Coronavirus tests were slow to arrive at Highland Cove, where 9 elderly and disabled Utahns have died

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Millcreek • No one in Kathleen Hardy’s family knew she had contracted COVID-19, says Ruth Schmidt, her cousin and the executor of her estate.

Then, on May 1, Schmidt said, the family was notified that the 72-year-old Hardy was dying from the coronavirus at St. Mark’s Hospital. She died that day — a Friday.

The following Monday, Schmidt phoned Highland Cove Retirement Community, where Hardy had lived, to put her affairs in order. Schmidt said her call was transferred to a business office and a staffer who didn’t know Hardy had died.

“It almost seemed like a surprise to her that [Hardy] had COVID,” Schmidt said.

Hardy, who was buried Friday at the historic Salt Lake City Cemetery, is one of at least nine Highland Cove residents to have died from the virus, according to the Utah Department of Health. That means about 14% of the state’s fatalities have come from that facility. Interviews and public records describe the coronavirus’s arrival at Highland Cove and how the state, at the time, lacked the testing capacity that might have helped stop the spread.

Dr. Allyn Nakashima, program manager for Healthcare-Associated Infections/Antibiotic Resistance at the Utah Department of Health, said she can’t identify any mistakes Highland Cove made in trying to limit the spread of the virus.

“We had read a lot of reports about [asymptomatic] carriers and all of those things,” said registered nurse Karen Poschman, resident care director at Highland Cove. “We tried to act fast and early to try and protect people.”

Poschman often cried during an interview Thursday. She declined to discuss specific residents but said one of the deceased was a friendly woman who would visit her office while Poschman updated paperwork. The woman would bring the nurse a cookie and sit next to her.

In interviews, no family members with a loved one who got sick or died at Highland Cove blamed the facility for the virus’s arrival, but some believe Highland Cove didn’t communicate well with them. Highland Cove executives did not respond to requests for comment regarding communication issues.

Highland Cove knew on April 8 it had an outbreak, according to interviews. Jerry Marshall said no one at Highland Cove told his family that before his father, 93-year-old Keith Marshall, went to Intermountain Medical Center on April 12.

“If we would have known there was a [positive] patient,” the younger Marshall said, “we probably would have called and asked them questions. We would have asked if everyone was isolated. I don’t know what we would have done. I just think I would have wanted to know.”

Keith Marshall died three days after arriving at the hospital.

“We were pleased with Highland Cove up until all this broke out,” said Chuck Furca, whose 85-year-old sister, Vivian Raye, died at the retirement community April 23. “But I can’t complain. They were in a tough situation, too.”

Launching preventive procedures

Highland Cove is owned by Century Park Associates, an affiliate of Life Care Centers of America, according to Century Park’s website. Life Care operates the nursing home in Kirkland, Wash., where, as of Friday, 45 people had died after contracting the coronavirus, according to the area health department.

Unlike the Kirkland facility, Highland Cove is not licensed as a nursing home. Highland Cove provides independent or assisted living. From its driveway at 3750 S. Highland Drive in Millcreek, Highland Cove looks like a conventional apartment complex.

The Kirkland facility found its first positive coronavirus case in February, according to news reports. Poschman, whom Highland Cove executives made available for an interview regarding resident care, said the Millcreek facility began implementing prevention measures in early March, even before Utah unleashed such requirements.

Visits by families and friends were banned. So were group activities. The dining room and common areas were closed. Staffers were screened for symptoms before starting their shifts, and wore gloves and masks when interacting with residents.

All of Highland Cove’s coronavirus cases were found on its assisted living side. Nakashima said no one has been able to figure out who brought the coronavirus into Highland Cove.

In most other long-term care facilities, the virus was transmitted by a worker who wasn’t showing any symptoms, Nakashima said. Besides its own staffers still interacting with residents, Highland Cove was allowing visits from speciality home health care workers, such as physical therapists or hospice providers, hired by individual residents.

Nakashima said the health department was notified April 8 that Highland Cove had one positive resident. Her office made sure the facility was taking action to mitigate the spread, but the state did not provide Highland Cove with tests to examine who else there might have the coronavirus. Tests were scarce in Utah, at the time, and the recommendation from health experts then was to use them only on people showing severe symptoms.

“Our ability to react to these [outbreaks] has really changed with our availability of testing,” Nakashima said. “Early on, we really struggled.”

No one has disclosed the name of the first Highland Cove resident to test positive, but the description matches Mark Kendall. His sister, Kay Lynn Balluff, said she was notified April 9 that he had tested positive a day earlier.

