Why She Was Killed off “Animal Kingdom”

By administratorEntertainment and Media Discrimination and Denigration of the ElderlyNo Comments

I wrote the other day that Ellen Barkin was killed off her TNT series, “Animal Kingdom,” after four seasons. At the same time, she left her talent agency, CAA, and BFF Bryan Lourd, after 12 years.

Some fans speculated that Ellen wanted out. Let me tell you, no actor really wants off a TV series. If they leave, it’s usually because of a failed negotiation, i.e. money. But Barkin is loaded, so that wasn’t the reason. It wasn’t her decision, clearly, to have Smurf shoot herself in the head.

So what was it? A fan with few Twitter followers wrote in and asked Barkin a simple question: WHY? She answered succinctly: “65-year-old woman.”

Ouch!

Ellen Barkin, kids, is hot. She doesn’t look like a “65 year old woman.” But she’s made her point. And even though “Animal Kingdom” the movie was centered on a mother who rules her unruly brood of gangster sons, the series will now go on with just young people. How crappy is that? My guess is that without Barkin, the bottom drops out of whatever ratings they had.

But will outspoken Barkin speak about ageism and what happened to her? Or she is bound by an NDA? I sure hope not. I’ve never known Ellen to be anything but forthright on every subject. Stay tuned…

June 23, 2020

Love2724

The Dying American Prisoner

By administratorCriminal Justice ReformNo Comments

John Jay Roach was serving a 14-year sentence at Richard J. Donovan Correctional Facility in San Diego when he felt a knot in his gut that wouldn’t go away. “Bellyaches, bellyaches, bellyaches,” he later recalled. According to Roach, he went to the doctor, who said he was fine. Roach disagreed and kept returning for exams, eventually filing an appeal for more thorough testing. The following spring, a CAT scan confirmed late-stage liver cancer. “They looked at it and said, ‘Oops.’”

On August 16, 2018, at the age of 61, Roach was transferred to the hospice unit at the California Medical Facility, a prison in Vacaville where doctors and nurses are on hand to provide chronic care for more than 2,300 inmates, including terminally ill patients in hospice. (California Correctional Health Care Services, which oversees prison health care in the state, declined to comment on Roach’s account, citing patient-privacy laws.) During intake, Chaplain Keith Knauf interviewed Roach about his family and spiritual life. Part of Knauf’s job is to track down family members, old friends, and victims so that patients can seek forgiveness, if they wish. “These men have burned a lot of bridges,” he said. Roach told him his mother had passed away years before. Two younger sisters, Denise and Dawn Marie, now in their 50s, had heard enough apologies to last a lifetime, but Knauf tried to reach both of them. He managed to get through to Denise, but she refused to be put on the phone with her brother. The chaplain passed along the message that Roach wanted to apologize again.

There was someone else, too. For years in San Diego, Roach had lived with a woman he called his wife, though they had never set foot in a courthouse to make it official. On the streets and on the beach, in shelters and in cars, they had stuck together. Before Roach was sentenced for burglary, in 2017, and sent down to Donovan, they had finally gotten a roof over their heads with help from the street ministry downtown. It was a mobile trailer, condemned, but it was theirs. His wife, too, had recently been diagnosed with cancer. Lately she had been holed up in the Travel Time Motel on the east side of San Diego near the Lucky Lady Casino and Card Room. Roach was hell-bent on dying by her side, and he had heard that, for terminally ill prisoners like him, there was an escape hatch.In the hallway across from the TV room, someone had posted a pinboard of photos of men who had been released from the facility. Some had been paroled—among them, those granted “medical parole” because they were permanently and seriously incapacitated—but many had gotten out through a policy known as compassionate release, which lets dying inmates in California appeal to spend their last weeks on the outside. Patients gathered at the board to look at the snapshots and be reminded of a whole world beyond the fence. One man had ridden a Harley cross-country before his death. Another made it back to his mother’s house for one more home-cooked meal.

With the right signatures, Roach could see his wife again. With the help of the hospice staff, he filed an application for compassionate release. “It had always been them against the world,” Knauf says. “They wanted to leave this world together.”Roach had been arrested in Texas, Oklahoma, Oregon, and California, but he’d never stepped foot in a wing like the hospice in Vacaville. The 17-bed unit is tucked away from the rest of the prison down a hall called the X Corridor. Its walls are decorated with dozens of finished jigsaw puzzles. Portraits of Martin Luther King Jr. and the Dalai Lama overlook the common area where guys play pinochle, clean the fish tank, and finish the next puzzle to hang on the wall. Incarcerated pastoral-care workers attend to the patients for 15 to 37 cents an hour, depending on their level of experience. Wearing smocks and blue slacks, they help their fellow inmates eat, use the bathroom, and scrub clean in the group shower at the hub of the unit, pulling latex gloves from their pockets when the work gets dirty.Matthew Ferguson, a 39-year-old pastoral-care worker, spent countless hours listening to Roach talk about his wife. “He was okay and resigned to his own death,” Ferguson said, “but he hated the idea that he was abandoning her in her time of need.” Ferguson encouraged Roach to think about the times he had felt free. For Roach, freedom was shorts and flip-flops, wandering the beaches of San Diego with his wife. Ferguson had been homeless, too, and the two bonded over the cold nights on the street and the difficulties of finding a bite to eat—but also over that boundless freedom.

Roach filled his waking hours writing cards and letters to his wife, who had moved from the Travel Time Motel to a hospice in San Diego. Chaplain Knauf got in touch with the pastor down there, and now and then, he would come with his cordless phone and let Roach have a few minutes to talk with his wife. On October 10, she had a spark in her voice. They daydreamed about a visit. “She was way too sick to come up this way,” Knauf says. “The spirit is willing, but the flesh is weak.” Roach told her to hang tight. He’d come to her.The following day, Roach received word that his compassionate release had been approved by corrections. Next, a judge in San Diego would have 10 days to review the case.Thirteen days later, on October 24, Knauf got a call from the pastor at the San Diego hospice: Roach’s wife had died. When Roach took the phone and heard the news himself, he sobbed, with Ferguson by his side. “He held my shoulders,” Roach told me later. “He did everything he could to comfort me. I don’t actually know how you’d call it. It’s just … he was there.” The chaplain recalled, “I talked to him about what legacy she left for him. She would want him to keep living, keep fighting, just like they were when they were together.”Less than a week later, on October 29, Roach’s compassionate-release application was approved. With Roach’s wife no longer waiting for him, Knauf and the hospice staff had to come up with an alternative release plan.

