‘ALL IT TAKES IS JUST ONE’: How a nursing home that was a COVID-19 hot spot battled back

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Greenfield Healthcare Center's Eileen Robinson takes the temperature of a visitor. The facility moved its last patient out of its COVID-19 ward on June 25 and has been allowing visitors since July 8. (Tom Russo | Daily Reporter)

GREENFIELD — Gary Janes remembers having dinner with his father at Greenfield Healthcare Center earlier this year, before COVID-19 came crashing into their lives.

As they ate, a news story played referencing the first cases of the disease in the U.S. — mostly near the country’s coasts and far away from the nursing home in Indiana where they enjoyed each other’s company.

“I just remember saying to myself, ‘Boy, I’m sure glad we live in the Midwest and not having to deal with that,'” Janes said. “Then, a week or two later, we’d be dealing with it and how it affected my life, and not being able to see my dad; it just tore me up. When you’re used to seeing him and you can’t see him, you can’t do nothing, it’s just unreal.”

It was one of the last times he’d ever get to be in the same room with his father, Harold Janes, who later tested positive for COVID-19 and died on May 19 at age 84.

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Harold Janes was one of about 20 people staying at Greenfield Healthcare Center to die from COVID-19 since the pandemic began in March, making up more than half of Hancock County’s fatalities from the disease. Almost 80 people staying at the facility and 15 employees have tested positive for the virus, which spreads through respiratory droplets and can give symptoms like a cough and fever.

Greenfield Healthcare Center moved its last patient out of its separated COVID-19 section on June 25, and has been allowing visitors since July 8. Getting to that point has been arduous, as staff and residents can attest to.

The Hancock County Health Department reported Wednesday, July 15, that Greenfield Healthcare Center residents account for 21 COVID-19 deaths and 76 cases. Overall, 36 people in Hancock County have died of complications from the disease.

Andrew Clark, executive director of Greenfield Healthcare Center, disputes figures at his facility and reported Thursday, July 16, that the facility has had 19 deaths, 77 cases and 58 recoveries. He also said 15 employees have tested positive for COVID-19; all have recovered; and most worked taking care of COVID-19 patients.

Three other of the eight long-term care facilities in Hancock County have reported COVID-19 cases and deaths among residents since the pandemic began. According to the latest data from the county health department, Traditions at Brookside in McCordsville had five cases that all resulted in deaths; Woodland Terrace of New Palestine had two cases, one of which resulted in a death; and Springhurst Health Campus in Greenfield has recorded two cases.

Golden LivingCenter-Brandywine in Greenfield; CrownPointe of Greenfield; Sugar Creek Nursing and Rehabilitation in western Hancock County; and Pleasant View Lodge in McCordsville haven’t recorded any COVID-19 cases or deaths.

With 163 beds, Greenfield Healthcare Center is the largest skilled-nursing facility in Hancock County, Clark said, adding its census before the pandemic was around 140.

The facility restricted visitation shortly after Indiana’s first known COVID-19 case was confirmed on March 6 at Community Hospital North in Indianapolis. Greenfield Healthcare Center staff started wearing masks, Clark said. Communal dining and activities ceased. Residents and staff started getting their temperatures taken and were screened for symptoms every day.

Even after taking all those measures, the virus made it inside.

“Unfortunately it got in the door, and that’s half the battle,” said Craig Felty, vice president, chief nursing officer and chief operating officer of Hancock Regional Hospital, which has assisted Greenfield Healthcare Center throughout the pandemic.

Exactly how it got in, Clark doesn’t think they’ll ever know.

“We did all those things early on, and we felt like we were getting through it pretty good, especially being in Hancock County, with the numbers being as low as what they were, but all it takes is just one person,” he said.

The facility confirmed its first case on April 18, Clark said, about a month after Hancock County reported its first positive test and about a week before Greenfield Healthcare Center’s first COVID-19 death.

When that first case was confirmed, another resident on the same hallway started having COVID-19 symptoms and was administered a test, which came back positive, Clark said. Both residents were moved into a separate section of the facility. The rest of the residents on the same hallway where the two COVID-19 patients formerly stayed were tested and those with positive results were also moved to a separate section of the facility.

