Editor’s Note:  The video originally included in this article showed scenes from a facility that is not connected with this story.  Those scenes have been removed.

AUSTIN (KXAN) — Peggy Brown was the anchor of her family for decades. She was exuberant, funny, often singing. But that joy was gone on March 24, when her grandson Neal stood at her bedside at Gracy Woods Nursing Center in North Austin.

Neal watched as Peggy struggled to take shallow breaths. He stood vigil for nine hours. Neal doesn’t know what ultimately caused his grandmother’s death early the next morning. She was 93, weak and had a history of pneumonia.

“The question of COVID never crossed my mind, at that time,” he said.

Three days after Peggy died Gracy Woods said it announced to its staff on March 27 that a small number of residents at the facility tested positive for COVID-19, the virus that has spread rapidly throughout the world and poses the greatest danger to elderly people and those with existing medical problems.

Peggy Brown (courtesy of Neal Brown)

Brown said Gracy Woods’ staff provided excellent service for his grandmother. He remembers about 10 workers entering the room to help assist. Neal said he only saw one staff member wearing a face mask.

Gracy Woods administrator Amanda Smith confirmed the positive COVID-19 cases to KXAN. She said her facility, which has 118 beds, has followed guidelines from the Centers for Disease Control and Prevention, both before and after learning of the first positive coronavirus case on March 27.

The situation at Gracy Woods underscores the difficult task nursing centers and long-term senior care facilities face across the country. COVID-19 can still enter a facility that follows CDC guidelines. Once inside, the virus can spread through a close-knit community before symptoms are felt, according to the the CDC.

Smith provided documentation showing the Health and Human Services Commission investigated her facility on March 29 and 30 to check for deficiencies in infection control. The facility was found in compliance, and no violations were issued.

Personal protection

Gracy Woods employees have reached out to KXAN with concerns about how personal protective equipment, commonly called PPE, has been used at the facility.

On March 13, the Centers for Medicare and Medicaid Services issued a memorandum guiding nursing homes to restrict all visitor and non-essential personnel access to their facilities, except certain cases of compassionate care and end-of-life situations. The memo offered guidance, did not create rules and was provided to all state health and human service departments.

“For individuals that enter in compassionate situations (e.g., end-of-life care), facilities should require visitors to perform hand hygiene and use Personal Protective Equipment (PPE), such as facemasks,” according to the memo.

One Gracy Woods current employee, who asked to remain anonymous, told KXAN it wasn’t until the first positive case of COVID-19 was confirmed at the facility, which was two weeks after the federal government’s March 13 memo, that face masks were distributed to staff and personal protective equipment was widely used. KXAN independently confirmed the worker’s employment with the business and spoke with three separate employees.

“What’s the point if, you know, you are trying to prevent it, but it’s already in the facility, and you hadn’t given the proper protection a week prior,” said the worker.

Neal Brown said he was not required to wear a mask at Gracy Woods on March 24.

“I was signed in. My temperature was taken. I was given a travel questionnaire of which most of us are aware,” Neal said. “There was a box of surgical masks. I asked if I should take a mask. The attendant said, ‘No. They are reserved for doctors.’ At the time I entered the home, no one in view was wearing a mask.”

Smith said her facility followed CDC guidelines at the time of Brown’s visit. Smith said Neal was allowed only to stay in his grandmother’s room, she was on hospice care and she was not suspected of having COVID-19. There were not known cases of the virus in the facility at the time of her stay, and gowns and masks were only to be used at that time in residents’ rooms that required isolation, Smith added.

The CDC lays out extensive guidelines for nursing and assisted living facilities on its website. Since March 13, those guidelines for nursing homes have included the following:

  • Active screening of residents and staff for fever or respiratory symptoms.
  • Remind residents to practice social distancing and perform frequent hand hygiene.
  • Cancel communal dining and all group activities, such as internal and external group activities.
  • For individuals allowed in the facility (e.g., in end-of-life situations), provide instruction, before visitors enter the facility and residents’ rooms, provide instruction on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the resident’s room.

HHSC is regularly updating its guidance web page with new information for nursing homes. On Thursday the agency created a living document to answer frequently asked questions and provide new information for nursing facilities.

Breakouts across Texas

Gracy Woods is not alone. NBC News reported on March 20 over 400 long-term care facilities across the country have found COVID-19 cases among residents and staff. Six Austin-area facilities have had cases confirmed by KXAN. We have found no evidence of violations at any of the facilities specifically related to COVID-19 cases.

KXAN independently confirmed nursing home cases in and around Austin after receiving emails from concerned viewers. HHSC would not provide a list of nursing homes with confirmed COVID-19 cases.

Beyond Austin, Galveston County Health Officials confirmed 83 cases at a single facility called The Resort in Texas City. At San Antonio’s Southeast Nursing and Rehabilitation, 67 people have tested positive and three have died, according to media reports.

Lubbock news station KLBK confirmed numerous cases of COVID-19 at nursing homes in that city. As of March 31, over 40 of the city’s 100 cases were confirmed in senior facilities.

In Dallas, one nursing home in Oak Cliff confirmed at least 30 COVID-19 cases, according to a Dallas Morning News report.

One of the earliest major outbreaks of COVID-19 in the U.S. occurred at a nursing home in Kirkland, Washington. Life Care first discovered cases in late February. On March 21, The New York Times reported over 80 residents had tested positive for the virus and 35 had died.

Past problems

The state cleared Gracy Woods of any problems in late March, but the facility has had HHSC violations in the past. In its last comprehensive inspection of Gracy Woods on Aug. 22, 2019, HHSC found seven violations of state standards. The violations included improperly administering drugs, failing to safely cook, store and distribute food, and failing to correctly store and handle oxygen cylinders. All the violations were corrected within four days, according to state records.

Since 2016, HHSC has received 50 complaints about Gracy Woods. Of those complaints, only three have been substantiated, according to data obtained by KXAN.

Gracy Woods was sued twice in 2019 for wrongful death; both of the cases are pending. The federal government scored Gracy Woods “below average” on medicare.gov, giving the facility low marks for staffing and quality measures.

‘I would go back in today’

Neal Brown regarded the quality of service his grandmother received, in her last moments of life, as exemplary.

“There were 30 staff on shift when I visited. I believe I visibly saw approximately 10 of them. None of them were wearing masks. Everyone was exceptionally friendly, caring and understanding,” he said.

At the time, Neal said he was more concerned for staff than himself. But within a week of his visit, he began feeling the tell-tale symptoms of COVID-19: loss of smell, coughing and fever.

On April 6, Neal received confirmation he tested positive for COVID-19 himself.

“In order to give my family that closure, that piece of mind, I would go back in today,” Neal said. “But, knowing what we know now, I would wear personal protective equipment.”