On Friday afternoons, a van full of sisters from Sacramento arrives at the California Medical Facility, and they proceed down the X Corridor. They are the sisters of the Missionaries of Charity, an ascetic order that follows the teachings of Mother Teresa. They pray with the patients who are awake and pray for the patients who are sleeping. Their fellow sisters in Pacifica run a hospice home for patients with nowhere else to go, and they always let Chaplain Knauf know when they have a bed for a new patient to rest during his final days.So, on November 2, a medical transport drove Roach beyond the prison’s concertina-wire perimeter. They hit the highway, speeding west toward the ocean, where the sisters of the Missionaries of Charity had a bed waiting. “Can you imagine being cared for by a bunch of Mother Teresas?” Knauf said. “What better way to go home?”

Beginning in 2010, the U.S. prison population began to fall for the first time in decades—yet the number of older inmates has nearly tripled since 1999. Inconsistent data and accounting make health-care costs difficult to track across all 50 states, but one trend is evident: As the average age of prisoners has risen, so too has the cost of caring for them. The isolation and stress of prison life accelerate the aging process, and a lack of quality medical care can lead to health problems that could be managed with ease on the outside. By some estimates, incarcerating older inmates costs anywhere from three to nine times more than younger prisoners—largely due to health-care costs as prisoners age.

In California, the percentage of inmates 55 or older rose by more than 500 percent between 1990 and 2009, and health-care costs multiplied along the way. In 2001, the average annual health-care cost per California inmate was $5,362. By 2018, that number had ballooned to $27,756, nearly three times the amount of money the state spends per public-school student. Add the cost of security and transportation, and that figure is even higher. “These prisons were built for young healthy men,” said Michele DiTomas, the chief physician and hospice director at the California Medical Facility. “Nobody expected to be spending $100,000 for an inmate for a year.”Congress authorized a federal compassionate-release program in 1984 to grant judges the flexibility to adjust sentences for inmates in “extraordinary and compelling circumstances” such as terminal illness. Over time, 49 states and the District of Columbia adopted similar policies. Critics of compassionate release, including law-enforcement unions and victims’-rights groups, argue that violent offenders pose a risk to public safety, regardless of their age or medical status. Many want convicted inmates to serve the full time to which they have been sentenced, even if that means dying behind bars in a wheelchair or on an oxygen tank. Advocates believe that releasing sick, elderly inmates does not put the public at risk, and that shifting the burden of care from prison to the health-care system can lower the cost of mass incarceration. They also say that it is humane, sparing people the indignity of hospice in handcuffs and orange jumpsuits.

Yet while the possibility of compassionate release exists in many places, it is rarely granted, with inmates often dying in custody while seeking release. According to a 2018 analysis of data obtained by the Marshall Project and The New York Times, the Federal Bureau of Prisons approved less than 6 percent of the 5,400 requests for compassionate release it received between 2013 and 2017 from people in federal prisons. While 312 inmates were granted release, all the other applications were denied or hadn’t yet been processed—including those of 266 people who died in custody before the end of 2017.It is unclear how many of the applications in progress at the end of 2017 were eventually accepted or denied, but reviews of individual cases showed that decisions are inconsistent—and often go against the recommendations of the doctors and wardens who know the patients best. A 2013 review by the Office of the Inspector General found that nearly 60 percent of inmates who had their applications denied were rejected on the basis of their criminal history, but that the bureau “does not have clear standards on when compassionate release is warranted, resulting in ad hoc decision making.”At the state level, statistics on the compassionate-release process are scarce and rarely made public. What’s clear is that cases are regularly bogged down by complex and confusing policies that can raise false hope for inmates and their families—or discourage them from applying in the first place.

In California, patients first have to be deemed terminally ill by a doctor who gives them a prognosis of six months or less to live; that finding must be approved by the state prison system’s chief medical executive. From there, they are evaluated by custodial officials to ensure that they present no harm to the public. Those convicted of attacking an officer of the law or sentenced to life without parole, for example, are automatically disqualified. From there, depending on the nature of their sentences, they go up to the state parole board for review, or they may ultimately be redirected back to the county court where they were originally convicted.With so many eligibility requirements and variables, compassionate release cannot be rushed, but given the time-sensitive nature of these cases, the entire process is supposed to be completed within roughly 30 to 60 days. In practice, review times and acceptance rates vary dramatically, depending on whether the case is taken up by the state parole board or local courts. According to data I requested from the California Department of Corrections and Rehabilitation, 64 inmates applied for compassionate release in 2018. Of these, 13 patients were granted release (including Roach) after waiting, on average, 70 days for a decision. Fourteen applications were rejected. Twenty inmates died while still awaiting a decision. Of the remaining 17 inmates, one reached his parole date during the process and 16 rescinded their applications before a decision was made, either because they realized they weren’t eligible or because their intensive treatments started working. All told, the data indicate a sprawling, unpredictable process that spans correctional facilities, doctor’s offices, administrators, and courtrooms across the state.

Even if compassionate release is granted, prisoners cannot be released without an approved place to stay. The ideal solution is for them to return home to spend their final days with family, but even with supports like Medicare and in-home hospice, returning home isn’t always realistic. “Some family may have not seen them for quite some time,” Paul Reyes, a social worker at the California Medical Facility, told me. “They may not be able to walk. They may be in a wheelchair. They may be bed-bound. They may need help bathing or feeding. Initially some families are like, ‘Yeah, great’ … but they come to understand what it means.”

According to DiTomas, the California Medical Facility doctor, some families simply don’t have the space or the means, even when they want to bring their loved ones home. Other options can be limited. Few hospices and skilled-care facilities take in convicted felons. Others are too close to a playground or a school to permit a registered sex offender. Even when there’s a perfect fit, beds are often full.Organizations like the Missionaries of Charity fill a void, offering hospice care to people who have nowhere else to turn. Historically, that has meant taking in terminally ill homeless people or AIDS patients who are estranged from their families, but as California’s prison population has aged, the sisters have become a fixture at the California Medical Facility. These days they try their best to save a bed for the chaplain. Their compassionate-release patients and terminally ill parolees are treated like any other hospice patient—no handcuffs, jumpsuits, or special rules—and someone’s criminal past is of no concern to the caretakers.

