Veterans Services, said the South Carolina-based company has been running Alabama’s homes since 2004. Bill Nichols has been hit harder by the virus than any other facility they operate.
It’s also become one the deadliest spots in Alabama, as Tallapoosa County with just over 40,000 people now has 42 deaths. Within Alabama, only the two largest urban counties, Mobile and Jefferson, have recorded more COVID-19 deaths. In Tallapoosa County, more than half of those deaths have been inside Bill Nichols.
As more residents and staff became sick, leaders at the home tapped resources from the Veteran’s Affairs hospital in Birmingham and the National Guard. On April 18th, staff members tested every resident at the facility and a unit from the Alabama National Guard cleaned and sanitized the home, installing temporary hand washing stations and restocking hand sanitizer and protective gear.
“As this thing took hold and took hold fast, a bunch of people stepped up quickly,” Hilliard said.
Davis requested investigations by the U.S. Department of Veterans Affairs and Alabama Department of Public Health. State investigators did not find any issues that warranted immediate correction.
A team of seven investigators from the VA urged employees to focus on frequent, consistent hand washing and proper use of protective equipment.
“The availability and general use of PPE in the facility is to be commended,” the federal report said. “However, the specifics and education surrounding appropriate use appeared lacking. At this time, all residents should be considered as potentially having COVID-19 and appropriate PPE should be worn as recommended by the CDC and CMS.”
Investigators also found that staff struggled to group all infected patients in one place at the beginning of the outbreak.
“It is the team’s understanding that this was difficult initially given the high occupancy rate, but vigilant cohorting of patients is necessary and should be done consistently,” according to the report.
Alabama Rep. Ed Oliver, R-Alexander City, is not satisfied with the VA and ADPH reports. He is calling for an investigation to determine whether the contractor or state could have done more to prevent the spread of coronavirus at Bill Nichols.
“I am interested in finding out why we lost so many of our veterans to this illness,” Oliver said. “I want a full-blown investigation from top to bottom so we don’t repeat it.”
A life cut short
Kynard-Hackworth and her husband had moved to Alabama in 1994, after he transferred to Tuscaloosa from a General Motors plant in Detroit. Hackworth retired in 1999 but never stopped working. He and his wife had a house in Shelby County near Birmingham with a large front lawn that sloped gently.
“He was a hard worker,” Kynard-Hackworth said. “When he retired, he worked in the yard.”
But a few years later, Kynard-Hackworth began noticing lapses. Her husband would forget his tools in the yard or leave a ladder propped against the side of the house. His forgetfulness got worse, and in 2012, he received a diagnosis of Lewy Body Dementia, a progressive disease that slowly steals a person’s memory, stability and health. The average patient dies about eight years after diagnosis.
She first heard about Bill Nichols at a support group for caregivers.
State veterans homes offer a low-cost option for families of former service members. Her husband had served in the Army on active duty from 1966 to 1969, then spent three more years in the reserves.
Kynard-Hackworth retired from her job as a registered nurse in 2014 to take care of her husband. She knew caregiving would become overwhelming, and that her husband would eventually need round-the-clock nursing care. When that time came, she put in applications at all four of Alabama’s veterans homes.
“I thought they could take care of him better than me,” Kynard-Hackworth said. “I think I was wrong.”
In 2019, a bed opened up at Bill Nichols State Veterans Home in Alexander City. The facility in the quaint lakeside town had a beautiful courtyard, big windows and a special secure ward for dementia patients like Hackworth.
“It’s a beautiful place,” Kynard-Hackworth said.
Epicenter of an epidemic
Priya Chidambaram, a policy analyst with the Henry J. Kaiser Family Foundation, has been studying the characteristics of nursing homes hit hard by coronavirus, trying to determine why some facilities suffer devastating outbreaks and others remain relatively untouched.
“Long-term care facilities really seem to be the epicenter of this epidemic,” Chidambaram said. “They represent a lot of the cases and a huge proportion of the deaths.”
Nursing homes were vulnerable to outbreaks before COVID-19 arrived in the United States. Many residents of nursing homes have preexisting respiratory conditions. Many are frail and older, and facilities often struggle with staffing and infection control. Research by Chidambaram showed that nursing homes hit hard by coronavirus had lower-than-average ratings by federal regulators.
In Alabama, almost half of nursing homes had deficiencies related to infection control, according to Chidambaram’s research. In 2017, state inspectors cited Bill Nichols for lapses in infection control. In 2019, another inspection report again cited the facility for failing to ensure nursing assistants washed their hands properly.
Alabama does not report the number of coronavirus cases in each long-term care facility. That can make it difficult to determine what some homes are doing right to keep outbreaks in check, Chidambaram said.
“It’s going to be difficult to identify any risk factors if they won’t say which facilities are most heavily affected,” Chidambaram said.
An invisible enemy
Hackworth moved into Bill Nichols in September 2019. Although Lewy Body Dementia had weakened his mind, his body remained strong.
That changed after he moved into the home, Kynard-Hackworth said. His health care team increased his medication, and he seemed heavily sedated. In January, he contracted pneumonia, Kynard-Hackworth said.
He had recovered from that health scare when coronavirus hit. Staff informed family members about the first cases and their efforts to screen and test residents, Kynard-Hackworth said.
Still, she had no idea cases had been found on the dementia ward, she said.
“I think they did what they thought was best, but I think they should have told me that someone tested positive on that floor and given me the option of taking him home,” Kynard-Hackworth said.
In early April, a nurse called about her husband. He had a fever. Looking back, she believes it might have been a sign of coronavirus.
A couple weeks later, she received more dire news. Her husband’s oxygen saturation had dipped, and he was at the hospital. He returned to the nursing home, but again took a turn for the worse. A nurse on the afternoon shift told her to come down and say her goodbyes.
On the last visit, she realized how serious the situation had become. She and her children spent an hour with Hackworth, while fearing they too might contract the virus. Kynard-Hackworth went back home.
“I didn’t sleep,” she said. “I just kept waiting for them to call me and tell me he had passed.”
That call came the next morning. Kynard-Hackworth also learned that her husband had tested positive for COVID-19. She believes the virus caused his death.
“We just wasn’t ready. Wasn’t anybody ready,” Kynard-Hackworth said. “I’ve seen it up close and it’s not pretty.”
Herman Hackworth would have turned 75 this year. Even after his death, Kynard-Hackwirth finds herself constantly reminded of his presence.
“Now that it’s spring, I feel his presence here,” she said. “The wind blowing and the roses blooming. Everything around here is Herman. The paint on the walls and the plants in the garden. He’s still here with me.”
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