Note: This special report on a retirement community’s plight to get vaccinated against COVID-19 first appeared in The Pilot on Jan. 29, 2021.
SOUTHERN PINES, N.C. — Marian Andersen is scared to leave her small apartment at Gracious Retirement Living in Southern Pines.
The 85-year-old is, like most of her fellow tenants, at high risk of serious complications from COVID-19. In addition to her age, Andersen has diabetes, hypertension and other conditions that make her particularly vulnerable to the coronavirus.
“If I get COVID, I will probably die because I’ve got all of these things against me,” she said in a phone interview. “I’m in constant stress over this whole thing.”
A few weeks ago, Andersen and other residents of Gracious Living were told they would be among the first wave of people eligible for vaccination in Moore County. Hawthorn Senior Living, the Washington company that owns the facility, said it had enrolled the residents into the federal Pharmacy Partnership Program, the Centers for Disease Control and Prevention’s pipeline for delivering the vaccine to long-term care facilities.
Andersen was eager to get her shot. She said the virus had spread ferociously through the apartment building, with several people on her floor testing positive.
But in a letter to tenants on Jan. 18, Hawthorn said that Gracious Living had been dropped from the program because the facility is not “attached to a skilled nursing or assisted living community.”
Gracious Living, a so-called independent living community with more than 100 residents, was deemed “ineligible and removed from the CDC Pharmacy Program,” according to the letter.
“We understand this is frustrating and disappointing,” the company wrote. “Rest assured, the entire Hawthorn family will continue to do all we can to ensure timely vaccines for all residents and staff in our independent living communities.”
Andersen said that while Gracious Living is billed as independent living, it operates more like an assisted living community. Many residents receive physical therapy and other health care services from providers with satellite offices at the facility, she said.
“Most people here need some kind of help,” said Andersen, who moved to Gracious Living from New York two years ago to be closer to her daughter. “A lot of them can’t even get dressed in the morning or shower themselves.”
Meals are prepared in-house and delivered to residents’ apartments, which are not furnished with stoves or ovens. The facility had provided bus transportation to tenants without vehicles, but Andersen said the service stopped after the bus driver “got COVID and retired” last year.
“We are an assisted living place without being called assisted living,” she said. “It’s one large building with a lot of elderly, handicapped people.”
DIFFERENT STANDARDS
For all the ways Gracious Living is similar to an assisted living community, there are some key differences.
Assisted living facilities are licensed and regulated by a division of the N.C. Department of Health and Human Services. They are subject to routine inspections and can be penalized for deficiencies.
Independent living communities like Gracious Living are exempt from such oversight. And unlike assisted living communities, they are not required to notify the state of coronavirus outbreaks.
An outbreak is defined by DHHS as two or more active infections in a congregate living setting. When an outbreak is declared at a long-term care facility, all residents and staff members must undergo weekly testing.
The facility is also added to the state’s online list of ongoing outbreaks. The list, which is updated twice a week, shows the number of cases and deaths in places where outbreaks have been reported.
There is no public data on cases at Gracious Living, and a Hawthorn spokesperson did not respond to a question Tuesday about the number of infections at the facility. Judy Halstead, who has lived at Gracious Living for three years, estimated that as many as 20 tenants have tested positive in recent weeks.
“I know there’s been right many cases, and we’ve had a few people that passed away,” Halstead said. “They don’t like to tell us anything if they can help it.”
Another woman, who asked not to be identified for fear of reprisal from her employer, said her 79-year-old father contracted COVID-19 after spending months quarantined in his apartment. She suspects her father was infected by an asymptomatic staff member who delivered meals to his room.
Eight other people on his floor tested positive around the same time, the daughter said. But because Gracious Living is not considered a congregate living setting by DHHS, it was not flagged with an outbreak.
“If you have that many cases, you should be required to report it as an outbreak just like the other facilities,” she said. “It’s crazy not to.”
The daughter, a health care professional whose employer is not affiliated with Gracious Living, believes the facility should be prioritized for vaccination along with nursing homes and assisted living communities.
“Even though they call it independent living, there are several people there that aren’t independent,” she said. “Half the people in there have their own personal nurse, and in the very beginning they mandated lockdowns and all of these other rules as if they were a nursing home. It’s like they pick and choose when they want to act like a nursing home.”
She made arrangements last week for her father, a cancer survivor suffering from Stage 4 liver failure, to get vaccinated at a different location. She said she would have sought an appointment for him much earlier had she known that Gracious Living did not qualify for the Pharmacy Partnership Program.
“They were told this whole time that they were going to be getting their shots at the facility, and then they were told they wouldn’t,” she said. “Now they’re just leaving people in their rooms indefinitely after telling them to hold tight because they were going to get the shots. Well, why did we wait this whole time when they could have been registered to get vaccinated elsewhere?”
‘NOT FAIR FOR US’
Adam Bryan, spokesperson for Hawthorn Senior Living, said the company expected independent living communities to be included in the CDC’s vaccination initiative.