For Roach, the sisters were offering the only bed available to him in the state of California, and after all the rigmarole of petitioning for compassionate release, he would only need to complete a simple, one-page form to secure it. “The sisters always take our guys,” said the chaplain.

The Gift of Love is a 10-bed hospice in a residential neighborhood off Highway 1 in Pacifica, where the cliffs drop to the sea. There the sisters of the Missionaries of Charity live a contemplative life inspired by their founder, Saint Teresa of Calcutta. They spend about six hours in prayer six days a week, and nearly every waking hour on Thursdays.

By the time I meet Roach, he is just weeks away from death. The sisters provide interviews about their work only on background, preferring to avoid media attention, but they grant me permission to visit Roach so long as he’s comfortable talking. What I want is to spend time with one of the rare inmates granted compassionate release to learn what freedom means to someone who is dying—and to understand what matters most to him in his final days. We speak at his bedside between his doses of morphine, tracing the contours of his life when his mind is clear. To fill in the details, I speak with his friends, lawyers, and caretakers, and follow a trail of papers documenting a life entangled in the criminal-justice system.

The first time I visit, in January 2019, I find Roach resting in room two, across from the medicine room. His adjustable hospital bed sits beneath a crucified Jesus, and a window lets in a trapezoid of sun from the patio. Eight months after his diagnosis, he still fills out his dark sweatpants, gray shirt, and black ski cap, but the tattoos on his wrists and chest look as if they are melting into his jaundiced skin. On a bedside table is a smoothie and a bell to ring if he needs one of the sisters.

“The sisters here, they stepped up and took me in,” he says. When he first arrived, he was feeling well enough that he could walk down to the corner market for cigarettes, or take in a view of the ocean. The sisters even drove him across the Golden Gate Bridge to Muir Woods, where he stood in Cathedral Grove at the foot of the redwoods.Nowadays he’s unsteady on his feet, but when a wave of energy lifts him, we step outside for a cigarette and sit down at a plastic table. A black man about Roach’s age, in a white shirt, cap, and glasses, sweeps the patio, whistling. He steps up to our table to shake my hand and introduce himself: Ronnie Roy Taylor. He and Roach both came here from the hospice in Vacaville, where I’ve seen Taylor’s picture on the chaplain’s wall.As we stand together, Taylor bursts into a coughing fit and pounds his chest with his palm. “You know what I’m doing?” he asks, then pulls down his shirt to reveal a nicotine patch over his chest. “Taking a cigarette break. Ha!” Taylor is dying of lung cancer, but he’s been feeling better lately, taking walks around the neighborhood.When I ask Roach about what brought him to the Vacaville prison, he seems hazy from his morphine treatments; he falls back in time to 2016, his last mix-up with the law, the charges that took him away from his wife. “They said it was Burglary 1,” he growls. “It wasn’t Burglary 1. It. Was. Not. Burglary. One,” he repeats like a rosary. “It was a collection.”

He finishes his smoke, shuffles back to his room. In the corner, his guitar leans against a chair, his leather jacket hangs on the door, his watch ticks on the bedside table. Soon he’s drifting off.The records say it was midmorning on a Saturday in August 2017. Gloomy clouds lingered over Pacific Beach in San Diego. Roach and three other men climbed the stairwell to a second-floor apartment on Bond Street, one of them holding a gun. A woman answered, her little boy standing in the living room behind her. The guy who owed them money wasn’t home. One of the men—a former roommate of their target—asked if he could charge his phone. When the woman unlatched the chain, all four men forced their way inside. One of them held the gun on the woman and the boy while the other three searched the apartment. Finding no cash, they gathered up bags of drugs and the woman’s jewelry. When they heard sirens in the distance, they ran down to the riverbed in Rose Canyon, a marshy creek nearby. Roach hid belly-down in the muck, the jewelry and drugs under his shirt. He knew they were finished when he heard a growl—a police K9. Within the hour, they were all in handcuffs.It was the last of a lifetime’s worth of arrests and convictions—for rape, assault, hit-and-run, robbery, and other crimes. Whenever I steer my conversations with Roach to his criminal background, he keeps it simple: “I was me … badass.” It’s as if, in preparation for the next life, he is determined not to revisit the mistakes of this one. During some of our talks, he isn’t thinking clearly enough to know the current year, let alone comment on decades of convictions, so in those moments I turn off the recorder and let him rest. At other times, he is sleeping, barely breathing, and all I can do is refill his water pitcher and hope for another, better day.

By late January, Roach can’t walk by himself without falling over. The sisters put him in a wheelchair. When I visit on January 24, he hasn’t eaten in three days, and he’s pondering what’s coming next. “Nobody knows what’s on the other side,” he tells me, speech slow and labored. “I don’t. I’m sure you don’t. I wish I did. Then I could embrace it. Or look away.”Between stories—or in the middle of stories—he takes long pauses to catch his breath, lick his lips, or close his eyes to visit the past. In 1976, he tells me, at the age of 18, he left his mother’s house in San Diego and caught a bus to Fort Ord to join the Army. “I hated everything about it,” he says. Eight weeks later he was discharged for reasons he doesn’t have breath to recount.Later, he went north to Syracuse to find his old man, who was working as a boilermaker. It’s hard for Roach to pinpoint when he got into his first big trouble, the kind that lasts your whole life, but arrests followed him across the country—Oklahoma, Texas, Oregon, back to California.Even Roach isn’t sure why they let him out of prison. “Because of my age, I guess,” he says. “My illness. Because of my ability to atone.”

I ask how they knew he’d atoned. When he doesn’t respond, I ask if he thinks he’s atoned.

“No,” he says. “Not really.”

The sisters got in touch with Denise and Dawn Marie, but they said they didn’t want to be contacted again, not even when their brother died. One of the volunteers found Roach’s sisters on Facebook and showed him their pages. “There was a picture of my mother on there,” he says. “It was a nice picture. I’d like to get that picture.” When Roach drifts off to sleep, I take out my phone and pull up his sister’s account. When he comes to, I show him a picture I found of his mother. “That’s her,” he says, coughing. “She was a good-looking woman.”

