Saran Walker protests along with the SEIU Healthcare Michigan union for working conditions at the Ambassador nursing home in Detroit, April 9.

This article is brought to you by the Detroit Free Press. Please support journalism in Detroit and across Michigan by subscribing to the Free Press. Or you can make a tax-deductible contribution to the nonprofit Report for America to help the Free Press put new reporters on the ground in metro Detroit. If you have story tips about how coronavirus is affecting Detroit and Michigan, including health care workers and nursing homes, please email city@freepress.com.

Coronavirus cases have swept through nursing homes across Michigan, putting the state’s most vulnerable at risk at a time when elderly residents are isolated from family under rules intended to keep them safe.



There have been hundreds of confirmed coronavirus cases among residents and staff and dozens of deaths linked to nursing homes in Michigan, the Detroit Free Press has found, even as facilities take steps to stem the spread and health officials work to monitor outbreaks.

In Wayne County — not including Detroit, which has its own health department — 35% of all of the county's confirmed COVID-19 deaths had been nursing home residents, based on a review of the state's disease surveillance system, a spokesman said Friday. And in Detroit, officials have said all of the city's nursing homes had reported confirmed or suspected COVID-19 cases.

"It has now become the center of the battle in the city of Detroit," Mayor Mike Duggan said last week.

[BuzzFeed News published this investigation by the Detroit Free Press as part of a partnership promoting local journalism. Sign up to be a BuzzFeed News member and subscribe to our newsletter about the coronavirus, Outbreak Today.]



Just how rampant the coronavirus is at nursing homes across the state is difficult to discern. Michigan health officials have said they hadn't been actively tracking data on nursing homes cases statewide.

A Free Press investigation, though, has identified a number of facilities in metro Detroit and across Michigan that have been impacted by coronavirus cases, including those in Livonia, Roseville, Riverview, Detroit, Mount Clemens, Farmington Hills, West Bloomfield, Harper Woods, Redford, Romulus, Wayne, Rochester Hills, Battle Creek, Lapeer, Kent County, and Shiawassee County.

Despite outbreaks, local health departments in most instances would not provide the names of affected nursing homes. Some companies and facilities have declined to address how widespread the disease is in their nursing homes.

Local health departments in metro Detroit have reported hundreds of cases:

The health department in Wayne County, which does not include cases in Detroit, found that 94 out of the county's 272 confirmed COVID-19 deaths as of Friday had been nursing home residents, based on the department's review of the Michigan Disease Surveillance System, county spokesperson Bill Nowling said.

Macomb County said Wednesday that there had been 203 confirmed coronavirus cases across 45 facilities, which include nursing homes, long-term care, skilled nursing, memory, and assisted living facilities, and 21 deaths.

In Oakland County, as of Thursday, 92 senior care facilities have had COVID-19 cases, Oakland County Executive David Coulter said. He said 254 people had tested positive and 24 deaths were reported across the senior facilities.

According to the Detroit Health Department, the city has 26 nursing homes and all had reported confirmed or suspected COVID-19 cases, a spokesman for the city said Saturday. The city said Friday there had been 191 cases, including 20 deaths. The city has launched an initiative to do widespread, quick testing of nursing home staff and on-site testing of patients.





Duggan on Thursday drove home the importance of widespread testing at nursing homes, announcing that 160 residents at facilities would be tested each day, to stop the spread. Oakland County is also working to identify more positive cases at nursing homes and recently ordered COVID-19 swab testing kits for symptomatic residents at facilities.

Across the country, mounting cases have illustrated how the disease can ravage facilities. In Washington, an early epicenter of the virus was Life Care Center of Kirkland, which was linked to roughly three dozen deaths. Since then, clusters of cases and deaths connected to nursing homes have crept up across the country.

States like Louisiana, Minnesota, New York, Mississippi, and Georgia have provided some information publicly about care facilities and in Maryland, the governor announced "strike teams" to provide support for nursing homes.

In Michigan, state officials said they are trying to improve the data they provide and began releasing statistics Thursday about those who have recovered from the coronavirus, when people were tested and hospital information. So far, though, no statewide information on nursing home cases has been available.

Lynn Sutfin, a spokesperson for the state health department, said information about respiratory outbreaks is reported on a weekly basis in a report published online but the system does not break out COVID-19 cases.

"We are reviewing this infrastructure to identify COVID-19 outbreaks," Sutfin said.

