The Braddock Glen assisted-living community in Northern Virginia was losing workers — fast. So many, in fact, that a maintenance supervisor had to help lift the elderly residents out of their beds — something a trained personal care assistant usually does — and a nursing director added haircuts to her growing list of duties before those workers, too, quit.
The exodus began last year, just as the coronavirus crept into the affordable housing development owned by Fairfax County and managed by Sunrise Senior Living, one of the country’s largest elderly care providers.
Even though harried workers wiped down surfaces and isolated residents, the virus eventually infected 33 residents and staff members, leaving five dead.
Sunrise and county officials acknowledged that the pressures of the pandemic led to problems with staffing but said temporary employees were brought in and that the changes never affected the residents’ care.
Former employees and the residents’ families — who saw their bills for services go up by several hundred dollars a month last fall — say it did.
“Our medical technicians were in tears,” said the former nursing director, who spoke on the condition of anonymity out of worry that she would be unable to find work elsewhere in the industry. “Every morning, they’d see me and say: ‘What are we going to do?’ Because of covid, our needs were higher. The residents’ needs were higher. But we didn’t have the care managers to take care of their needs.”
Advocates for the elderly say the problems are part of a pandemic-fueled labor shortage affecting the country’s long-term care industry that, in Virginia, has unfolded against the backdrop of the state’s historically weak system of oversight.
“These problems have been decades in the making,” said Natalie Snider, associate director of advocacy and outreach for AARP in Virginia.
“We need standards of care,” Snider said. “We need better wages for long-term care workers. It’s a whole slate of issues that need to be resolved.”
'Desperately seeking help'
Braddock Glen is among nine affordable housing developments for seniors owned by Fairfax County. The homes — 60 studio apartments and one-bedroom suites — are meant for people older than 62 who require limited nursing services and have low-to-moderate incomes. Rents start at about $3,000 per month, which includes some minimal forms of care and meals.
Families of some residents said the quality of care there had been great — until the pandemic took hold. Then, they complained of a lack of care for their relatives, and a drop-off in communication as the facility shut down to visitors and their monthly costs went up.
Elena Schlossberg said Braddock Glen staff neglected her mother’s personal grooming to the point that her overgrown toenails — part of basic care the staff normally provided — left her with bruised feet.
Diane Haines said her father, who had dementia, lost 30 pounds after being diagnosed with covid-19 — weight loss she says Braddock Glen staff never informed her about during the six weeks she was unable to visit him.
“I could not believe my eyes,” said Haines about the first time she saw her father in early December, when the staff informed her he couldn’t move and she arranged to transport him to Inova Fairfax Hospital. He died inside a Falls Church nursing home on Dec. 13, weighing 106 pounds.
Sunrise, which began operating Braddock Glen in 2006, would not comment on specific allegations made by the residents’ families and ex-employees. But the organization said it followed all state regulations.
In a statement, the McLean-based company said “the unrelenting nature of the pandemic” has taken a toll inside several of its 325 facilities in the United States, Canada and the United Kingdom.
When full-time employees became sick or quit, Sunrise hired temporary workers and enlisted its regional supervisors to pitch in, the organization said.
“Together with Fairfax County, we worked to adapt our operations to reflect the ever-changing circumstances of the evolving pandemic,” Sunrise said in a statement. But several of those new workers also quit, former employees said.
Sunrise also said it abided by a county requirement to provide a 30-day notice before making any changes in treatment that would affect one’s monthly bill.
County officials said they were first made aware of the string of departures in mid-November.
By Jan. 4, there were seven vacant jobs, including the nursing director, two care managers and a medication manager, an email exchange between Sunrise and a Fairfax County housing director shows.
The facility’s executive director, Carmen Louise, had also recently resigned and two more employees — a dining service coordinator and a business office manager — quit in February.
In an interview, Louise said the facility had been running smoothly until the pandemic took hold.
But the physical distancing requirements — where meals were served inside residents’ homes instead of in a communal dining room — and the extra cleaning that was required became too much to handle.
“Most of us worked six days a week for a couple of months,” said Louise, adding that she left her job after seven years to deal with family issues.
Soon, workers took on tasks that weren’t part of their jobs.
Kathleen Klingenberg, a former part-time concierge, said she became the facility’s unofficial TV repairwoman. The ex-maintenance supervisor, who spoke on the condition of anonymity because he was worried about being unable to find another job in the industry, said he also began repairing broken wheelchairs — a job that requires a certified technician familiar with safety protocols.
After fixing the brake on one chair, “the bolt got loose again and the resident couldn’t brake,” the maintenance worker said. “And they blamed me for that.”
The former nursing director said she repeatedly urged her bosses to hire more full-time employees.
