KIRKLAND, Wash. — Loretta Rapp, 79, was easy to spot as she zipped through the Life Care Center nursing home in her electric wheelchair, dressed in one of her bright muumuus.
It had been hard for her to leave her apartment after she took a bad fall last year. But she was a no-nonsense woman who had raised three children, and she was trying to make the best of things. She went to physical therapy. She devoured detective novels. At the skilled-nursing facility tucked next to a row of Douglas firs in suburban Seattle, she was elected president of the residents’ council.
Life Care made an effort to keep things fun. There were shopping excursions to the Fred Meyer, lunch trips to Olive Garden, a recent afternoon with “cute and cuddly animals.” The Honky Tonk Sweethearts, a country group, came in for a show early in February. Rapp spent her days buzzing the hallways, visiting newcomers and cheering up bed-bound friends.
Then people started getting sick.
Not sick like what happens all the time in a nursing home, the bad flus and septic infections and old bones that will not heal. This was different. In the last few days of February, people’s temperatures started going off the charts. Some could not breathe. Then came word that the coronavirus, the one in China that was all over the news, was right there in Kirkland, population 89,000.
Two Life Care residents died Feb. 26, though it would be days before tests confirmed they had the coronavirus. And 911 records showed that more people were failing. A 60-year-old man was not responding to liter after liter of oxygen. One patient was fading in and out of consciousness. Another was turning blue.
The staff put the facility on lockdown. The halls emptied. Bedroom doors were closed.
In Room 32W, Rapp lay, straining to breathe as her fever spiked to 103 degrees.
At 1:52 p.m. Feb. 29, a nurse called 911 to report Rapp’s failing health. “She’s running a temp,” he told the dispatcher. “We think she, um — ”
He stopped himself.
“This is the place that has the coronavirus.”
Confusion and delays
As confirmed cases of COVID-19, the disease caused by the virus, now surge across the country and overturn every facet of normal life, the troubled nursing home in Kirkland looks like a frightening preview of what could lie ahead.
Since the first positive tests at Life Care came back Feb. 28, 129 people there — including 81 residents, about two-thirds of its population — have tested positive for the virus, and 35 people have died. Dozens of its workers have received coronavirus diagnoses, suggesting that the center’s frantic efforts to sanitize the building, quarantine residents and shield staff members with gowns and visors may have come too late.
“This caught them completely off guard,” Jim Whitney, the medical services administrator for the nearby Redmond Fire Department, said. “They just were not prepared for what was happening. None of us were.”
Accounts from emergency responders, public health officials and those who had loved ones at Life Care show a cascading crisis marked by confusion and delays. A federal strike team of doctors and nurses did not arrive until more than a week after the first coronavirus cases were reported. Several crucial days ticked by before the facility was able to get tests for all its residents, making it impossible to tell which patients were already infected.
As one-third of the center’s workers fell sick or stayed home to avoid infection, the remaining nurses and aides strained to keep up as they worked 18-hour shifts. Patients were left in their beds, some of them scared and lonely.
Some of the health care employees at Life Care also worked at other nursing homes in the Puget Sound region. The ones who had been exposed to the virus at Life Care, investigators for the federal Centers for Disease Control and Prevention found, took it with them to other facilities, opening new pathways of infection.
Tim Killian, a spokesman for Life Care, said that as the crisis unfolded, administrators and nurses were left largely on their own, with little help from the county, state, and federal governments to confront the worst public health crisis in a century.
“Who do you see in the parking lot helping?” he said last week. “Where’s everyone else? Why is it falling to this one nursing home to solve it for everybody? Why was the entirety of government unwilling to come in and help?”
Life Care is part of a Tennessee-based chain of 200 facilities across the country. The facility earned five stars out of five on its federal ratings for overall care last year, and families praised the workers and quality of care.
Many of the home’s roughly 120 residents were in their 80s or 90s, suffered from dementia and were there for good. Others were there for rehabilitation after a fall or surgery and hoped to be on their own again.