The reports could provide additional information on outbreaks at facilities, such as nursing homes and other senior care facilities, but require a manual review, she said. The timeline on when the data may be available remains unclear.

“There are limitations on the data we do have,” Sutfin said Thursday, adding, “We are very concerned about COVID-19 in our state.”

Wayne County spokesman Nowling said in a statement that County Executive Warren Evans "is very concerned about the high concentration of COVID infections and deaths in Wayne County, especially among minority populations which seem more adversely affected."

The state's disease surveillance system, which is an online communicable disease reporting system developed to facilitate coordination with local, state and federal health agencies, "struggles to capture an accurate picture of all the data of this pandemic," Nowling said. He said Evans "has dedicated a team of data and epidemiological experts to work on improving the county’s tracking of COVID-19 cases. This includes more resources to allow for increased data collection from affected individuals.”

Many nursing homes have publicly posted changes to their facilities to protect residents and staff during these unprecedented times — restricting visitors, providing appropriate personal protective equipment, working closely with health departments to prevent exposure, increased cleaning, screening staffers for temperatures and practicing social distancing.

Still, one union official said the nursing facilities are "petri dishes."

Mary Kay Henry, international president of the Service Employees International Union (SEIU), whose health care arm is the largest health care union in North America, said many facilities lack sufficient supplies and personal protective equipment, such as masks, gloves and hand sanitizer.

Some nursing home workers are doing two or three jobs and going from one facility to another, which can contribute to spreading the virus.

"Because of the lack of testing, we don't know if nursing home workers are carrying the virus from one nursing home to another,” she said.

Families with loved ones in these homes say facilities need to do a better job sharing timely information about cases, especially when visitors aren't allowed inside to check on their elderly loved ones.

Korey Hill said his 75-year-old mother, Mildred Hill, was rushed from her Detroit nursing home to Ascension St. John Hospital in late March, fatigued and feverish. Days later, her family says they learned she had COVID-19. She died Tuesday. The day before her death, a nurse at the hospital called Korey Hill on FaceTime so he could speak to his mother. She was sleeping when he delivered a message.

“I told her I love her,” he said. “I told her I miss her.”

More information earlier from the nursing home would have been helpful, Mildred Hill's family said.

For nursing homes, the goal is to keep the virus out of facilities. Once it strikes — as it did at the Macomb County–owned Martha T. Berry Medical Care Facility, which announced its first case earlier this month — facilities move on to the next step.

“We have been saying …'its not a matter of if, but when,'” the Mount Clemens facility announced in a Facebook post. “Our team has worked hard to keep it out (defend) for as long as we could, but now comes the next phase — containment.”

LACK OF INFORMATION

As of Saturday, there had been nearly 24,000 confirmed cases of the coronavirus across Michigan and 1,392 deaths, according to the state health department. Michigan’s most populous counties — Oakland, Macomb, and Wayne — account for 79% of infections and 85% of COVID-19 related deaths statewide and also have the highest infection rates per capita. In Detroit, there were 924 confirmed cases per 100,000 residents.

Though infections have been reported in dozens of nursing homes in metro Detroit, local health departments have declined to release information about specific long-term care facilities.

Oakland County said it wouldn't name facilities, citing protected health care information; Macomb County also declined, "based on the advice of our county Corporation Counsel"; and the Detroit Health Department said releasing the names of the nursing homes "could place undue stress on these businesses.”

Washtenaw County has had 15 deaths from the virus as of Friday, according to state data, but the health department wouldn't provide specific details on whether any have been at nursing facilities.

"There are outbreaks associated with our more vulnerable populations," spokeswoman Susan Ringler-Cerniglia said. "Talking about those in terms of the numbers is gonna be too identifying for those individuals and facilities."

Wayne County did not release the names of all affected licensed care facilities, but did identify several in Livonia that have seen COVID-19 infections. This includes SKLD Livonia and Regency at Livonia.

As of Friday afternoon, 15 residents at Regency at Livonia and six at SKLD Livonia had died, according to the county. Including the deaths, 26 residents from Regency at Livonia and 20 from SKLD Livonia had fallen ill with the virus, the county reported.

Both facilities had indicated in statements last week that they had isolation units and could treat COVID-19 patients. It's unclear whether any of the deaths linked to the homes were of patients who had been transferred from other locations.

A statement from Regency at Livonia on Friday said the facility had discharged residents with and without coronavirus symptoms to local hospitals.

