Amanda Bumin, executive director of Seven Lakes Assisted Living & Memory Care, said her “entire life was consumed” by the six-week struggle to quell a coronavirus outbreak at her facility.
The virus is thought to have moved furtively into the assisted living community through an infected worker. Another infection was later identified at the facility, prompting state-mandated testing for all employees and residents.
Staff members soon bore the stigma of having their facility placed on the state’s list of outbreaks in congregate living settings. The list includes a running tally of infections and deaths at places where outbreaks have been identified.
Seven Lakes Assisted Living & Memory Care was added to the list in early July. A total of 36 infections and four deaths were eventually linked to the facility in what remains the county’s third largest outbreak in a long-term care setting.
But Bumin knows the numbers don’t tell the whole story. She knows that successfully managing an outbreak also means overcoming professional challenges and personal turmoil. And she knows her team succeeded.
“We did a pretty damn good job,” she said in a recent phone interview. “Looking back, I’m a thousand percent confident of that.”
The Travails of Testing
A coronavirus outbreak is defined by the N.C. Department of Health and Human Services as two or more active infections in a nursing home, prison or assisted living community.
In facilities with outbreaks, all residents and employees must undergo testing. This meant Bumin had to find enough testing kits for her 45 residents. She also needed to find a registered nurse who could administer the tests.
“We’re not a skilled nursing facility, so we don’t have a nurse on site 24/7 to just administer tests,” she said.
The Moore County Health Department had recently offered to conduct mass testing at any local long-term care facility that requested the service. But when Bumin contacted the health department, she was told it would be at least a week before testing could begin.
“I can’t wait until the middle of next week to even administer a test,” said Bumin, who urgently needed to know how many of the facility’s elderly residents may have been exposed to the virus. “That’s not fair to residents, families or staff members.”
She then reached out to NCDHHS, which offered to ship enough testing kits overnight to cover the facility’s residents. A nurse from Bumin’s corporate office arrived the next morning to swab the residents’ noses.
Wanting the results back as quickly as possible, Bumin personally drove the nasal samples to a state-run laboratory in Durham for processing.
With the residents’ tests taken care of, Bumin could focus on finding testing for her 25 employees. The problem, she said, was nearly all of the testing sites available in Moore County at the time required a referral from a primary care physician.
“A lot of my employees might not have doctors,” Bumin said. “A lot of them go to the ER or a walk-in clinic for their health care needs, so getting a doctor’s order is not feasible.”
She was eventually able to secure testing for her staff through CVS Pharmacy, which was the only local provider willing to test patients without a referral. A handful of employees tested positive, including Bumin.
“I was really lucky in that I didn’t have symptoms,” she said. “(The virus) doesn’t discriminate, and it’s kind of unpredictable in who it will or will not affect, and how severely.”
Bumin continued to work following her diagnosis, isolating in her office each day while dressed in layers of personal protective equipment. She did not want to “abandon the ship,” she said.
As results from the state started streaming in, it became clear that the virus had spread rapidly among the facility’s residents. A total of 31 residents, over two-thirds of the facility’s population, tested positive for COVID-19.
Bumin began the difficult task of notifying their loved ones. A colleague offered to call the families for her, but Bumin decided to tell them herself. She felt it was her responsibility.
“That was the hardest part for me personally,” she said. “You feel like you’ve done something wrong.”
Bumin worried that the residents’ families would blame her for the outbreak. She worried she would be a “failure in their eyes.”
Some of the family members cried on the phone, and Bumin wept with them. “No one was mad,” she said.
“Of course, they’re not happy that their mom or dad has COVID, but they trust us and they know that we’re doing everything that we can and we’re doing our very best to keep (their parents) safe and to not let their symptoms get out of control.”
The families continued to receive updates from Bumin as the outbreak wore on. She also posted about the situation on the facility’s Facebook page, and encouraged people in the Seven Lakes area to send notes and gifts to lift the residents’ spirits.
And while most other local facilities with outbreaks ignored inquiries from the press, Seven Lakes Assisted Living regularly sent out news releases detailing its response to the outbreak. Some of the releases included surprisingly forthright comments from Bumin. In a statement to The Pilot on July 7, she spoke out against the politicization of “basic infection-control measures,” and urged everyone to wear face coverings.
“Transparency is key,” she said last week. “You can’t try to pretend like it’s not happening. You have to be totally transparent, suck it up and have those hard conversations.”
Several of the facility’s workers stayed in hotels to avoid exposing their own families to the virus.