The 180 staff members included physicians, physical therapists, nurses and nursing assistants, many of them immigrants, who did the intimate work of bathing residents, getting them dressed and lifting them out of bed to use the bathroom.
From coughs to deaths
In early February, the staff began to get concerned about what appeared to be a rash of seasonal influenza. Nineteen long-term care centers had reported similar infections, King County health officials said.
Some families received phone calls that now look like flashing warning signs.
On Feb. 18, Cami Neidigh said, Life Care called about her 90-year-old mother, Geneva Wood, whom she described as an “independent and crotchety and strong” Texan who was recovering from a stroke. She had pneumonia, the facility said. The next day, another patient suffering from a respiratory ailment had been sent to a hospital — Life Care’s first evacuation.
On Feb. 20, 86-year-old Chuck Sedlacek, who was recovering from a fall that had broken his ankle, was moved into a shared room at Life Care with a man suffering from what had been diagnosed as pneumonia.
Wood and Sedlacek later tested positive for the coronavirus.
The Mardi Gras party went ahead Feb. 26 under purple and gold ribbons garlanding the entertainment room. Residents snacked on king cake and sausage and rice, clapping and singing to the tunes of a visiting “Gatsby Jazz” band.
“In hindsight, once we heard the news about what was there, we thought that maybe there shouldn’t have been a party,” said Patricia McCauley, 79, who had visited, with her husband, more than half a dozen times in the previous two weeks to see a friend who subsequently tested positive for the coronavirus and died.
Around that time, Lt. Dick Hughes of the Kirkland Fire Department began to notice a troubling pattern in the 911 calls from Life Care: patient after patient suddenly overwhelmed by fever and cough. The center had made seven 911 calls in January. From Feb. 1 through March 5, there were 33.
“We had one. Then we had another one, then we had another one,” Hughes said. Patients were falling ill and deteriorating with troubling speed. “The nurses kept saying, ‘They were not like this two hours ago.’”
Neither the paramedic crews nor the sick residents had been wearing masks or other protection. As they loaded up patient after patient, Hughes thought to himself: This is way too many.
The nursing home started to discourage visitors, but it did not forbid them, and family members said they did not think anything was seriously wrong.
“I didn’t see anything,” said Amy Jou, who visited Feb. 28 to do her 93-year-old mother’s laundry.
Neidigh came that same morning to bring her mother coffee and discuss plans for moving her back into her own apartment. She said the staff warned her about what it still thought was a respiratory outbreak and urged her to wear a mask. She slipped one on, but since several staff members were not wearing protection, she said, she figured there was little to worry about.
Killian, the spokesman, said that while some administrators or reception staff may not have been wearing protection at that point, the workers in contact with patients were all in masks. “Of course we were geared up,” he said. “Of course we were.”
The first coronavirus case would be confirmed later that night.
A scared, exhausted staff
Two days later, on March 1, the first death of a Life Care resident was announced. It was described in the terse language of a government news release as “a male in his 70s” with “underlying health conditions.” Nearly every day since has brought news of more.
As news crews swarmed outside, residents were tucked behind closed doors and signs warning about droplet precautions were taped onto the walls.
“The workers, you could see they were stressed and worried,” said Curtis Luterman, who managed to move his mother out of Life Care. “Worried about getting sick. Worried about if this place is going to close. Worried about the people they were taking care of.”
A staff member’s voice was shaky as she called 911 in early March to help a 63-year-old man who was struggling to breathe.
“Is the patient awake right now?” the dispatcher asked.
“He’s somewhat conscious. He’s turning blue. He’s having a hard time breathing.”
The dispatcher asked whether the man had traveled to Asia, Iran or Italy in the last 14 days. No, said the caller, but she pointed out that the nursing home had already had two coronavirus cases.
“OK, sure. So what we’re going to ask you to do is, we are going to ask you if it’s possible to wheel him outside and place a mask on him?” the dispatcher asked.