In an email to The Pilot, Bryan said that Hawthorn, which owns eight other facilities across the state, enrolled more than 6,000 residents into the Pharmacy Partnership Program back in October. At the time, the CDC told the company it would be notified if there were any issues, Bryan said.
But when Hawthorn asked earlier this month when vaccinations would begin at its facilities, the CDC told the company that Gracious Living was not eligible for the program. The CDC advised Hawthorn to instead work with the Moore County Health Department and DHHS to vaccinate residents.
“At this time, neither the State of North Carolina, nor the Moore County Health Department, have been willing to assist in vaccinating the residents living at Southern Pines Gracious Retirement Living, despite numerous requests for assistance,” Bryan wrote in the email.
Matt Garner, public information officer for the Moore County Health Department, contends that the department is unable to hold a vaccination clinic at Gracious Living because of the “limited amount of vaccine available to us and the fragility of handling procedures for the vaccines.”
“In the future, as the vaccine supply increases and vaccine variations from other manufacturers are available, we do have plans to offer the vaccine in other locations, including sites where our more at-risk populations reside,” Garner said in an email.
The health department is currently administering shots to all citizens aged 65 and older at its office in Carthage. While most residents of Gracious Living meet the age requirement, they must still wait for the health department to work through its backlog of eligible individuals who have already pre-registered for vaccination.
This is not an issue for nursing homes and assisted living communities. Residents of these facilities are being vaccinated where they live by Walgreens and CVS pharmacies under the federal program.
Andersen said it is unfair to force Gracious Living residents, many of whom cannot drive, to travel to Carthage. The vaccine, she said, should come to them.
“I keep seeing these pictures on TV of all of these cars waiting in line (for vaccination), but what about the people that don’t have cars?” she said. “And these people get to go back to their houses. They don’t have to go back to a building that’s getting COVID cases every day. It’s not fair for us. We desperately need to be vaccinated.”
Ron Clarke, 86, lives in a cottage on the Northwest corner of the Gracious Living campus, about 56 yards away from the four-story apartment building where most of the facility’s residents reside. He has friends in the building, but he hasn’t visited them for weeks.
“Too many people in there are coming down with the virus,” Clarke said. “I see the funeral home up there all the time at night.”
Before the pandemic, he enjoyed eating lunch with one of his friends in the building’s dining area, which is currently shut down. His friend used a walker with a bicycle horn attached to the handle, and Clarke would tease him by imitating the sound of the horn.
Clarke said his friend died less than 48 hours after testing positive for COVID-19 last month.
“They told us he caught the virus from his caregiver,” said Clarke, a retired police officer who worked in Washington, D.C., for 44 years. “It was piss-poor planning not to vaccinate these people.”
Asked about the facility’s designation as an independent living community, Clarke said it is “time to call a spade a spade.”
“It should be cited as an assisted living facility because they’ve got a lot of people in there who have no clue as to where they are or what they’re doing, and they need somebody to help them around,” he said. “Either call it assisted living or tell these people they require housing in a different facility.”
MAKING EXCEPTIONS
Before Gracious Living was deemed ineligible for the Pharmacy Partnership Program, another independent living community in Moore County made the cut.
A vaccination clinic was held on Jan. 8 for residents of Pine Knoll, an apartment building less than three miles from Gracious Living. John Presley, a resident of the building, said the shots were administered by CVS.
“We’re independent and we got it, so I have no idea why they’re being excluded,” Presley said of Gracious Living. “Why would they not take it there if they would take it here?”
While Pine Knoll is also considered to be independent living, there is one overriding difference between the two facilities.
Pine Knoll, located off N.C. 22 in Southern Pines, is part of St. Joseph of the Pines, a senior care network that offers both skilled nursing and assisted living accommodations on a separate campus near Camp Easter Road. Despite being detached from that campus, Pine Knoll was included in the federal program because its parent organization satisfies the CDC’s definition of a long-term care setting.
Hawthorn Senior Living does not operate any regulated nursing facilities or assisted living communities in Moore County, leaving most residents of Gracious Living with a more tangled path to inoculation.
They must first pre-register with the Moore County Health Department, which is currently scheduling appointments for all citizens aged 65 and older, a group that makes up nearly a quarter of the county’s total population. They must then travel to the health department’s vaccination site in Carthage, where they will receive the first dose of a vaccine that requires two shots to be fully effective.
After receiving the first shot, they must return to an apartment building where the virus has somehow managed to spread among tenants who have been quarantined in their rooms for months.
Gordon Galtere, a Pine Knoll resident who was hospitalized with COVID-19 in November, expects to receive his second dose of the vaccine next week. Just like the first shot, the second dose will be administered as part of an on-site clinic at Pine Knoll.
Galtere believes the same service should be extended to Gracious Living.
“Everybody there should get the vaccination there,” he said. “For us older people in group settings, the worst thing that can happen is someone getting the virus and spreading it.”
Jaymie Baxley 