Randy Odette at her RV, parked in Los Angeles County on May 21, 2020. Her mother has tested positive for the coronavirus. (KQED/Molly Peterson)
A milkshake got into the nursing home; the daughter of the patient it was intended for could not.
Ninety-six-year-old Betty Odette, a resident at the Astoria Nursing and Rehabilitation Center in the San Fernando Valley, has a sweet tooth. Often brownies and vanilla ice cream, says her daughter Randy, who in early March came to the lobby of the facility with a shamrock shake instead.
State and county orders, and the way health care professionals interpret them, stopped her from seeing her mother; a care aide let the shake in.
"I mean, test me, go ahead and test me, and then let me in," Randy said.
Nearly 8,000 Californians in skilled nursing facilities have tested positive for COVID-19. According to the most recent state data, almost 20 percent of those patients have died — a far greater percentage than among the general population. That heightened risk is why the state has locked down nursing homes to most visitors, with a few exceptions.
So far, Randy Odette has not been one of them.
By April, the coronavirus crept into Astoria. On May 4, the nursing home reported that 19 workers were sick. At the outbreak's peak, on May 11, the nursing home reported 52 residents had tested positive.
As of early May, officials have recommended to all licensed facilities in California that they permit some exceptions to the lockdown, including support visits for end-of-life visitors, and for people experiencing cognitive impairments when medically necessary.
What the state offers is guidance, not a rule. The federal Centers for Disease Control and Prevention recommends screening everyone who enters a nursing home and restricting visitors except in "compassionate care" situations. Those, too, are only guidelines.
Advocates and family members report wide variation in how state and federal guidance is interpreted.
At Astoria, "They basically have to be at death's door, you know, suffered a massive stroke or they're gonna die that day, that night," Randy Odette said.
That's a call she fears. Because she's already received it, about a month ago. Early one weekend morning, around 3 a.m., her mother's blood pressure plummeted. Astoria care workers called Randy, who is her mother's guardian, to ask about end-of-life plans. So Randy asked to come in.
The night shift told her to call back in the day. She did, a few times.
"Finally, I was a little bit persuasive and they tell me, OK, are you ready to go in today, if we got you all garbed up?" Randy remembers. "And then he goes, oh, tomorrow, tomorrow; I'll call you and we'll set up a time."
Tomorrow came; a call did not. Randy called back, and she said they told her "no."
Manny Ruiz is the home's administrator. He said it was against doctor's orders to permit Randy inside.
"It is a medical decision, it is not an administrative decision," he said. "There [are] no visitors allowed to be in the facility unless it's a critical situation. And if that is a critical situation, it has to be defined by the attending physician."
Ruiz said doctors are worried about liability for spreading COVID-19 beyond Astoria's walls, and that Betty is not critical. "I feel for these residents, not being seen by their relatives. But we want to play safe as well."
Betty's doctor works for Kaiser Permanente. Kaiser spokesman Terry Kanakri didn't respond to questions about liability, emphasizing that while Kaiser doesn’t own Astoria or any other nursing homes in California, "our physicians assess and treat patients being cared for in these facilities, and their health and safety are our top priorities."
Kaiser says it is Ruiz's call.
"As far as the rules and policies at each site, including visitation, they are set at the discretion of the management teams at the nursing homes," Kanakri said.
"They all were like passing the buck and didn't want to take any responsibility for what I was asking," Randy said. "That's the way I took it."
Back in January, Randy and her mother both made big moves: Betty, to the nursing home; 62-year-old Randy to an RV now parked 20 minutes from Astoria's door. A retired hairdresser, she took care of her mother at home for almost a dozen years. The last two were especially hard. Randy was hoping to visit friends around the country in her RV; the national shutdown has delayed her plan indefinitely.
Everything she owns is inside the vehicle, including family pictures.
"She was like a movie star type," Randy said, pulling snapshots of her mother from behind the front seat. "You'll see."
They're glamorous: a candid shot from 1969 of her mother in a beaded shift dress and drop earrings; an undated portrait shows off her perfectly waved red hair and lipstick to match. In a recent picture, that glamour remains in a tilt of her chin, even as memory loss has hollowed her gaze, while age and disease have shrunk her body.
Randy says after a dozen years of caretaking, she knows her mother's health as well as the facility does. Four years ago, doctors told her Betty was in the last stages of Alzheimer's.
"I know she's going to pass soon. I can't even believe she made it to 96," she said, her voice rising and cracking. Then more quietly: "I just haven't seen her for two-and-a-half months. I want to see her before she passes."
Randy vows she would take any test, or put on any amount of personal protective gear. She's not worried she'll get COVID-19. She just wants to touch her mom one last time.
"When she goes, I think she's just gonna go in her sleep, and there won't be any time to drive down to the hospital," she says. "And they should know that."
Betty remains at Astoria, in a ward for residents with COVID-19.
The nursing home just turned Randy away again. For now, she remains at her RV.
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