There were a lot of room moves as the virus spread among the residents, Clark said. The sections were set up like a traffic light. The red unit was for residents who had COVID-19. Yellow was for those more at risk, like patients who had to be transported offsite for dialysis treatments. In green, residents and patients were known not to have COVID-19 and were not considered at much risk.

Along with the hospital, Clark said Greenfield Healthcare Center has also been assisted by the county health department throughout the pandemic.

Two halls ultimately designated for the facility’s red unit were cordoned off with plastic sheets with zippers down the middle, Clark said. Residents who tested positive for COVID-19 had to remain in the red unit for at least 14 days or until their symptoms went away, per guidelines from the Centers for Disease Control and Prevention.

Clark and Felty said rooms were never equipped with negative airflow pressure capabilities, as was claimed by a spokesman for the Ohio-based CommuniCare Family of Companies, of which Greenfield Healthcare Center is a part.

Testing continued, Clark said. The facility launched its first round of testing all residents in mid- to late April, he estimated. Some residents have been tested four to five times. Some have been tested again after testing positive, but none were positive a second time, he said.

Many who tested positive never had any symptoms, Clark said, even throughout the 14-day separation period.

“It’s just a weird virus; it truly is,” Clark said.

He said the most common symptom seen in the facility among COVID-19 patients, besides a fever, has been loss of appetite.

Clark said at first glance, it’s easy to assume COVID-19 has had a devastating effect on the facility. But he’s not sure it’s as bad as the data suggests. Some of the residents who died with COVID-19 were in hospice care, he said. He also said the facility saw about the same number of deaths from April through June for the past three years.

“That’s just the type of industry that we’re in,” Clark said. “We’re always seeing people who unfortunately have underlying conditions or they’re on hospice when they come to us.”

Nursing home residents are vulnerable to COVID-19 due to their age, often having underlying health issues and living in close proximity to others.

“It’s a perfect storm,” Felty said. “Once you get it in there, it just flies like wildfire.”

As of Thursday, there were 302 long-term care facilities in Indiana with at least one COVID-19 case and 183 with at least one death, according to the Indiana State Department of Health. There were 5,695 total novel coronavirus cases in long-term care facilities and 1,245 deaths, almost half of the state’s total COVID-19 fatalities.

The front lines

Clark praised his staff’s work throughout the pandemic.

“We had people step up like you couldn’t believe,” he said.

Jennifer White, nursing supervisor at Greenfield Healthcare Center, said she hasn’t found the pandemic to be intimidating in the sense of the work it has required, but perhaps slightly due to how little is known about the disease.

“I think that it was difficult, but when you face something like that… you have to take it head on and deal with your emotions later,” she said.

The fear that stems from the lack of knowledge about the virus and keeping up with ever-changing guidelines has also posed challenges, she continued.

“And trying to decide with the physician if this recommendation’s appropriate for this patient, if not and why, and being able to look at that as a whole for every single patient and be able to effectively communicate it and monitor it,” White said, addressing how complicated the care became.

White said the impact that fear has had on Greenfield Healthcare Center residents motivates her and her colleagues to comfort them.

“Even if that meant staying 30 minutes past your shift or whatever, sitting with them, explaining to them, reassuring them, FaceTiming with their families, giving that whole sense of comfort,” she said. “Because at the end of the day, that’s why we’re there, and if they don’t feel their best or they have a lot of worry and they’re scared, we don’t want to leave them like that. You might not be able to take all of that away, but you can at least let them know, ‘I’m here.'”

Stacey Jaynes, director of nursing at Greenfield Healthcare Center, stayed at a friend’s home in Greenwood for two to three weeks in an effort to prevent those she lives with from getting COVID-19, should she get it. After returning home, she got it anyway, despite using personal protective equipment and following protocols. Her 18-year-old daughter, 22-year-old son and his girlfriend later tested positive as well and have since recovered.

Jaynes came down with COVID-19 in May. At first, she thought it was a cold or sinus issues, she said. She had been working a lot of night shifts, something her body wasn’t used to.

She said she had a little bit of a cough, but never a fever. She was tested at the triage clinic Hancock Regional Hospital set up in Brandywine Plaza. The test came back positive, requiring her to stay home for two weeks.

White also was worried about contracting the virus. She sent her 10-year-old daughter and 7-year-old son a two-hour drive away to stay with her father for almost a month. She kept in touch with them over the phone, which included making sure they were keeping up with their e-learning.

