Kasi Korum awoke on the floor of her Minneapolis nursing home with searing pain in her lower back and no one to help her into her wheelchair.
The 41-year-old recovering cancer patient had spent the night sleeping on a thin foam pad in the common area of the Villa at Bryn Mawr after learning the previous evening that her roommate had tested positive for COVID-19, the deadly respiratory illness caused by the coronavirus.
Korum said her requests for a private room had been denied, and she refused to return to a cramped room with a sickened roommate. “I was scared out of my mind,” she said. “Being told to go back to that room felt like a death sentence.”
Her experience highlights a persistent health hazard in Minnesota’s nursing homes: lack of space.
Many of the state’s 370 nursing homes are laid out like hospitals, with residents doubled up and as many as four people sharing a single bathroom. Some nursing facilities have shower areas shared by dozens of residents on entire floors. This institutional design was meant to be cost-efficient, but it has contributed to the rapid spread of the virus from one vulnerable resident to the next and the stunning death toll within Minnesota’s nursing homes, say public health experts.
In Minnesota and nationally, the deadliest clusters of the coronavirus have tended to be in large, multistory nursing homes with people doubled up in rooms and separated by curtains. Two such facilities, St. Therese of New Hope and North Ridge Health and Rehab, also in New Hope, together account for at least 105 of the state’s 869 virus-related deaths. But there have been smaller outbreaks in dozens of other nursing homes, from Winona to Duluth, with similar institutional designs that date back decades.
The dense layout of many nursing homes has become an emerging source of concern as facilities scramble to find places to put infected residents. Some have cleared out entire floors or wings of their buildings to isolate COVID-19 patients. Others do not have the space. Some nursing home residents said they have been left to share rooms with infected residents over their objections.
Since the pandemic began, the virus has spread to more than 200 nursing homes and assisted-living facilities in Minnesota.
Across the state, nearly 2,500 residents of long-term care facilities have contracted the illness and 709 have died. Taken together, residents of these facilities account for 81% of the state deaths from the virus. No other state reports such a high percentage of deaths in long-term care.
“We accepted these arrangements as a society, and now our elders are paying the ultimate price,” said Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota’s School of Nursing.
A painful night
Korum said she moved to the Villa at Bryn Mawr several months ago to recuperate following a back injury. Like other residents at the facility, she was placed in a room with another person, separated only by a curtain, with a bathroom she shared with two residents in an adjoining room.
Still, Korum did not voice concerns about the living arrangement until an evening about a week and a half ago, when staffers informed her that her roommate had tested positive for COVID-19. Korum assumed that she would be offered a separate room to avoid getting infected. Instead, she was told to quarantine in the same room because of concerns that she might also have the virus, she said.
“I was astounded,” Korum said. “This virus is airborne. Besides, we are touching the same toilets, the same sinks, the same doorknobs. I didn’t want to be anywhere near this [infected] person.”
After arguing with staff, Korum said she wheeled her way down to the first-floor common area near the patio and found an open spot on the floor to sleep. Another resident at the facility gave her a mat, blanket and pillow. Because of nerve damage in her back, Korum is unable to move around without a wheelchair.
“It was a painful night, but I’d rather sleep on the floor than die in my room,” she said.
In a written response, the Villa at Bryn Mawr said that a private room was provided to Korum once an administrator was made aware of the situation. The 120-bed facility said it has moved to mitigate the spread of the virus by testing all its residents and by moving residents who have tested positive for COVID-19 to a unit with dedicated staff. As of Thursday, four residents at the nursing home had died of the virus and 24 had become infected.
“Long term care is a high-touch environment where social distancing is not an option in providing care,” the facility said. “Most of our population cannot perform the normal activities of daily living without the help of our staff.”
Thomas Wright, 62, another resident at the nursing home, learned last week that he contracted the virus, and he suspects the tight living quarters are to blame. Even before the pandemic, he said, hygiene was a serious concern. Wright said he frequently had to wipe feces off the toilet he shares with three other residents. Sometimes there is no disinfectant or toilet paper, he said.
Wright says he showers once a day using a separate bathing room that is shared by at least a dozen other residents on his floor. He does not know if they are infected with the virus.
“This is a COVID breeding ground,” Wright said.
Wright, a painter from Minneapolis, said he moved to the nursing home in February to recover from a pit bull attack, and now he’s not sure if he will return home alive. Last week, he began showing signs of the virus, including shallow breathing and a fever.
“I absolutely think the physical design of these places is critical and deserves more attention,” Wright said. “It’s the difference between life and death.”
A state of unease
Long-term care industry representatives said residents with COVID-19 should not be sharing rooms with residents who aren’t infected. However, facilities are allowed to house people with the same pathogen in the same room, under federal guidelines. Many nursing homes have also begun to separate COVID-19 residents on designated floors or units, a practice known as “cohorting.”
“It’s about density. Where the populations are more dense, it’s harder to contain the spread,” said Bob Dahl, chief executive of Cassia, an Edina-based operator of nursing homes and other senior facilities.
Sen. Karin Housley, Republican chairwoman of the Senate Family Care and Aging Committee, said the state needs to explore the designation of entire facilities for COVID-19 patients as a way to ease crowding in nursing homes and contain the virus’ spread. Connecticut and Massachusetts have already begun to convert facilities into dedicated COVID-19 sites.
“Of course, it would be ideal if all residents in long-term care settings had their own rooms,” Housley said. “Any time you’re sharing a space with somebody there is a risk — unless both residents are on lockdown all day, which isn’t a reasonable solution.”
For weeks, many nursing home residents across Minnesota have been kept in a state of perpetual unease as facilities shuffle people between rooms and floors in a desperate bid to prevent the contagion from spreading.
Kim Orsello of Prior Lake said she “became sick to my stomach” after learning that her father’s room was on the same floor where his nursing home had moved residents infected with COVID-19.
She was worried because he took showers in a room shared with about 20 other residents. On Friday, her fears were realized: A nurse at the facility called to tell her that her father had tested positive for COVID-19.
“I felt like, given the design of the facility, it was inevitable,” she said.
Already, at least 24 residents of his nursing home, Southview Acres Healthcare Center in West St. Paul, have died of the virus and nearly 100 have been sickened, according to families.
A spokesman for Southview Acres said the facility began efforts to mitigate the spread of the virus in early March and has been housing COVID-19 residents together in the same units, in keeping with federal guidelines.
“If they weren’t in such cramped spaces, perhaps our loved ones would not be dying so fast,” Orsello said.
Since her night sleeping on the floor, Korum said she was moved four times before finally being placed in a windowless room with another roommate, separated again by curtains. As of Friday, many of her clothes and other belongings were still unpacked in boxes.