When he falls asleep again, I head down the highway to get the picture printed. The air is brisk and tinged with salt. When I return, Roach is awake. I hand him a letter-sized full-color print. He takes a long look, as if he’s being transported to the year it was taken—when his mother was a young woman, when he was a boy. “Can you set that over there where I can see it?” he asks.Before I leave, he asks me to get a message to his sisters. “Tell them I’m close to going out,” he says. “I feel it. I’m not afraid, but I know.” On my way out the door, he reiterates how much he wants to talk to them one more time: “I could use a goodbye.”That night I find his sisters again on Facebook, both still in San Diego. I send them each a message. The next morning, I see the blue check that indicates Dawn Marie has seen my message. I imagine her giving it a second thought, as if all this effort—Knauf, the sisters, some reporter—will be enough to unlock whatever has rusted shut. Instead she deactivates her account. Several months after John’s funeral, I send them each a personal letter asking for comment, but I hear nothing.

One reason compassionate release isn’t as effective as advocates want it to be is because it can be difficult to prove that a person fulfills its requirements, and the requirements themselves are idiosyncratic. In California, for example, patients require a prognosis of six months to live to qualify for compassionate release, yet predicting how long a patient has to live is one of the most difficult things for a doctor to do. “A prognosis doesn’t mean I guarantee he’s dead in six months,” DiTomas said. “It means there’s a greater than 50 percent chance that you will not be alive in six months.” She and other experts argue that the prognosis requirement should be extended to one year to give doctors a more realistic time horizon for determining whether patients are eligible.

Take Roach and Taylor. Both were receiving palliative care for terminal cancer at the California Medical Facility in the summer of 2018. By the fall, Roach was shedding weight, experiencing spells of confusion, and going days at a time without eating before being granted compassionate release. Taylor was putting on weight, sweeping up at the Gift of Love house, and shopping at Target after being released on parole.A challenge of writing and implementing compassionate-release policies, or even parole procedures for elderly and dying inmates, is balancing a patient’s physical condition with an inmate’s capacity to do harm. Some offenders, no matter how sick, are deemed too dangerous for release. Prisoner’s-rights advocates say recidivism among inmates over the age of 50 is exceedingly rare. Yet Roach and Taylor both committed crimes well beyond 50 and even into their 60s. Some people in their physical condition verbally assault caretakers and other patients, though Roach and Taylor were known to be friendly.It seems that Roach was granted compassionate release and Taylor was paroled partly because of their benevolent behavior in hospice and the willingness of doctors and staff to advocate for a place for them to stay on the outside. But staff at the California Medical Facility hospice are generally devoted to advocating for compassionate release and medical parole, whether a patient is well behaved or not, and they have the training and experience to navigate the process. The hospice staff process more compassionate-release cases than any other facility in the state, so they know the ins and outs of the system. Cases from other facilities, by contrast, are often caught in a confusing web that spans multiple agencies at the state and local levels.

“There are problems at every level, from doctors being trained to prognosticate properly to understanding what prognosis means,” DiTomas said. With so many steps in the process—and no alert system when an application stalls—it’s all too common for cases to be delayed. Sometimes a case is left “spinning for three months” before ending up right where it started, she said. “Then we just start all over, but it would’ve been nice if we’d started three months ago.”Even if the path to compassionate release is streamlined at the state level, bureaucratic obstacles would remain in county courts. “The penal code says they have 10 days to hear the case, and they just don’t do it,” DiTomas said. “And yeah, their dockets are full. I think they don’t understand. They don’t know that this guy, number 6, his mother is sitting at his bed sobbing, hoping that he gets out.”

On February 8, I’m at Roach’s bedside again. His head is sunk in the pillow, eyes closed, hands folded as if in prayer. One of the sisters has hung the picture of his mother above the window.

Dying can bring two bodies together. And so it is Taylor who has been sitting with Roach, who talks even when his friend is too far gone to listen. Taylor looks even better than the last time I saw him, sporting a camouflage jacket and a baseball cap. He’s just received a free smartphone from a public-assistance program, and he’s learning to use the touchscreen.

While Roach was growing up in San Diego, Taylor was in South Central Los Angeles, cruising Compton and downtown in a Jaguar XJ12. Taylor’s bread and butter was home invasions: Beverly Hills, Palos Verdes, Rolling Hills. His Jaguar didn’t look out of place in those neighborhoods. “By the time you left the garage and went to close it, I was inside, gun out and everything,” he says. “I was doing some sick stuff, man.”He wasn’t caught until the summer of 1975. “My downfall was simply this: I took a couple of knuckleheads out of my neighborhood with me one night,” he says. When the job took a violent turn, Taylor was arrested after a high-speed chase. He was convicted of first-degree robbery and rape, and sentenced to life with the possibility of parole. He was released after 15 years, but, in the decades that followed, kept getting convicted on other charges and incarcerated again.Now, in the sisters’ place, Roach licks his parched lips. “Snap out of it!” Taylor shouts at him. To me, he adds, “He won’t eat if you don’t literally do that mama thing, ‘Hey boy, you know you gotta eat.’ He’ll eat. Especially hot dogs.”Taylor knows the spell of morphine. It was June 2018 when he first entered the hospice unit in Vacaville. For a time he was still on his feet, watching TV, playing cards, chatting up the nurses. His favorite prank was to ring the call light and hold his breath, still as a dead man, until the nurses got close enough to see him smiling. But before long, Taylor needed a walker to get up, wheezing from whatever was growing in his lungs.

Before long the nurses felt he was too weak to stand, so they took his walker away. “Next thing I know, here come morphine, that little brown pill, man. And I’m like, ‘Aw, no, this is how they get rid of people.’” (The California Medical Facility says that hospice patients have autonomy over their own pain management, and can always choose to take less morphine, or none at all.) Despite his terminal diagnosis, Taylor was determined not to die in prison. He demanded a walker, quit taking morphine, and exercised to maintain his strength until his parole date; with the help of the doctors and the chaplain, he ended up with the sisters of the Missionaries of Charity.Now one of the sisters comes in to wake Roach for a bowl of soup. “Hey, snap out of it!” Taylor shouts again. “Lunchtime, Roach!” Taylor and I retreat to the kitchen, where he continues his story over a bowl of steaming clam chowder.“I got here, man, and I walked in this house, and I’m seeing these little nuns running around, and I’m like, man, where the heck did they send me?” he says. Taylor passed time in the living room, surrounded by books. “I’ve been a Baptist. A Muslim. A Buddhist. Every type of religion they got out there, I done stuck my hand in it. None of it changed me, whatsoever … I had a void in my heart, brother, that I couldn’t fill it for nothing, and it ached, like that thorn Paul had in his side.” Taylor whistles. “Brother, the moment I got reading about Mother Teresa and the saints, man, let me tell you, it got filled. And then, a couple days after it filled, I got up and I walked in that office down there, and I told them sisters, you have to baptize me.”