White and Jaynes said the source of their resolve is that nursing is a calling for them.

“I became a nurse to help people,” White said. “That was something from a very young age that I knew I wanted to do. And this was a huge need. It’s a pandemic. So for me it wasn’t an option. This is what needs to be done.”

Jaynes said their colleagues are the same way, like the admissions coordinator who obtained her certified nursing assistant license to help out, and the social worker who used to be a CNA who took on those duties as well.

“There wasn’t one person that didn’t pitch in and help,” Jaynes said.

Losing a father

Harold Janes is one of 25 Hancock County residents age 80 or older to die from COVID-19. Seven of the county’s victims were in their 70s, three were in their 60s and one was in their 50s.

Gary Janes used to pick up his father at Greenfield Healthcare Center to take him out to eat on Friday nights. He remembers arriving one Friday in March to learn visitors were no longer allowed inside the building. From that point on, he was only able to communicate with his dad via phone and through his room’s window.

“He was a hard worker, he was a farmer, just a wonderful father,” Gary Janes said. “He provided for all of his kids.”

Harold Janes was also a Marine Corps veteran and worked at Eli Lilly and Co.

Gary Janes couldn’t recall exactly when his father was first tested for COVID-19, but said it was when everyone at the facility was tested, and that his first result came back negative.

About a week or two later, he noticed his dad’s health seemed to be slipping. Eventually, Harold Janes was tested again, and it came back positive.

His son wasn’t surprised.

“He just wasn’t quite right,” he said, adding when he spoke to his father on the phone, it seemed like he wasn’t registering much of what was being said.

Harold Janes was moved to the facility’s red unit.

“Everything was somewhat OK that first week or so, but he didn’t have much of an appetite,” Gary Janes said.

Not long before his father died, Gary Janes stopped by to deliver a bottle of Gatorade and a hamburger before heading over to his window. A nurse gave Harold Janes the burger and drink. He downed the Gatorade but took only a few bites of the hamburger. He had a cough and had been vomiting a little too, Gary Janes recalled.

He remembered the nurse telling him his dad wasn’t having a very good day.

The nurse asked Harold Janes if there was anything he wanted to say to his son. He whispered in her ear, and the nurse relayed the message to Gary: His father loved him.

The son told his father he loved him, too. He told his dad to hang in there and that he’d see him the next day.

When Gary Janes returned, he talked to his father through the window for what would be the last time.

“He knew I was there, but he couldn’t open his eyes; he was trying to open them up,” he said.

Harold Janes died that evening.

Gary Janes said he can’t help but wonder if Greenfield Healthcare Center could have done more for his father, like transporting him to a hospital as his health worsened.

“I would have thought that they’d have tried to move him, tried to get him out of there,” he said. “…I can’t imagine they didn’t try to do a better job of trying to keep him going or anything like that. I’m disappointed.”

He also praised staffers he described as hardworking and the demeanor of the nurse who took care of his father at the end of his life.

“She was just super, super nice,” he said.

Survivors

Patricia Thompson, 71, has lived at Greenfield Healthcare Center since last September. Her first COVID-19 test came back negative, but her second was positive. The virus left her with a cough and severe pain in her lungs. She was in the red unit for six to seven weeks.

Recovering “was like coming home again,” she said, adding she was happy with the care she received.

“Everything came so quickly and they had to move so fast,” she said of Greenfield Healthcare Center staff. “And they were on it. Even though we were in a panic mode as patients and residents, they had to do what they had to do, and at the time we didn’t understand; but now, looking back, we understand. They did the best that they could do.”

Greenfield Healthcare Center resident Donna White, 61, tested positive for COVID-19 but never had any of its harsher symptoms. Instead, she lost her sense of taste and smell for about two weeks.

“I wasn’t feeling bad,” she said. “I was in good hands.”

David Brinkman takes care of his father, Henry “Paul” Brinkman, 85, who lives in his own home and has Parkinson’s disease and dementia. When David Brinkman and his fiance head out of town, they bring Paul Brinkman to stay at Greenfield Healthcare Center, including throughout the pandemic.

David Brinkman said staff put him at ease by explaining how residents and patients who tested positive for COVID-19 were separated from others and cared for by assigned staff. His father never contracted the virus.

“I trust them,” he said of Greenfield Healthcare Center. “I put a lot of trust into them.”