“I was desperately seeking help,” she said.
Meanwhile, the facility was losing revenue, due in part to a string of new vacancies, records show.
By the end of 2020, revenue from resident fees were $210,000 under budget, according to a December financial statement emailed to the county.
“Covid-19 continues to impact all revenue sources,” the statement read. “Team continues to utilize all avenues possible under company guidelines, to maximize revenue on a daily basis.”
A push for oversight
Such problems have grown more common inside long-term communities across the country, industry groups say.
It was already hard to retain low-paid caretakers whose jobs often entail intimate contact with residents. The outbreaks raging through many facilities made that challenge harder, industry leaders say.
The strain has been particularly acute inside the nation’s nearly 40,000 assisted-living communities, which have received less federal stimulus aid than nursing homes that house elderly residents with more serious medical needs.
So far, assisted-living communities have been allocated $3 billion in Cares Act funding while nursing homes have received $13 billion, industry groups say.
The recently approved $1.9 trillion federal stimulus package largely excludes long-term care facilities, those groups say.
Argentum, an assisted-living umbrella group, said more than half of its 20,000 members recently reported that they may be forced to shut down in the coming year.
“If communities close, seniors will lose their homes, caregivers will lose jobs, and the financial burden on Medicaid will rise steeply,” James Balda, the group’s president, said in a statement.
Virginia officials have worked to support the long-term care industry, whose frail and elderly population has accounted for 40 percent of the state’s more than 10,000 covid-19 deaths.
In October, Gov. Ralph Northam (D) signed a law that shields assisted-living communities, hospices and other long-term care providers from being sued for a lack of care connected to the strains of the pandemic — a protection already given to hospitals and nursing homes under a state code that acknowledges the extreme circumstances introduced by public health emergencies and other disasters.
Tied to a state of emergency declaration the governor issued last April, the protections — which exclude cases of gross negligence or willful misconduct — would end when the state declares the pandemic is over.
Advocates for the elderly said the measure weakens accountability in the industry during a time when the additional strain on staffing and resources requires more vigilance.
“The last thing we should be doing is removing culpability,” said Del. Dawn M. Adams (D-Richmond), a nurse practitioner who has worked in long-term care and was among 13 House members who voted against the law.
Some state lawmakers have tried to tighten oversight — part of a national industry restructuring effort that would set higher operating standards, create initiatives to boost staffing and hold poorly performing facilities more accountable.
Democrats and Republicans are seeking more state funding for the industry and to set minimum staffing requirements in Virginia, which is among just 13 states without such standards.
So far, the effort has been uphill.
Last month, bills that would set minimum caretaker-to-patient ratios — initially inside nursing homes — were tabled in House and Senate committees without a vote.
Sen. Jen A. Kiggans (R-Virginia Beach), who sponsored one of those bills, said industry lobbyists opposed the requirements, calling them too expensive to implement.
Kiggans, a geriatric care nurse practitioner, said she has heard “horror stories” from overwhelmed caretakers with impossibly large patient loads during the pandemic.
“What are you going to do, change someone who needs new bedding or new clothing when you have 40 more patients to see?” she said. “Nurses, too, need to go home at some point.”
Back to stability
The Virginia Department of Social Services, which regulates assisted-living communities, said it has emphasized the need to maintain basic services during the pandemic.
Assisted-living facilities must generally maintain staff “with adequate knowledge, skills, and abilities to serve the resident population,” including “daily direct care needs and any identified special needs of residents,” a department representative said in a statement.
But amid concerns over the virus, confirming that a facility is following the rules can be tricky.
Last month, a state inspector reported that no violations were found at the Braddock Glen site. But the investigation was conducted remotely with no in-person visits or interviews, as per state guidelines for most cases during the pandemic.
In an email sent to Schlossberg a week later, the inspector shared her frustration with that policy.
“I hate she had to go through the ordeal she went through,” the inspector wrote on Feb. 25, referring to Schlossberg’s mother. “I also regret that my ability to investigate is currently limited to off-site only.”
The inspector referred questions about the investigation to the agency’s press office.
Fairfax County officials say they have been working to help Sunrise bring Braddock Glen back into stability.
A replacement for Louise was hired in January and some of the other vacant senior positions have been filled, officials said.
As of mid-January, there were no longer any coronavirus infections detected at the property, Sunrise officials told residents’ families in a letter. Vaccinations have also been administered on the property, with the final round on March 12.
County Supervisor James Walkinshaw (D-Braddock), whose district includes Braddock Glen, said he has pushed for Sunrise to communicate more effectively with the residents’ families.
“As cruel as covid-19 has been to all of us, it’s been cruelest and hardest on our residents and staff of long-term care facilities like Braddock Glen,” he said.
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