Soon after, Taylor got a message that his brother Daryll had called. It had been 10 or 15 years since they’d heard each other’s voices. “I was there crying and sobbing; it was a mess,” he says. Daryll, his wife, and their son came up from Los Angeles. They barbecued right there on the patio of the Gift of Love. Laughter. Meat smoke. Music. “My sister-in-law made some greens that are still being talked about.” Even the sisters were dancing.Taylor will tell you that he is a new man, baptized, forgiven. The sisters will tell you the same. The sisters will tell you these men are children of God, thirsty, like all of us. The sisters will bring them water.

By the year 2030, one-third of U.S. inmates will be over the age of 50. In hopes of expanding compassionate release to meet the oncoming wave of ill and elderly inmates, criminal-justice advocates are pushing for reforms like clearer eligibility criteria, more realistic timelines, and more supportive release planning. Yet a lack of transparency about the programs makes it difficult for policy makers to take action, or even recognize the scale of the problem. Fewer than half of states with compassionate-release policies collect and track data on how many people apply for and receive compassionate release. The information I requested from the California Department of Corrections and Rehabilitation for this story is part of a new data-collection process that began just this year. Without meaningful records of the process, the stories of the men seeking compassionate release might well die with them.

On Thursday, March 14, John Jay Roach passed into the next world with a seminarian praying quietly by his side. “Death happens like that,” Taylor says. “All of a sudden.”Roach was to be buried in an indigent grave at the Holy Cross Catholic Cemetery, the nearest burial grounds to the Gift of Love, on the windswept hills between the San Francisco Bay and the Pacific Ocean. At 11 a.m. on a Monday, his three-car procession winds through the labyrinth of cemetery roads to the donated gravesite. For months it has been raining in Northern California, the wettest winter in decades after years of drought. For now the next storm is holding off.At the gravesite we are met by a funeral director on whom the sisters rely for discount services. Three young Dominican novices in training for priesthood sing hymns with an acoustic guitar. Three white chairs, reserved for loved ones, are empty. They overlook a blue plywood casket, suspended on planks across the open grave. By the trees, six gravediggers in clean uniforms and sunglasses stand in a line, hands folded in respect.One of the sisters hands me a hymnal. The deacon, who never misses these funerals, seems wobbly in the rising wind that flaps the pages of his Bible. “The Lord promised paradise to the repentant thief … Bring John to the joys of heaven … Praise the Lord.”

The sisters stand and sing. Taylor, weak on his feet today, sits on a fourth chair, across from the empty ones. Roach wanted to be buried side by side with his wife, and now I wonder where she is buried and how she got there. Whether there was an empty chair for her husband at her funeral.

The coffin looks too small, the way all coffins look too small. When the casket is lowered into the ground, the young men on the guitar play “Amazing Grace.” By the time I raise my eyes from the hymnal, the coffin is below ground, and the gravediggers are driving away in a utility tractor. They’ll return to replace the dirt and sod when the mourners leave, but in the meantime, we toss daisies into the earth while the deacon sprinkles holy water over the casket.Clouds mount. The missionaries slip their guitar away, but Taylor isn’t satisfied. Roach was a classic-rock guy. Taylor asks if they know “Fly Like an Eagle.” No, not “I’ll Fly Away,” the church song—the Steve Miller tune. The guitarist makes an effort, trying to finger the opening lick. Taylor jumps into the song a cappella, his voice smoky. “Time keeps on slippin’, slippin’, slippin’, into the future …”By spring, Taylor will be losing strength. Come the end of summer, he will be bed bound again. On Thanksgiving, the sisters will wheel him to chapel for prayer, then into the dining room for a feast. Then, on a wet Sunday night in December, he will slip away.But right now he is clapping. He even sings the guitar parts. The sisters smile.

When Taylor’s voice fades out, there’s a charge in the air, like rain is coming. The deacon retreats to visit his wife, who is buried elsewhere on this hill. Taylor isn’t ready to go home. Just when everyone turns for their cars, another song overtakes him: “We are standing on holy ground, and I know there are angels all around …” He takes a deep breath for the next line, and his voice comes again, stronger now, as if from the good, clean lungs of a young man.

June 18, 2020

Love162

Elderly Inmate Population Soared 1,300 Percent Since 1980s: Report

By administratorCriminal Justice ReformNo Comments

The population of aging and elderly prisoners in U.S. prisons exploded over the past three decades, with nearly 125,000 inmates aged 55 or older now behind bars, according to a report published Wednesday by the American Civil Liberties Union. This represents an increase of over 1,300 percent since the early 1980s.

More than $16 billion is spent annually by states and the federal government to incarcerate elderly prisoners, despite ample evidence that most prisoners over age 50 pose little or no threat to public safety, the report said. Due largely to higher health care costs, prisoners aged 50 and older cost around $68,000 a year to incarcerate, compared to $34,000 per year for the average prisoner.

Unless dramatic changes are made to sentencing and parole policies, the number of older prisoners could soar as high as 400,000 by 2030, posing a tremendous threat to state and federal budgets, said Inimai Chettiar, a co-author of the report.

“If we continue spending on prisons the way that we are, particularly on this aging population that’s low risk, we’re going to get to a place where states can’t afford to spend on anything else,” Chettiar said.

And while elderly inmates released from prison will require medical care and other public services, a fiscal analysis by the ACLU found that states would save an average of more than $66,000 per year for each elderly prisoner they release.

“Simply put, it is an unwise use of taxpayer dollars to spend enormous amounts of money locking up elderly prisoners who no longer need to be behind bars,” said William Bunting, an ACLU economist and co-author of the report.

The population of elderly prisoners is not booming due to a geriatric crime wave. In fact, statistics show there are fewer old people committing crimes than before, Chettiar said.

Rather, the report found that the graying of the nation’s prisons is largely the result of harsh sentencing laws enacted during the 1980s and 1990s, creating a vast pool of prisoners serving extraordinarily long sentences, often for non-violent crimes or drug offenses. Many states created statutes that triggered long sentences — including life in prison — for repeat offenders, even for those convicted of a series of relatively minor crimes.