Looking ahead

The Indiana State Department of Health’s Division of Long Term Care conducted a Focused Infection Control Survey at Greenfield Healthcare Center on June 8 that found no deficiencies.

The facility’s current visitation procedure allows for two family members per resident at a time, by appointment only and during established visitation hours. Visitors are screened upon arrival and provided masks if they don’t have one.

As Clark thinks about the future, he can’t help but be reminded how much is still unknown about the virus as cases continue to rise in parts of the U.S. and Indiana.

“We’re nowhere out of the clear with all this,” he said. “I don’t say that to scare people; I say that to be realistic.”

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COVID-19 data

Hancock County

  • 484 cases
  • 36 deaths
  • 7,492 tests
  • 5 new cases on July 16
  • 0 new deaths
  • 118 new tests between June 27 and July 15

Indiana

  • 54,813 cases
  • 2,610 deaths
  • 604,635 tests
  • 747 new cases on July 16
  • 8 new deaths between July 4 and 16
  • 9,122 new tests between April 29 and July 16
  • 54.5% ICU beds in use – non-COVID
  • 11.2% ICU beds in use – COVID
  • 34.4% ICU beds available
  • 14.1% ventilators in use – non-COVID
  • 2.7% ventilators in use – COVID
  • 83.2% ventilators available
  • Hospital census: 815
  • Hospital census peak: 1,799 (April 13)

Source: Indiana State Department of Health as of 11:59 p.m. Thursday, July 16

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Hancock County COVID-19 demographics

Cases (484)

Age

  • 0-19: 5.4%
  • 20-29: 14.3%
  • 30-39: 12%
  • 40-49: 15.7%
  • 50-59: 16.9%
  • 60-69: 13.6%
  • 70-79: 10.3%
  • 80+: 11.8%

Gender

  • Female: 51.9%
  • Male: 47.3%
  • Unknown: 0.8%

Race

  • White: 63.6%
  • Black or African American: 4.5%
  • Asian: 0.6%
  • Other: 10.5%
  • Unknown: 20.7%

Ethnicity

  • Not Hispanic or Latino: 33.9%
  • Hispanic or Latino: 2.3%
  • Unknown: 63.8%

Deaths (36)

Age

  • 0-19: 0%
  • 20-29: 0%
  • 30-39: 0%
  • 40-49: 0%
  • 50-59: 2.8%
  • 60-69: 8.3%
  • 70-79: 19.4%
  • 80+: 69.4%

Gender

  • Female: 52.8%
  • Male: 47.2%

Race

  • White: 91.7%
  • Black or African American: 0%
  • Asian: 0%
  • Other: 2.8%
  • Unknown: 5.6%

Ethnicity

  • Not Hispanic or Latino: 55.6%
  • Hispanic or Latino: 0%
  • Unknown: 44.4%

Tested (7,492)

Age

  • 0-19: 8.3%
  • 20-29: 12.3%
  • 30-39: 15.3%
  • 40-49: 14.7%
  • 50-59: 18.3%
  • 60-69: 13.9%
  • 70-79: 10.6%
  • 80+: 6.5%

Gender

  • Female: 57.6%
  • Male: 41.2%
  • Unknown: 1.2%

Race

  • White: 70.5%
  • Black or African American: 2.3%
  • Asian: 0.5%
  • Other: 11.4%
  • Unknown: 15.3%

Ethnicity

  • Not Hispanic or Latino: 28.3%
  • Hispanic or Latino: 0.5%
  • Unknown: 71.2%

Source: Indiana State Department of Health

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Indiana COVID-19 demographics

Cases (54,813)

Age

  • 0-19: 7.9%
  • 20-29: 17.1%
  • 30-39: 15.9%
  • 40-49: 16.4%
  • 50-59: 15.4%
  • 60-69: 11.8%
  • 70-79: 7.4%
  • 80+: 8%
  • Unknown: 0.1%

Gender

  • Female: 52.2%
  • Male: 46%
  • Unknown: 1.7%

Race

  • White: 46.2%
  • Black or African-American: 11.7%
  • Asian: 1.4%
  • Other: 17.2%
  • Unknown: 23.5%

Ethnicity

  • Not Hispanic or Latino: 33.7%
  • Hispanic or Latino: 11.1%
  • Unknown: 55.2%

Deaths (2,610)

