Family questions Lima nursing home care

Jan. 16—LIMA — Glenna Casto arrived at the hospital one day in December with a fever, during what was supposed to be a routine appointment. But when she was transferred to the emergency department, nurses discovered extensive pressure wounds along Casto's legs, buttocks and heels, wounds which her daughters fear may be a sign of neglect by the nursing home where their mother had been living for two years.

Casto, 71, was malnourished; her heels covered in blotches of red and purple blood-filled blisters; the backs of her legs discolored by sores, one of which had grown so long and so deep that it now appeared almost black.

On her buttocks, what Casto's daughter said started as a small wound that developed weeks earlier was now a gaping black and purple wound.

Andie Fallon and Angel Hopkins were distraught when they saw photos of their mother's wounds.

"We were lucky by the grace of God — and I can honestly say by the grace of God — to be able to find this out," Fallon said. "Because if the nurse that was getting ready to start her paracentesis didn't send her down to the ER, we would have never known."

Casto is one of the millions of nursing home residents whose access to loved ones was disrupted by the coronavirus pandemic, as long-term care facilities sought to balance the emotional wellbeing of their residents against the possibility that visitors could unintentionally bring the virus into their facilities.

Nearly 5,000 long-term care residents in Ohio have since died due to complications from COVID-19, accounting for roughly half of all COVID-19 deaths the state has recorded.

But family members and elder advocates have raised concerns that inconsistent access to long-term care residents exposes those residents to other risks like depression, loneliness and neglect.

'Did anyone check on her?'

Casto started dialysis in the fall, requiring her to leave her home at Springview Manor twice each week.

That meant she was now in the "Yellow Zone" to avoid potentially exposing other residents to COVID-19, Fallon said. Casto tested positive for the disease herself too, Fallon said, but was asymptomatic.

At least 102 Springview residents and staff have been infected with COVID-19 since last March, according to Springview's parent company, Trilogy Health Services. Twenty-one of those residents and staff have died.

Fallon and Hopkins were surprised about the progression of their mother's wounds when she was admitted to Mercy Health-St. Rita's Medical Center that December day. She tested positive for sepsis, a life-threatening condition typically caused by bacterial infections.

The last Fallon knew, a wound that developed on Casto's buttocks in late October had been healing since she was discharged from the intensive care unit that month. But the photos told Fallon a different story.

Older adults are at higher risk for developing sepsis, as are people with weakened immune systems or chronic medical conditions, including diabetes and kidney disease — all of which made Casto, whose complex medical history of stroke, congestive heart failure, Type 2 diabetes and kidney and liver failure, more vulnerable to developing an infection that led to sepsis.

While diabetic and dialysis patients are more susceptible to developing foot ulcers and slow-healing wounds, Fallon and Hopkins say an infection specialist who treated Casto told them the progression of their mother's wounds suggests they could have been prevented.

"It just makes me wonder: Did anyone even go in her room during that time to check on her? To clean her?" Fallon asked. "And not only that — it makes me wonder how many other patients in there are going through the same thing that we're going through."

While Trilogy did not respond directly to questions about Casto's wounds, the company said it is continuing to monitor the COVID-19 situation in its campuses and the surrounding communities "with the goal of protecting our country's most vulnerable population."

Residents' representatives receive daily text messages and emails with updated COVID-19 statistics, while employees are equipped with personal protective equipment and Trilogy campuses are subject to frequent infection control surveys by Trilogy employees and state surveyors, the statement said.

Infection control policies were updated to meet federal, state and local coronavirus guidelines, while Trilogy teams started using hospital-grade disinfectants like 40-A that were "tested and proven by the EPA to kill COVID-19" when used correctly.

Visitors, employees and vendors are all screened for COVID-19 before entering Trilogy facilities. The company also adopted a policy to separate residents and staff into zones to mitigate the spread of coronavirus in its facilities. A resident in the Red Zone, for example, is "observed at all times," the statement said.

More recently, Trilogy increased the frequency with which it tested residents and staff for COVID-19, and Trilogy campuses have started their vaccination effort with Walgreens.

"We understand how important it is for our residents to be able to visit with their loved ones, so we have developed policies and procedures to host indoor and outdoor family visits as state and local guidance permits," Trilogy said in its statement. "If at any point visits to our campuses must be suspended per this guidance, we also have technology in place that allows our residents and their loved ones to connect virtually."

Casto's sepsis was caught early enough that doctors could purge it from her body, Fallon said, but she and Hopkins refused to let their mother return to Springview once she was ready to leave the hospital.

Casto was transferred to another Trilogy-owned nursing home instead, where Hopkins said her mother's physical therapy has resumed and new treatments like an air-pressure bed that rotates Casto's body were implemented. She and Fallon are cautiously optimistic about the changes, but worry other nursing home residents may be in similar situations.

"These people can't defend themselves," Fallon said. "They don't deserve to die that way. They don't deserve to be treated that way."

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