Harsh anti-drug statutes and ‘truth-in-sentencing’ laws — which dictate that inmates serve the majority of their sentences before being paroled — also led to a sharp increase in the number of inmates growing old in prison.

As prisons increasingly resemble nursing homes, some states are considering more cost-effective alternatives. In 2011, the Louisiana legislature passed a law making it easier for inmates over the age of 60 to obtain parole hearings. The law only applies to non-violent offenders. Louisiana’s prisons suffer from some of the worst overcrowding in the nation.

Marjorie Esman, executive director of the ACLU of Louisiana, applauded the move. “Louisiana should not be using taxpayer dollars to lock up elderly individuals when they pose no danger to our communities,” Esman said in a statement at the time.

Statistics show that the likelihood of a prisoner committing a new crime post-release drops sharply in old age. However, many older inmates do end up back behind bars for parole violations.

June 18, 2020

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The Obama administration’s plan to deal with elderly inmates isn’t working. Can it be fixed?

By administratorCriminal Justice ReformNo Comments

A bipartisan group of U.S. senators led by Brian Schatz (D-Hawaii) has asked the Federal Bureau of Prisons (BOP) to take a fresh look at expanding compassionate release programs for elderly inmates. The attention is long overdue.

From 2009 to 2013, the number of federal prisoners over the age of 50 increased by 25 percent even as the figure for the incarcerated under age 50 dropped. Remarkably, the BOP houses more than 10,000 inmates who are in their 60s, 70s or 80s.

Older inmates have significantly higher medical costs than younger inmates. Elderly inmates also often need special accommodations (such as lower bunks or wheelchair-accessible areas) the BOP is ill-equipped to provide, according to a 2013 report by the Department of Justice’s Inspector General.

Recognizing these challenges and the fact that elderly inmates have a very low rate of committing further crimes after release, Attorney General Eric H. Holder Jr. announced in 2013 that compassionate release programs would be expanded for BOP inmates who were elderly, seriously ill or both. But as Schatz and his colleagues recently noted in a letter to acting BOP director Thomas Kane and Deputy Attorney General Rod J. Rosenstein, only 2 of the 296 release requests made by elderly inmates were granted during the first 13 months Holder’s expanded guidelines were in place.

The senators are asking the BOP to explain why compassionate release has been so rarely granted, as well as what could be done to expand it. The scientific field of behavioral economics would suggest that at least part of the problem lies less in the merits of individual inmate cases and more in the “default” for decision-making about compassionate release.

The current default is that elderly and infirm prisoners do not receive compassionate release unless significant time and effort is expended by the inmate and multiple levels of the federal bureaucracy. If anyone at any level disapproves or indeed just doesn’t put in any effort one way or the other, the compassionate release isn’t granted. Likewise, if the bureaucracy is simply slow at reviewing even the most meritorious cases, the release isn’t granted, which is why a significant proportion of applicants die waiting for their case to wind its way through the system.

Changing defaults changes decisions, the most famous example being that employees save much more for retirement if they have to fill out a form to opt out of their company’s 401(k) plan rather than fill out a form to opt in. If Congress wants compassionate release more broadly employed, legislators could pass a law that shifts the default to granting compassionate release for elderly inmates instead of denying it.

For example, all federal prisoners over the age of 70 who have served 15 years or more could be automatically granted compassionate release unless the BOP puts in the work to convince the sentencing judge that release is not justified for a particular prisoner. A different option would be to require the BOP to grant compassionate release to at least 5 percent of elderly prisoners every year, giving the bureau decisional authority only to choose which inmates would be most appropriate.

The specific rules Congress would put in place are less important than establishing the principle of assuming that compassionate release becomes the norm rather than the exception for elderly prisoners. Without such a meaningful change of course, the BOP could end up as the world’s most expensive nursing home.

June 18, 2020

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Frail, Old and Dying, but Their Only Way Out of Prison Is a Coffin

By administratorCriminal Justice ReformNo Comments

Credit…Jenna Schoenefeld for The New York Times

Kevin Zeich had three and a half years to go on his prison sentence, but his doctors told him he had less than half that long to live. Nearly blind, battling cancer and virtually unable to eat, he requested “compassionate release,” a special provision for inmates who are very sick or old.

His warden approved the request, but officials at the federal Bureau of Prisons turned him down, saying his “life expectancy is currently indeterminate.”

Congress created compassionate release as a way to free certain inmates, such as the terminally ill, when it becomes “inequitable” to keep them in prison any longer. Supporters view the program as a humanitarian measure and a sensible way to reduce health care costs for ailing, elderly inmates who pose little risk to public safety. But despite urging from lawmakers of both parties, numerous advocacy groups and even the Bureau of Prisons’ own watchdog, prison officials use it only sparingly.

Officials deny or delay the vast majority of requests, including that of one of the oldest federal prisoners, who was 94, according to new federal data analyzed by The Marshall Project and The New York Times. From 2013 to 2017, the Bureau of Prisons approved 6 percent of the 5,400 applications received, while 266 inmates who requested compassionate release died in custody. The bureau’s denials, a review of dozens of cases shows, often override the opinions of those closest to the prisoners, like their doctors and wardens.

Advocates for the program say the bureau, which oversees 183,000 inmates, denies thousands of deserving applicants. Roughly half of those who died after applying were convicted of nonviolent fraud or drug crimes.

Credit…Jenna Schoenefeld for The New York Times

“It makes sense to release prisoners who present very little danger to society. It’s the humane thing to do, and it’s the fiscally responsible thing to do,” said Senator Brian Schatz of Hawaii, a Democrat. “The Bureau of Prisons has the theoretical authority to do this, but they basically do none of it.”

Case files show that prison officials reject many prisoners’ applications on the grounds that they pose a risk to public safety or that their crime was too serious to justify early release. In 2013, an inspector general reported that nearly 60 percent of inmates were denied based on the severity of their offense or criminal history. The United States Sentencing Commission has said that such considerations are better left to judges — but judges can rule on compassionate release requests only if the Bureau of Prisons approves them first.

Late last month, Mr. Schatz introduced legislation — co-sponsored with Senators Mike Lee of Utah, a Republican, and Patrick Leahy of Vermont, a Democrat — that would let prisoners petition the courts directly if the bureau denies or delays their requests.