"Based on information received from County health officials, it is being reported that numbers of former residents have later tested COVID-19 positive, as well as passed away from COVID-19," the statement said. "We do not always have firsthand knowledge of the status of discharged residents, but have no reason to doubt the accuracy of the information from the county health department."

The facility also said it has an isolated unit and can treat "a limited amount of existing and/or admitted positive COVID-19 patients."

Henry Boutros, vice president of Illuminate HC, which manages SKLD Livonia, said in a statement last week that the facility has an isolation unit and was working with area hospitals and the MDHHS in order to free up hospital beds.

"We have treated COVID-19 patients [and] will continue to do so," Boutros said.

Health departments are notified about coronavirus cases several ways, including lab reports, infectious care specialists, hospitals, physicians and senior care facilities.

“Often, we have already heard from the care facility, but there are times when we find out they lived or worked at a care facility during our contact investigation,” said Bill Mullan, spokesman for the Oakland County executive.

Contact investigations are done to determine who a COVID-19 patient has come in contact with, officials have said.

Sutfin, the state health department spokeswoman, said if there is a threat to nursing home residents or staff — like the spread of a communicable disease — notice is to be provided to employees and residents, such as postings in entranceways and isolation areas. But there is no requirement for a nursing home to issue public announcements about cases in its facility, unless there is a threat to the public, she said.

Some nursing homes have publicly confirmed cases in recent weeks.

Advantage Living Centers, in letters posted in March to its website, confirmed cases of the coronavirus at seven of its locations, including those in Detroit, Harper Woods, Redford, Wayne, and Battle Creek. The nursing home group also confirmed last month that two residents from its Roseville facility died after being diagnosed with COVID-19.

“We care deeply for our residents and team members and are working hard to provide them with the resources needed,” the owners of Advantage Living Centers said in an earlier statement.

In Riverview, 21 residents and 15 associates from Rivergate Terrace had been diagnosed with COVID-19 as of Thursday, according to a statement from Executive Director Sujata Chaddha. Seven of the 21 residents had died, three had returned to the facility under isolated care and the others remain hospitalized, and the associates were recovering at home, the statement said.

In the statement, Chaddha said the nursing home was working with the state and Wayne County health departments.

"Our heartfelt condolences go out to the friends and loved ones of the patients who have passed away," the statement said.

Another facility on the same campus in Riverview, Rivergate Health Care Center, has also had cases of COVID-19. Four residents and 13 associates had tested positive, according to a statement Friday from Executive Director Michelle Peeper. It says all four residents are recovering at a local hospital. Two, it says, had only recently been admitted to the facility from the hospital and were transferred back, where they tested positive for COVID-19.

A Villages of Lapeer resident, a man in his eighties, also died this month, according to the Lapeer County Health Department. On Friday, the Lapeer County Health Department reported the death of a woman in her eighties who was a resident at the Lapeer County Medical Care Facility in its coronavirus update.

And James House, a nurse at Omni Continuing Care in Detroit, died in late March after falling ill. He had not been tested for COVID-19, but his sister told the Free Press that he had symptoms, including cough, low-grade fever and shortness of breath.

In Shiawassee County, the health department announced in a news release on its website Thursday that eight employees of Durand Senior Care and Rehab had tested positive for the coronavirus.

On the western side of the state, six patients have died of COVID-19 at Metron of Cedar Springs nursing home, where 31 residents and five staff members tested positive for the virus.

One resident, LouAnn Dagen, repeatedly asked her Amazon Echo Show for help with her pain in the days leading up to her death. WOOD-TV reported that her sister found the recordings on the device in her sister's room — 40 in all, over the last few days of her life. Dagen died at a hospital.

Paul Pruitt, director of operations, said in a statement that Alexa was Dagen's primary way to communicate with her sister. He said because of patient privacy regulations, they could not share information about a resident's physical or mental health, but said she received "excellent care."

Dagen, Pruitt said, was a resident there for more than 10 years "and we cared for her deeply."

TESTING CRUCIAL TO STOPPING THE SPREAD

Testing for COVID-19 remains a widespread problem — and that's true for nursing homes, as well.

In Detroit, Mayor Duggan announced an initiative to test nursing home employees and residents from facilities across the city, with fast turnaround of results.

Duggan said residents at one or two nursing homes each day would be tested by a team of EMTs from the Detroit Fire Department, and Wayne State University med students would run tests overnight, so that results are available the next day.