Age

  • 0-19: 0.1%
  • 20-29: 0.3%
  • 30-39: 0.7%
  • 40-49: 1.8%
  • 50-59: 5.1%
  • 60-69: 15.9%
  • 70-79: 24.6%
  • 80+: 51.5%

Gender

  • Female: 48.7%
  • Male: 49.3%
  • Unknown: 2.1%

Race

  • White: 64.8%
  • Black or African American: 14.3%
  • Asian: 0.5%
  • Other: 13.3%
  • Unknown: 7.1%

Ethnicity

  • Not Hispanic or Latino: 52.6%
  • Hispanic or Latino: 2%
  • Unknown: 45.4%

Tested (604,635)

Age

  • 0-19: 8.4%
  • 20-29: 15.5%
  • 30-39: 15.5%
  • 40-49: 15%
  • 50-59: 16.2%
  • 60-69: 14.2%
  • 70-79: 8.9%
  • 80+: 5.8%
  • Unknown: 0.5%

Gender

  • Female: 57.2%
  • Male: 40.8%
  • Unknown: 2%

Race

  • White: 58.3%
  • Black or African American: 8.7%
  • Asian: 0.8%
  • Other: 13.4%
  • Unknown: 18.8%

Ethnicity

  • Not Hispanic or Latino: 38.6%
  • Hispanic or Latino: 3.3%
  • Unknown: 58%

Source: Indiana State Department of Health

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Hancock County COVID-19 deaths (36)

  • March 21: 1
  • March 28: 2
  • April 4: 2
  • April 10: 1
  • April 18: 1
  • April 25: 2
  • May 1: 1
  • May 2: 2
  • May 4: 2
  • May 5: 2
  • May 6: 2
  • May 9: 1
  • May 12: 2
  • May 14: 1
  • May 15: 1
  • May 18: 1
  • May 19: 2
  • May 20: 1
  • June 8: 1
  • June 12: 2
  • June 16: 1
  • June 18: 2
  • June 19: 1
  • June 20: 1
  • June 24: 1

Source: Indiana State Department of Health

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Back on Track Indiana Stage 4.5

Through July 31

Elkhart County remains in Stage 4 through July 31

Guidelines for all Hoosiers

  • Hoosiers 65 and older and those with known high-risk medical conditions should adhere to social distancing guidelines and remain cautious at work and in their communities
  • Continue remote work as needed
  • Face coverings are highly recommended
  • Social gatherings of up to 250 people may take place following Centers for Disease Control and Prevention social distancing guidelines. The coronavirus is often spread among groups of people who are in close contact in a confined space for an extended period of time. This limit applies to wedding receptions, parties and other events where people are in close physical contact for extended periods of time, particularly in indoor locations
  • Outdoor visitation has resumed at assisted living facilities and nursing homes in accordance with Indiana State Department of Health visitation guidelines
  • Indoor nursing home and assisted living facilities must have a plan for indoor visitation
  • Hospital visitations encouraged with precautions

Stage 4 restrictions that continue

  • State government building access available by appointment; state employees are required to wear masks in public areas, with exceptions
  • Dining room food service may operate at up to 75% capacity as long as social distancing is observed
  • Bar seating in restaurants may operate at 50% capacity as long as social distancing is observed
  • Bars and nightclubs may operate at 50% capacity adhering to social distancing guidelines
  • Cultural, entertainment and tourism sites may operate at 50% capacity, including museums, zoos, aquariums and like facilities
  • Movie theaters, bowling alleys and similar facilities may operate at 50% capacity, adhering to social distancing guidelines
  • Raceways may operate at 50% grandstand capacity
  • Venues may operate at a 50% capacity with adherence to social distancing guidelines
  • Amusement parks, water parks and like facilities may operate at 50% capacity; reservations are encouraged to limit the number of customers at any one time
  • Personal services continue operations with restrictions
  • Gyms, fitness centers and other workout facilities continue operations with restrictions

What opens in Stage 4.5

  • K-12 school operations may begin the 2020-21 academic year on July 1; extra-curricular, co-curricular activities may resume July 6
  • Pari-mutuel horse racing and county and state fair racing may begin with 50% spectator capacity
  • Youth overnight camps may open
  • Fairs, festivals and other similar outdoor events may open and conventions may resume

Source: State of Indiana

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