Many are turned down for not meeting medical requirements. Mr. Zeich, who was serving 27 years for dealing methamphetamine, requested compassionate release three times, but was repeatedly told he was not sick enough. On his fourth try, his daughter, Kimberly Heraldez, finally received a phone call in March 2016 saying her father would soon be on a plane, headed to her home in California.

Early the next morning, she was awakened by another call. Her father had died.

Mr. Zeich’s ashes now sit in a container in her closet alongside the splitting cardboard box of the possessions he had in prison: an insulin pump, glasses, stacks of medical records, and an album filled with photos of Ms. Heraldez and her three children.

“We brought him home,” Ms. Heraldez said, “but not the way we wanted to.”

‘I Begged Them’

When Anthony Bell applied for compassionate release in October 2014, he had served all but one of a 16-year sentence for selling cocaine.

Prison doctors treating his lupus and liver failure estimated that he had less than six months to live. It took about that long for the bureau to hand down its response: Denied.

After reading Mr. Bell’s medical records, officials concluded that he had more than 18 months to live. Two days later, he died.

“I begged them to please get him home,” said Mr. Bell’s sister, Denise Littleford, of Gaithersburg, Md. “And while the blood was still warm in his body, instead of sending him home in a body bag.”

Compassionate release dates back to an overhaul of federal sentencing laws in the 1980s. While abolishing federal parole, Congress supplied a safety valve, giving judges the power to retroactively cut sentences short in “extraordinary and compelling” circumstances. But a court could do so only if the Bureau of Prisons filed a motion on an inmate’s behalf.

For years, the agency approved only prisoners who were near death or completely debilitated. While nonmedical releases were permitted, an inspector general report found in 2013, not a single one was approved over a six-year period.

Credit…Jenna Schoenefeld for The New York Times

The report said the program should be expanded beyond terminal illness cases and used more frequently as a low-risk way to reduce overcrowding and health care spending. The Bureau of Prisons widened the criteria to explicitly include inmates over 65 and those who are the sole possible caregiver for a family member. Then Attorney General Eric H. Holder Jr. promoted the changes as part of his “Smart on Crime” initiative to “use our limited resources to house those who pose the greatest threat.”

But the bureau, which is part of the Justice Department, has yet to fully embrace those changes. Of those inmates who have applied for nonmedical reasons, 2 percent (50 cases) have been approved since 2013, according to an analysis of federal prison data. And although overall approval numbers increased slightly between 2013 and 2015, they have since fallen.

At a 2016 sentencing commission hearing, Bureau of Prisons officials said they believed the program should not be used to reduce overcrowding. And even the principal deputy assistant to Mr. Holder, Jonathan Wroblewski, said the program was not an “appropriate vehicle for a broad reduction” in the prison population. “Every administration has taken the position that part of our responsibility is to ensure that public safety is not undermined,” he said.

After the hearing, the commission released new guidelines encouraging prison officials to determine only whether inmates fit the criteria for release — that is, if they are old enough, sick or disabled enough, or if they are the sole possible caregiver for someone on the outside. Whether the prisoner poses a risk to the public should be left to a judge to decide, the commission said.

Mark Inch, who was appointed director of the Bureau of Prisons by Attorney General Jeff Sessions last August, has made no public statements about the program. The bureau declined to make Mr. Inch available for an interview and did not respond to emailed questions.

Dying in Shackles

The inmates who meet the criteria for compassionate release tend to be among the oldest and frailest in the federal prison system, whose population is getting older and more expensive. The Bureau of Prisons spent $1.3 billion on health care in fiscal year 2016. Roughly 12 percent of prisoners are 55 or older, and of those, many will spend their final years behind bars. Some are dying in shackles.

When Andrew Schiff arrived at a medical facility for inmates to say his goodbyes, his dying 87-year-old father was unconscious and on a respirator. Yet he was cuffed to his hospital bed and under 24-hour watch by an armed guard, according to Mr. Schiff. “There’s no humanity in there,” he said.

His father, Irwin Schiff, had less than two years left on his sentence for tax fraud. He had tried and failed for two years to win compassionate release.

To win approval, an inmate must get the blessing of the prison warden, and must have an acceptable home waiting. Doctors at the facility assess whether the applicant meets the medical criteria, such as being completely disabled or having fewer than 18 months to live.

If the warden signs off, the application gets passed on to the Bureau of Prisons’ central office, which has its own medical director review the records. Even after the central office approves, the deputy attorney general may object. If approved, the request is passed on to a judge, who makes the ultimate decision. An analysis of federal prison data shows that it takes over six months on average for an inmate to receive an answer from the bureau. Almost 400 of the applications the bureau received between 2013 and 2017 are still awaiting a decision.

Pushing for Change

Most state prison systems have some version of compassionate release, sometimes known as medical parole. Nationally, prisons are facing an explosion in elderly inmates, but officials can still be wary of the idea of letting them out early. Recently, a Senate committee in South Dakota turned down the prison system’s request to establish a similar program, citing concern over releasing violent offenders.

In recent months, both Democratic and Republican lawmakers have called on the Bureau of Prisons to speed up the federal process and grant more requests. Senator Richard Shelby of Alabama, a Republican, pressed the bureau for details on how it was improving the process in a report he submitted with the 2018 appropriations bill. A bipartisan group of senators, led by Mr. Schatz of Hawaii, wrote a letter last August saying they were “deeply concerned” that the bureau was failing to carry out its duties under the program.

The Justice Department’s Office of Legislative Affairs issued a response in January, citing approval rates that were slightly higher than those reflected in the data provided by the Bureau of Prisons to The Marshall Project and The New York Times. The bureau did not explain this discrepancy.

The January letter stated that cases were most commonly denied because inmates did not meet the criteria or lacked a stable place to live if they were released. But in 2016, officials turned down one of the oldest federal prisoners, 94-year-old Carlos Tapia-Ponce, on the grounds that his crime, a role in a large-scale cocaine trafficking operation, was too serious. He died the following month.

Tommy Leftwich died in prison last September. He had been serving 12 years for making meth when he was diagnosed with advanced liver cancer. The bureau said in October 2016 that his early release would “minimize the severity of his offense and pose a risk to the community,” noting a history of drug offenses and impaired driving.

