Across the country, health care professionals in nursing homes are dying and facilities are being blamed for not doing enough to protect them. Maurice Dotson, who loved his work and his patients, was one casualty. "He clung to people who could not help themselves."

Courtesy Florence Dodson Maurice Dotson

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With the novel coronavirus sweeping through the West Oaks Nursing and Rehabilitation Center in Austin, Maurice Dotson posted a stark message on his Facebook. "Off to work again. Healthcare never closes . . . pray 4 me," he wrote. That same day, a state inspector showed up at the sprawling facility to check on a complaint that managers failed to order the staff to wear masks and gloves, despite strict federal guidelines. During the visit on March 26, the inspector found the facility had violated critical infection control practices, including failing to isolate a sick patient, not sanitizing their hands, and not properly disposing of protective gear. It was the second time in two years the state had found such problems. Two weeks later, Dotson, a certified nursing assistant who had worked at the facility for 25 years and was now caring for patients with COVID-19, feared he was coming down with something. "I’m hurting so bad,” he said in a Facebook post. “I don't know what's going on with me.” Ten days later, on the morning of April 17, at the age of 51, he died from the virus. Inspection records reveal that, like many nursing homes, West Oaks has a history of safety and infection control problems and now must confront an unprecedented crisis. The state said one Austin facility has at least 35 patients who have tested positive, and employees at West Oaks say it's their facility. West Oaks will not say how many have died among its residents and workers.

With thousands of nursing home residents and employees dying across the country, unions are demanding N95 respirators and even more basic equipment — masks and gloves — from government agencies, hospitals, and long-term care facilities where the virus has flourished. Dr. Karl Steinberg, a geriatrician and chief medical officer for a California nursing home chain, said the facilities’ failure to move quickly at the onset of the virus put their residents and workers at risk. "A two-week delay in instituting basic and mandated precautions is highly likely to have contributed to the number and severity of cases," said Steinberg, who also is president-elect of the Society for Post-Acute and Long-Term Care Medicine.

Google Maps The exterior of West Oaks Nursing and Rehabilitation Center in Austin.

It's not clear what precautions were taken by the West Oaks staff after the state inspection in March, but two days after Dotson died, inspectors turned up at the facility and found multiple violations for immediate jeopardy, a charge that can cost a home its license unless corrected. That kind of citation can include anything from a failure to keep critical medical records to hazards that cause injuries and deaths. State officials did not provide records of the findings, and the nursing home said it could not comment until it sees a final report. Brooke Ladner, an official for Regency Integrated Health Services, which runs the center, said the nursing home implemented federal and state guidelines after the Center for Disease Control released its protocols on March 13 and the company has "worked diligently to continually improve the standard of care at the facility." Any alleged violation is immediately investigated, she said. Ladner said all inspection violations prior to last year took place under a different manager, and that the deficiencies from late March have since been corrected. As far as the most recent inspection by the state, Ladner said she could not comment pending the final report.

“The loss of Maurice Dotson was deeply felt by his friends and co-workers at West Oaks Nursing and Rehabilitation Center,” she said, “and we grieve with his family." Dotson's sister, Felicia, said her brother faced enormous hazards when he went to work each day. “You see people dying around the world, the main place they're dying is in nursing homes,” she said. “Why would they not use more precautions?" Her brother would never have considered quitting his job or not showing up for work, she said. With relatives barred from visiting, "he would say, ‘I am their family. They don't have their family.’" The facility’s documented problems date back well before the pandemic. In 2018, inspectors found that caretakers were not showering patients for a week at a time and discovered some residents with gaping, infected wounds. In other cases, caretakers were not properly cleaning catheter tubing or washing their hands, risking the spread of infection, records show.

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At the end of 2018, the facility’s operator, Senior Care Centers LLC, filed for bankruptcy, citing cuts in government reimbursements, and the home was taken over by Regency Integrated Health Services, a parent company that runs 57 facilities in Texas. As recently as last month, a source familiar with the state’s inquiry said, nursing home managers were not ordering all employees and patients to engage in social distancing. On March 24, staff members learned that a nursing assistant, a woman, had been infected. In the following weeks, at least five other staff members tested positive, according to three former employees. For days, Dotson, described as a hard-working nursing assistant with a passion for movies and cooking, shared what it was like caring for people while the virus spread rapidly through the 125-bed facility. On March 26, with a host of patients infected at the time, he noted on Facebook: "Back to work again in this crazy world, Protect me lord."

Courtesy Florence Dodson Dotson in a message he included in a Facebook post.