“They were literally either here or at the hotel for a month, and that’s a long time,” Bumin said. “They did their laundry here, ate here and then went to the hotel.”
Bumin also planned to check into a hotel, but she abandoned the idea after her husband and daughter both tested positive. Like Bumin, they did not experience symptoms.
Many staff members took on additional responsibilities during the outbreak. Maintenance manager Allen Hamilton cooked breakfast for residents. Mercedes Webster, director of activities, and Ashley Robinson, an office manager, both helped with housekeeping.
“I was very, very proud of my staff,” Bumin said. “My team is phenomenal.”
The employees, she said, were constantly sanitizing surfaces and enforcing isolation protocols. This was a challenge for workers assigned to the facility’s memory care unit, where residents would often threaten to undermine the staff’s efforts to contain the outbreak.
“It’s very difficult to keep those residents in their rooms,” Bumin said. “They have Alzheimer’s, dementia and things like that, and they’re always on the move.”
At the same time, Bumin and her staff tried to make sure the residents did not feel neglected. They played Bingo together, with employees shouting numbers from the hall.
People in the Seven Lakes community donated puzzles and other activities that the residents could do alone in their rooms. Rodney Godwin, a financial planning consultant who lives near the facility, played his ukulele for the residents over Zoom.
“We tried to remind them that there are still people out there that love them and care for them,” Bumin said, adding that isolation has been shown to accelerate symptoms of dementia among the elderly. “I don’t think my residents through any of this have felt forgotten.”
Multiple agencies came to the facility’s aid during the outbreak. The N.C. Public Safety Department’s Emergency Management Division made sure Bumin’s staff never ran out of masks, gowns and other personal protective equipment. “They were a huge help,” she said.
Brandy Baker, a registered nurse on loan from Encompass Health, came in to monitor the sick residents’ symptoms. “She was an angel,” Bumin said.
And while the Moore County Health Department failed to provide timely testing, Bumin said Melissa Fraley, the department’s director of nursing, was a “rockstar” who shared updates on residents who had been admitted to FirstHealth Moore Regional Hospital for treatment.
“I don’t know what the health department’s staffing situation is or what their job descriptions are, but it did seem like Melissa was single-handedly trying to handle everything,” Bumin said. “I don’t know if that’s everybody’s experience, but for us she was trying her best.”
Through Fraley, Bumin learned that some of the hospitalized residents had died. Writing in a news release on July 21, the health department said the deceased included a woman and three men, all of whom were older than 65.
Again, Bumin knows the numbers don’t tell the whole story. “Those residents were our family,” she said.
In early August, Seven Lakes Assisted Living & Memory Care was removed from the state’s list. The outbreak had ended, according to NCDHHS.
Dr. Kevin O’Neil, a geriatrician and chief medical officer for the assisted living community's management company, said the facility's staff members "never once let the virus impact their commitment to caring for their residents." In their response to the outbreak, he said, the employees showed "both compassion and resilience at the highest levels."
“We have been impressed by how Amanda and her team have adapted to this unprecedented time, especially through their own battle with COVID-19,” O’Neil said. “All assisted living communities could benefit from leadership like Amanda brings to Seven Lakes.”
‘They Cannot Get Sick’
After losing four residents to COVID-19, Bumin has little patience for people who downplay the threat of the disease.
“I can’t comprehend how people don’t understand the reality of COVID-19,” she said. “The only reason that it’s going away a tiny bit is because we had to be forced, kicking and screaming, to abide by things. It’s not because the election is coming up or because the pandemic was made up. It’s because of the precautions that were put in place.”
Sixteen of the 27 deaths attributed to COVID-19 in Moore County are linked to outbreaks in long-term care facilities. Three of those deaths were announced earlier this week in connection with an ongoing outbreak at Accordius Health of Aberdeen, a nursing home where nearly 80 infections have been identified.
It is one of six local long-term care facilities now on the state’s list.
“A lot of people think (the virus) is not that big of a deal anymore, but it’s still a big deal and I don't know how to get people to realize that or see that,” Bumin said. “These people, this population, they cannot get sick. It is not a risk that should be taken.”
Face coverings, hand hygiene, social distancing. None of it is up for debate, as far as Bumin is concerned. People who haven’t gone through what she experienced “don’t get to argue about it,” she said.
“Society evolves and changes, and we have to evolve and change with it or we’re going to suffer, and there’s a lot of suffering associated with COVID-19,” Bumin said. “I can tell you that because I watched people suffer.”