“Ooh. OK. I’ll try.”
A nursing assistant who worked at the facility until she asked for leave during the first week of March said the work grew harder as the staff dwindled.
The woman, who spoke on condition of anonymity because Life Care did not give her permission to describe what she experienced inside, said it was agony to see stricken residents fitted with face masks and wheeled out to meet arriving ambulances, one after another. When she came home at the end of each shift, her husband met her at the front door and tossed her uniform into a garbage bag to launder.
“It was scary,” she said. “I didn’t want to be contaminated.”
Relatives worried from afar
Time dragged on. People anxious to connect with parents they could no longer be in the same room with pulled up lawn chairs outside their bedroom windows. They shouted “I love you” into their cellphones as masked, gowned workers held a telephone up to their parents’ ears on the other side of the glass.
When Charlie Campbell came to the window to visit his 89-year-old father, Eugene, who has dementia and later tested positive for the virus, a staff member helped his father into a wheelchair and handed him his room phone.
“We talked about the food, my mom and when he might be able to go back to living with her,” Campbell said.
Some had to search for answers from a distance as their relatives deteriorated.
Carolyn Lockley’s 65-year-old sister, Renee Gibbs, seemed incoherent and could barely remember what she had eaten for lunch when Lockley called her from her home outside of Philadelphia on March 2.
Gibbs, a longtime Life Care resident who was paralyzed because of multiple sclerosis, had received a pneumonia diagnosis weeks earlier. As they talked that afternoon, Lockley could hear her sister’s roommate coughing in the background. Because there were not enough tests to go around, her sister still had not been tested for the coronavirus, but her sister feared she might have it. A nurse reported that her blood pressure was rising.
She promised to call with any updates but did not. When Lockley tried to get through to the center later, the phone rang and rang. She hung up and called 911.
“I want them to take her to a hospital,” she told the 911 dispatcher, her voice shaking. “When I talked to her earlier today she was incoherent.” Several people at the facility had already died, she told her.
“I understand that,” the dispatcher replied.
“I am getting scared,” Lockley said.
A team drove out from the Fire Department that evening, but the responders said Gibbs had told them she felt fine and did not want to go to a hospital.
Hours later, around 4 a.m., Gibbs developed a fever and was taken to the EvergreenHealth medical center, where she learned she had the coronavirus. She died five days later.
Goodbyes, and a warning
After her fall, Rapp, who had worked in the office of an elementary school, had struggled with moving into a nursing home. She was partial to the senior-living complex she had shared with her husband of more than 50 years before his death. But she had been doing better lately. Her room was decorated with family photos, and she made friends. When a new resident arrived, she would assure them with friendly bluntness: Don’t worry, they can’t kick you out.
Three times a day, she would show up at the bedside of Susan Hailey, 76, who had moved into Life Care for rehabilitation after a knee replacement but had shattered her ankle in a fall and could no longer get out of bed. Rapp would chat with Hailey’s daughters and then buzz away in her wheelchair.
“She loved to joke,” said Hailey, who tested positive for the virus and is still at Life Care. “If there were too many people in my room, she’d leave. She didn’t want to interrupt us.” Hailey would tell her, “Oh, Loretta, you’re not.”
On Feb. 29, Rapp was transported to an isolated intensive care room at the hospital. When she tested positive for the coronavirus, she ruefully called it the icing on the cake.
She was in such pain. On a conference call with her son and her doctor, days before she died March 8, Rapp decided that she only wanted comfort care from there till the end.
Her son, Ken Rapp, said he and his mother spoke for a while longer on that final call; they exchanged “I love yous,” and he told her that he wished the family could be there with her. Eventually, they had to say goodbye.
“It’s the weirdest thing,” he said, “sitting there on the phone, hitting that red button and knowing you’ll never talk to her again.”
But he said his mother made it clear they should not try to come: She wouldn’t wish this on anyone. “Don’t,” she told him.