PITTSFIELD — As coronavirus deaths and infections mount at the second-largest nursing center in the state, so do challenges for staff as they work under strict guidelines and amid segregation to avoid new cases.
With 600 COVID-19 tests performed at Hillcrest Commons Nursing and Rehabilitation Center every week, more COVID-positive residents and staff without symptoms are being identified earlier.
Staff are working heroically under complicated and difficult conditions, said Lisa Gaudet, director of marketing and development for Berkshire Healthcare Systems, which owns Hillcrest.
"They're tired and sad," she added, noting the death toll, which stands at 24 as of Monday. "It could be easy to feel alone in this battle."
Amid stepped-up efforts to control transmission of the coronavirus, some Hillcrest residents and their families have reported decisions by the facility that reflect apparent space and staffing limits, especially as employee infections continue to mount.
One resident told The Eagle that the effect of staffing shortages appears to have worsened since before the outbreak. The timing of their medication is more unpredictable than before, and their call button goes unanswered for longer periods than before, the resident said.
Another resident who was COVID-free but had antibodies to the virus was placed in a room with a resident who just had tested positive, for instance. The resident is staying there for a serious health issue, and this upset them for a number of days.
But, the facility says it is following state health guidelines. Those policies say that if a private room isn't available, an infected resident can room with someone who recovered from a COVID-19 infection within the previous six months.
Jill Landis, a registered nurse who is vice president of quality management at Berkshire Healthcare Systems, said she has confidence in this and other Massachusetts Department of Public Health guidance. Landis said the facility is being monitored closely by senior agency epidemiologists.
Hillcrest reported its first COVID-19 cases Nov. 18. Since then, escalating infections, and two dozen deaths linked to the virus, left it scrambling to manage its first outbreak since the pandemic began. That day, it barred visitors and froze admissions.
The DPH sent a rapid-response team to augment Hillcrest staff and to manage infection control. The agency’s epidemiologist meets nightly with local health and company officials.
As of Saturday, 124 residents and six staff were infected, according to the company's website. The facility has 265 beds, more than 200 employees and more than 200 residents.
As of Monday afternoon, no new cases were reported, and 28 employees have returned from quarantine.
"That's been the biggest thing, just trying to pull on all the resources we have to backfill staff," Gaudet said, adding that employees are tired and are working extra shifts. The outbreak is linked to the virus' spread in Pittsfield. There also are other risk factors.
Hillcrest has a one-star rating — or “much below average” — on quality measures from federal regulators on a basis that includes health inspections and staffing. In the past three years, the facility has been fined $42,500 for a slew of violations, according to the Centers for Medicare and Medicaid Services.
A facility's one-star federal rating puts it at higher risk of an outbreak, according to a Centers for Disease Control and Prevention study. But, so does community spread, and local health officials suspect a link between the Hillcrest outbreak and a spike in cases last month linked to several large gatherings in and around the city.
Gaudet said public health and medical experts working with the company are "as mystified as we are about why COVID-19 hits some buildings especially hard while barely touching other facilities. Is it the size of the population that inhabits that facility that drives the numbers?" The company also is seeing a smaller outbreak at another of its facilities.
One long-term care expert says large size is a known risk factor.
"There are more people coming and going," said Dr. Charlene Harrington, a registered nurse and professor emerita at the University of California-San Francisco.
Gaudet also said that in addition to "obvious" infection control, the company's "efforts often exceed the state's mandates and occur before we have been asked, or ordered." Hillcrest had frozen admissions before the state ordered it to do so Nov. 24, she said.
And Gaudet said that last week's state infection control survey appeared to go well, though the results are not yet in.
One Holyoke attorney who serves as a guardian for a number of residents at various nursing homes, including one living at Hillcrest who is infected with COVID-19, said she always has found that staff there are "very attentive" and "doing their best."
Julia Durchanek said she has seen what negligence looks like: one of her clients died in the Holyoke Soldiers' Home outbreak last spring that killed 76 and sparked a criminal probe.
Most nursing home staff across the state are overworked and underpaid, and now are risking their health, she added.
"Thank God these people are willing to go to work," she said.
Late meds, and doubling up
Yet, two residents — they asked that their names be withheld — say they suffered from the impact of the outbreak.
The family of the resident who was worried about being placed with an infected roommate said they had heard contradicting information about immunity after a COVID-19 infection. The resident had tested positive in the past, and also had tested positive for antibodies.
The policy demonstrates an optimism stemming from research that indicates antibodies might impart robust long-term protection, despite the risk of reinfection in some people.
That resident eventually was moved to a private room, and still is testing negative for the virus. But, they were frightened for several days after learning that their roommate tested positive.
Another resident who is bedridden said that, since the outbreak started, care is delayed.
"It's gotten worse," the resident said. "Since COVID, it's all gotten worse."
Gaudet said she is prohibited from speaking to specifics about any resident, and said the company wants to be helpful to residents and their families "at every turn."
Hillcrest is one of at least three long-term care facilities in the state with deadly COVID outbreaks since October. The DPH is tracking 132 new clusters of 1,027 cases that were identified at long-term care facilities across the state from Nov. 1 to Nov. 28.
The number of deaths at the facility now equals the toll at the company's Williamstown Commons Nursing and Rehabilitation Center last spring. The virus also claimed the lives of four residents at Fairview Commons Nursing and Rehabilitation Center, also in the spring.