"We are going to address the spread," Duggan said.

Oakland County’s public health staff have been out to senior facilities to swab possible COVID-19 patients because they can’t get to their doctors, County Executive Coulter said.

“The sooner we identify COVID-19 patients, the better,” Coulter said Thursday, also announcing plans to distribute COVID-19 kits containing face shields, masks, gloves and hand sanitizer to senior living facilities to help meet their needs.

Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at the Detroit Medical Center, said widespread testing of residents and employees needs to happen at all nursing homes, where the population is vulnerable. She said more testing is needed "so we can figure out which one is positive, separate them out from those that are negative to break the chain of transmission.”

Some nursing homes in metro Detroit assume residents showing symptoms have the virus even if they haven’t been tested and isolate them just as they do with residents who have tested positive.

Because of the lack of people tested across the state, the number of confirmed coronavirus cases doesn’t represent anywhere close to the amount of likely cases, Dr. Russell Faust, Oakland County medical director, said.

“I think that number likely, if it represents anything close to reality, it probably represents the very sickest patients,” he said earlier this month.

The Oakland County Health Division has at least 50 people working on communicable disease devoted to COVID-19, Faust said. The work includes investigations that seek to answer questions about who a person had contact with and where they’ve been such as a jail, nursing home or long-term care facility.

“It’s a full-time job for a lot of people right now,” Faust said.

Wayne County Public Health Officer Carol Austerberry said the county has been doing outreach since earlier this year with senior citizens, long-term care facilities and the Meals on Wheels program. The county recently launched a data dashboard, which does not include information about nursing homes, but does provide city-specific information about the number of positive cases and deaths.

By reporting information about cities, Austerberry said, it puts the outbreak in perspective for residents.

"It becomes part of, part of their neighborhood and that's what's going to stop this, the spread of this disease," she said. "When you have that 'aha' moment of, 'wait a minute, now it has touched me ... kind of personally or my neighborhood or my own, my own, you know, world.' "

WORKERS BATTLE LOW PAY, LACK OF PROTECTIVE EQUIPMENT

The conditions in nursing homes for employees creates additional challenges, with dwindling stocks of personal protective equipment and, sometimes, a lack of paid sick time, according to union officials.

Kevin Lignell, communications specialist for SEIU Healthcare Michigan, said the union is asking that protective equipment be in the homes, that there be free testing, that all costs from the virus be covered by the homes, and employees have paid sick leave. He said some homes have adopted some of these requests, including hazard pay and child care.

The union said it scored a big victory last week when it negotiated an agreement for all nursing home workers represented by the union in Sava homes in Michigan, including higher pay, providing personal protective equipment and having medical bills paid by workers' comp if an employee is confirmed to have the virus, among other benefits.

Lignell said some nursing home employees are working without personal protective equipment and are not taking time off if they are sick. He said paid sick time is “barely existent in the nursing home,” adding that for many workers who get exposed and need to quarantine, “that’s 14 days of unpaid work for them.”

Many employees have more than one job and are working between multiple nursing homes, Lignell said. Some work full time, but others are part-time or temporary, earning low wages.

He said it’s not unusual for certified nursing assistants — who provide direct care to residents and help with things like using the bathroom and getting dressed — to be paid less than $15 per hour.

Many nursing facilities across metro Detroit are hiring for everything from health care to housekeeping to delivering meals to residents, who have to stay in their rooms.

On Thursday, SEIU Healthcare Michigan caravaned around Ambassador, a Villa Center, on Jefferson in Detroit in a show of solidarity for nursing home workers.

Andrea Acevedo, president of the union, sent a letter with complaints from employees to health officials in Detroit, including the medical director in the city's health department.

The letter asks that everyone at Ambassador be tested and personal protective equipment be supplied — immediately. The union said there were two residents and five staff who tested positive, but the home was failing to communicate to employees the existence of the positive tests or those suspected of having the virus, according to the letter.

Lignell told the Free Press on Friday that the union had filed workplace safety complaints on behalf of workers at the nursing home.

“The horrific shortcomings of the nursing home management are causing the COVID-19 virus to begin to spread like wildfire there,” Acevedo's letter says.

In a statement Friday, Villa Healthcare said at Ambassador, there are four residents in the center who tested COVID-19 positive, and four residents who were transferred to the hospital who tested positive. The first positive test at the facility was on Monday. It said Ambassador “has no factual confirmation that any resident or staff member died due to COVID-19."