Kendall was a paraplegic with related health problems. Balluff said she was told her brother was weathering the symptoms, but she worried.

“Because you can’t see them,” Balluff said, “you don’t know.”

Easter Sunday, April 12, was Kendall’s 63rd birthday. Balluff planned to drop off his card and presents. Before Balluff made it to Highland Cove, she received a phone call saying her brother had been taken to St. Mark’s Hospital. He died two days later.

Also on Easter, Keith Marshall’s oxygen level plummeted, son Jerry Marshall said. The elder Marshall, who was a gunner on a Navy ship during World War II, was taken to Murray’s Intermountain Medical Center, where he tested positive for COVID-19. He died April 15 after his son decided to remove life support.

Marshall said his father’s death certificate lists his cause of death as pneumonia with circumstances being COVID-19 and chronic pneumonia and kidney disease.

“I just hate to see him go that way — contract a disease and pretty much drown in your own fluids,” Marshall said Thursday through tears. “That’s what bothers me.”

Marshall said two Highland Cove staffers later called him to ask how hospital personnel had diagnosed his dad. The retirement home staffers, Marshall said, were surprised to learn no one had notified him of the previous positive case at Highland Cove.

It was April 16, eight days after Highland Cove’s first confirmed positive case, before the Utah Department of Health returned to the center to test all the residents and employees.

A letter dated April 21 and sent to residents said six of them had tested positive. In an April 29 statement, Highland Cove said nine staffers and 20 residents had tested positive for COVID-19.

Testing tells health care workers where the virus is and warns them to limit their contact with infected patients and to watch for symptoms. Could earlier testing have saved lives at Highland Cove?

“I think so,” Nakashima said. “I think our process is much better now than it was then. Our country was suffering great testing shortages six weeks ago.”

On April 30, Dr. Angela Dunn, the state epidemiologist, announced the creation of “strike teams” that will go to long-term care facilities and other potential hot spots to provide mass testing. Nakashima said the health department now has the capability to provide testing to an entire long-term care facility within two days of being notified of a problem.

Positives and negatives

After those mid-April tests at Highland Cove, employees who had tested positive were told not to come to work. Poschman said some of the residents who tested positive have shown no symptoms.

Among those who have been sick, symptoms sometimes have been difficult to gauge because of other health problems the resident may suffer, Poschman said. Are aches and breathing troubles due to the coronavirus or arthritis and chronic asthma?

“You have to go by the resident,” Poschman said. “How different is this than normal?”

Poschman said staffers were divided into those who would serve the COVID-19 residents and those who would not. Outside the doors of the coronavirus residents, employees used tarps and other material to erect a type of airlock.

Staffers would hang their gowns and other protective equipment in the airlock to reuse each time they went in or out of a resident’s room. Poschman said the protective equipment then was tossed out at the end of each shift.

Despite the mitigation, some residents died. Ralph Faulkner died April 18 at St. Mark’s at age 91. Carol Watts, 88, died April 20. Ann Louise Fletcher died May 1 at age 98.

Fletcher was buried Wednesday in the Salt Lake City Cemetery at the same time teachers and students from American Heritage of South Jordan, a private school, stood in the parking lot of Highland Cove with signs thanking staffers there for caring for the residents.

Schmidt said her cousin Kathleen Hardy enjoyed her years at Highland Cove. She was able to make her own health decisions, Schmidt said, and might have known she was positive and chosen not to share it with others.

There have been recoveries from the coronavirus at Highland Cove. Lori Heigert’s 85-year-old mother and 90-year-old father live there. Heigert said her mother tested positive; her father did not.

After Heigert’s mom received the positive result, a nurse put on protective equipment and facilitated a teleconference with a doctor, Heigert said. April 20, Heigert’s mother showed signs of dehydration and was taken to St. Mark’s Hospital. She was in critical condition for a few days but has since improved and been discharged to a transitional care facility, Heigert said.

Her family bought a banner to hang across the front sign of Highland Cove that hails the workers there as heroes. “We just felt like they were caring about them," Heigert said.

A new round of testing was conducted at Highland Cove on Tuesday. No new positives were discovered. That means, Nakashima said, the outbreak has been contained.

Poschman looks forward to the day when she and her staffers can take off their masks so the residents can see workers smile at them and safely trade hugs. For now, Poschman has to walk past the rooms of the deceased that still have personal effects on the doors and in the windows. It’s not safe yet for families to retrieve their loved ones’ belongings.

“You walk past places,” Poschman said, “it was somebody’s favorite chair. They would sit there a lot. There are those kinds of reminders that I’ll remember for a really long time. That’s the hard part.”