116 3rd St SE
Cedar Rapids, Iowa 52401
CEDAR RAPIDS — Roberta Maas was thinking about her mother's funeral.
About two weeks ago, when her mom took a turn for the worse while fighting an infection of COVID-19, Maas gathered some documents on her mother's final wishes so she would have them at the ready, just in case.
'I really didn't think she was going to make it for several days,' Maas told The Gazette.
Unita Schliemann, an 85-year-old resident of Heritage Specialty Care in Cedar Rapids, tested positive April 5 for the novel coronavirus. By the end of that week, she had lost her appetite, couldn't concentrate and was so exhausted she couldn't get out of bed.
Schliemann was moved into the isolation ward and Maas visited her the only way she could — from outside a window, the closest she could get after the facility barred visitors for the foreseeable future.
When the visit was over, she 'walked away in tears.'
Other families, too, have endured similar experiences since Heritage Specialty Care, a 201-certified bed skilled nursing facility in southwest Cedar Rapids, became the site of the worst coronavirus outbreak at a long-term care facility in Iowa.
More than 100 of its residents and staff have tested positive for COVID-19 since March 24. Eighteen residents have died as a result of the virus as of Thursday, according to Linn County Public Health.
West Des Moines-based Care Initiatives owns Heritage Specialty Care, home to 86 residents as of Thursday.
According to state officials, Heritage is one of nine long-term care facilities in Iowa that have reported outbreaks of coronavirus among residents and staff, making up nearly half of all coronavirus-related deaths in the state and accounting for about 10 percent of all positive cases.
These facilities, which house the most medically frail individuals, are at high risk for spread of an infectious disease, said Heather Meador, Linn County Public Health clinical services branch supervisor.
'Unfortunately, a nursing home is almost like a breeding ground for something like this to happen because of the individuals that are there,' Meador said. 'This virus spreads very quickly, so unfortunately the virus had probably spread before we realized what was going on.'
In the weeks leading up to the first positive case, staff followed federal and state public health guidelines in preparation for exposure, Care Initiatives wrote in an emailed statement to The Gazette.
'Before and during this outbreak, we have continued to implement CDC and IDPH guidelines for patient care and infection control,' reads the statement, referring to the U.S. Centers for Disease Control and Prevention and the Iowa Department of Public Health.
Nonetheless, state inspection records show that Heritage Specialty Care, 200 Clive Drive SW, has had infection control issues in the past.
According to records from the Iowa Department of Inspections and Appeals, the facility has faced a number of infection control violations, some occurring as recently as this past year and others dating back more than a decade.
One report from April 2015 stated that Heritage workers 'failed to put on all required personal protective equipment and failed to employ infection control techniques in accordance with facility policy.'
Other inspection reports include instances of staff not sanitizing or adequately cleaning medical equipment after patients' use.
The most recent report, dated April 2019, recounts a state inspector's observations made on two occasions of tubing for residents' catheters dragging on the floor. In one instance, a resident's urinary bag 'dragged on the carpet floor, approximately 8 to 10 feet.'
Heritage Specialty Care has a 3-star health inspections rating, out of 5 possible, and has had seven total health citations, according to the federal Centers for Medicare and Medicaid Services. The average number of health citations in the state is six, according to centers.
State public health officials would not say whether guidance or special consideration was given for those facilities with poor infection control inspections in the past. When asked, a spokeswoman for the Iowa Department of Public Health said that 'we work closely with any facilities that are experiencing COVID-19 cases, and especially those with outbreaks' of three or more residents with confirmed cases).
'Our Heritage staff has been using best practices for infection control and PPE use, to keep our well residents well, and nursing our sick residents back to health,' according to a statement. 'We mourn those we've lost, and our heart breaks for the families.'
State officials have released the names of long-term care facilities once an outbreak is confirmed, but Iowa Long-Term Care Ombudsman Cynthia Pederson believes the public should be made aware of any cases in the facilities.
'In my interaction with other states, the issue of information sharing in a timely manner continues to be of concern,' Pederson wrote in an email to The Gazette.
'It would be beneficial if the names of nursing facilities and assisted living programs could be released, if they have had positive COVID-19 test results for staff or residents and tenants after the first positive test result is confirmed to IDPH,' she said. 'This would allow the Office of the State Long-Term Care Ombudsman to provide concentrated advocacy efforts to those residents and tenants early in the throes of the infection.'
Linn County Public Health conducts a daily survey of every long-term care facility in the county to assess the number of people experiencing illness. Once a facility reaches an outbreak level, Meador said, the agency calls officials there daily to discuss illness progression, offer guidance on best cleaning practices and ensure the staff have enough personal protective equipment.
'It's a lot of stress they're going through,' she said. 'They care very much for the residents they take care of, so we're there to help provide support for them and for the residents.'
But Meador noted that the facilities also were having staffing issues with so many out sick with COVID-19.
Care Initiatives officials say they 'believe our staffing levels have been sufficient throughout to meet resident needs,' while noting that about 20 staff members have been 'deemed recovered' after a self-quarantine period.
While many family members of residents praise Heritage Specialty Care for its efforts, some fear the staff is overwhelmed and unable to keep them informed on the conditions of their loved ones.
'I'm getting updates on (my mom's) condition because I call three times a day,' Maas said. 'The last time I called, I had to call four times. I'd let the phone ring until it quit and called back. On the fourth attempt, someone answered. If that's not understaffed, then I don't know what is.'
Tom Vondracek, of Cedar Rapids, told The Gazette someone at the facility phoned him on April 7 to give him an update on his 86-year-old mother, Barbara, assuming he knew she had acquired the virus.
But he had never been notified. Vondracek said she had tested positive the week before.
When news broke that Heritage workers had tested positive for COVID-19, Vondracek said he was told the facility would give family members updates only if their loved ones had tested positive. He said that never happened.
'That's the thing,' he said. 'They would call me once a week that she stubbed her toe, or that she needed her nails cut. Stuff like that. But then this happens, and they assume I already know. I am a pretty calm guy, but once I get loaded, I am not a happy guy.'
He said he and his family understand the difficulty of the situation for Heritage. He said facility employees phoned him just hours before news broke of two workers testing COVID-19 positive, telling him his mother had a fever of between 100 and 101 but that it had gone down.
He believes that was a sign she had acquired the virus.
Care Initiatives said it is policy to communicate with designated family members of a resident when the resident has had a change in his or her condition.
When asked about Vondracek's case, officials said 'we're not aware of any particular situation where a family member wasn't notified of a change of condition or of a positive test. If this did occur, it would have been unintentional and we would certainly want to apologize to that family.'
Nearly 30 residents at Heritage Specialty Care who have tested positive for the coronavirus have recovered — including Schliemann, who was moved from isolation back into her old room.
Maas, her daughter, believes that a regimen of Z-Pak and hydroxychloroquine, a drug used to treat malaria, made a difference.
'It's hard to tell, being on the outside, but it looks like they did good work,' Maas said.
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Jeff Johnson of The Gazette contributed to this report.