It called the campaign by SEIU “a targeted smear campaign" and said that Ambassador is in "continual contact" with staff, residents, families and responsible parties.

The statement said Ambassador “is now and has always been stocked with sufficient PPE supplies for the use of its staff and for the benefit and protection of its residents. The standard in every Villa center, including Ambassador, is for center employees to wear the appropriate PPE for the conditions in place in the center."

“At no time during this pandemic has Ambassador not had adequate PPE for the use and protection of its staff and residents. Any claim to the contrary is without factual basis,” it said.

NOWHERE ELSE TO GO

Nursing homes also are facilities where some COVID-19 patients are going after being released from the hospital.

That includes facilities like Optalis Healthcare, which operates skilled nursing and rehabilitation facilities in Southfield, Shelby Township, St. Clair Shores and Bloomfield Hills. CEO Raj Patel said such facilities are an integral part of the health care system and hospitals rely on them to transition patients once they are stabilized. Taking patients into their care, he said, helps free up hospital beds for others in need.

He said Optalis won’t turn its back to patients and local hospitals in a time when they need them the most; and said units are isolated and separate from the rest of the facilities and have their own staff and personal protective equipment.

Samantha Webb, who lives in Virginia and is originally from Macomb County, and her family were concerned about COVID-19 patients being brought to the Shelby Township facility where their 92-year-old mother has lived for several years.

"When I heard, the shock set in. Why put the most dangerous people with the most vulnerable people, especially when the state was to lock down the facilities to protect people?” she said. “It seemed in direct contrast to ensuring the safety and well-being of my mother.”

Still, her family was in a unique situation.

While Webb was concerned about protecting her mother from undue exposure, she said, her 70-year-old brother was on a ventilator from the virus at a Macomb County hospital and would have needed a place to go if he recovered. He died April 3, Webb's sister, Dawn D'Elia, who lives in Florida, said.

which has 26 facilities, eight of which are branded the WellBridge Group, also is accepting COVID-19 patients from hospitals at the Clarkston location in a previously unoccupied portion of the facility.

Pomeroy Living also is accepting recovering COVID-19 cases. It has seven senior communities from independent living to assisted living to two skilled nursing homes, one in Rochester Hills and another in Sterling Heights — both with private COVID-19 units.

Manda Ayoub, chief operating officer for Pomeroy Living, said COVID-19 patients are isolated from long-term care residents.

“People are upset, they don’t want them coming to the community, but what do we do? How do you let people die in the hospital because people can’t get beds?” she said.

Ayoub said all patients coming in, whether sick with the coronavirus or not, are being isolated in a private room for 14 days as a precaution. She said nursing homes need access to quick testing for staff and residents, including new admissions.

And while employees are being screened via temperature and questionnaire multiple times a day, Ayoub said, “there’s no guarantee to anyone that one of us isn’t a silent carrier.”

"A LONG, TOUGH PROCESS"

The family of Mildred Hill, who died Tuesday after testing positive for the coronavirus, said it is important for information about COVID-19 to be shared with loved ones, given one person can infect dozens.

Eric Burse, Hill's son, said: “I believe that type of information should be passed along.”

The 53-year-old said his mother wasn't doing well in late March at Riverview Health and Rehab Center North in Detroit. Her family said she hadn't been eating or drinking fluids, was fatigued, weak and had a fever. She was taken to Ascension St. John Hospital and, days later, the family learned she had COVID-19.

Her family said they never heard about COVID-19 cases at her nursing home before their mother's death. Her son Korey Hill, 46, of Detroit, said his mother, who also had dementia and kidney problems, hadn't been anywhere but the nursing home and the hospital.

Richard Levin, CEO of Riverview Health, said workers are following guidelines and doing what they can to prevent infections in their buildings. As of Wednesday, there were no active COVID-19 cases in the buildings to his knowledge, he said, noting that could change.

Privacy laws prevented him from talking about specific situations.

“While I can’t speak to any case in particular, I’m saddened for any family that has to experience any loss associated with this disease,” Levin said. “It’s very difficult to lay blame on people given the widespread nature of the transfer of this illness.”

Family wasn’t allowed to visit Mildred Hill in person when she was in the hospital, but a nurse made it possible to see her Monday through FaceTime. The former beautician, mother of four and grandmother died the next day.

Now, the family is planning her funeral.

“It’s been a long, tough process," Korey Hill said, "dealing with this outbreak."