Wayne “Akbar” Pray, 69, who has served nearly 30 years of a life sentence for running a New Jersey cocaine operation in the 1980s, first applied for compassionate release under the elderly inmate provision in 2013. His supporters included his warden, the current and former mayors of Newark, the local N.A.A.C.P., and several former members of Newark law enforcement.

In January, the bureau denied his request, pointing to the severity of his crime and his conduct in prison.

According to his disciplinary history, Mr. Pray’s last violation was 20 years ago, for “improperly storing property and failure to follow sanitation procedures.”

June 18, 2020

Love162

Elderly Inmates Burden State Prisons

By administratorCriminal Justice ReformNo Comments

A patient in the medical wing of the Kentucky State Reformatory in LaGrange. As the elderly population in state prisons keeps climbing, correctional systems are adding more services geared toward aging inmates, including hospice services and assisted living units.

CAPRON, Va. — Walter Melvin Atkinson is a bit vague about how long he has been in the assisted living portion of the Deerfield Correctional Center and how long he has left on his sentence. He claims to not even remember the crime — pedophilia — that landed him here.

At 92, “Speedy,” as he is called ironically by fellow prisoners and guards, is frail enough to require a wheelchair to get around, and his inmate caregivers rushed to his side to grab from his shaking hand a coffee mug that seemed destined to spill all over his cot. A huge, bright orange star has been sewn on to the white blanket that covers the cot — an idea the unit manager, Kathy Walker, dreamed up to help Atkinson spot his own bed among the six rows of beds in the spotless unit.

Atkinson is representative of an ever deepening trend in state corrections systems, and an ever growing problem, too. According to Human Rights Watch, from 2007 to 2010, the increase in the elderly population, 65 and up, being sentenced to state and federal prison outpaced the increase in the total population by 94 to 1.

Nearly every state is seeing that upward tick in elderly state prisoners. In Virginia, for example, 822 state prisoners were 50 and over (corrections officials usually consider old age for prisoners to begin at 50 or 55) in 1990, about 4.5 percent of all inmates. By 2014, that number had grown to 7,202, or 20 percent of all inmates.

For state prisons, the consequence of that aging is money, more and more of it every year. Health care for aging prisoners costs far more than it does for younger ones, just as it does outside prison walls. Corrections departments across the country report that health care for older prisoners costs between four and eight times what it does for younger prisoners.

In 2013, nearly half the $58 million that Virginia spent on off-site prisoner health care went to the care of older prisoners, according to Trey Fuller, acting health services director in the state Department of Corrections. “Over time,” Fuller said, “we’ll need more and more money for that population because they will need more drugs, more specialist visits, more nursing hours, more everything.”

Many states have taken steps to reduce their prison populations by releasing nonviolent inmates or by diverting some offenders to community programs before sending them to prison. But corrections officials say those reforms alone will do little to decrease the population of older prisoners who are serving mandatory sentences or have committed violent crimes.

Several states have adopted programs such as early release for geriatric patients or “compassionate release” for the dying. But advocates for prisoners say the programs are often so cumbersome and restrictive that few older prisoners are able to take advantage of them.

Accommodating the Elderly

The graying of the U.S. prison population reflects the rising median age of Americans since 1970. But that broader trend doesn’t fully explain the sharp increase in older prisoners. For that, corrections officials point to two factors. One is a steady increase in the rate of older adults entering prison. The second, and more potent, factor is changes enacted in the get-tough-on-criminals 1990s that resulted in longer prison sentences.

“It was the push for mandatory sentences and three strikes you’re out,” said Linda Redford, who studies health issues related to aging prisoners and is the director of aging and geriatrics programs at the University of Kansas Medical Center. “So we’re seeing people who came to prison in their 30s and 40s and 50s in their 50s and 60s and 70s today.”

Virginia’s problem was compounded in 1995 when the General Assembly eliminated parole for any offender entering its prisons from then on.

To accommodate the growing number of older prisoners, most states have been adding or retrofitting facilities.

“Prisons weren’t designed for patients who are getting older,” said Owen Murray, chief physician for Correctional Managed Care, University of Texas Medical Branch, which overseas health care for most of that state’s prisons. “They were designed for people 18 to 55” and who were able to walk, Murray said. One in five Texas prisoners is older than 50.

States have had to install ramps and shower handles and make other physical modifications. Many prisons have had to create assisted living centers with full-time nursing staffs, as Deerfield has. In addition, at least 75 U.S. prisons, including Deerfield, provide hospice services for dying prisoners, according to the Vera Institute of Justice, a nonprofit that advocates for criminal justice reform.

In prison, services for the elderly are often stretched thin. The 57-bed assisted living unit at Deerfield is always full; there’s a waiting list to get in. The nearby 18-bed infirmary provides hospice services, but its beds are also needed for nonterminal acute care patients, such as inmates who have just had surgery and need special care while they recover.

As a result, Deerfield has tightened restrictions on which elderly patients can go to assisted living or hospice care. For example, it used to be that prisoners would be considered eligible for assisted living if they could not perform any one basic task such as bathing, dressing or walking, said Susan Wright, nurse manager of assisted living at Deerfield. Now, they must be unable to do two or three or them.

Worse Health

People sent to prison are generally less healthy than the general population, having abused drugs and alcohol or neglected their health for many years. Prisoners have much higher rates of cardiac disease, high blood pressure, hepatitis C, diabetes and other chronic diseases than the general population. That is why corrections officials consider that old age comes much sooner for prisoners.

“The norm in prisons is to use 55-and-older as the metric associated with older prisoners primarily because the consensus is that our population is 10 years ahead, clinically,” of people on the outside, Murray said.

Prison is a particularly treacherous place to get old. Getting to a top bunk is difficult for many aging prisoners, as is climbing stairs. Hearing loss, dementia and general frailty can make it difficult to comprehend or obey rules. And being infirm in an institution full of young predators can make older prisoners vulnerable. “If there’s an old lion or gazelle,” said Phillip Wheatley, one of the prisoner caregivers who tends to Atkinson, “the young ones are going to take advantage.”

When aging prisoners do reach the end of their sentences, corrections officials often have a hard time placing them, even if they look beyond their state. “Private nursing homes don’t want to take elderly offenders who were murderers or sex offenders,” said Virginia’s Fuller. He is currently keeping a wheelchair-bound former prisoner in a hotel, where a nurse visits daily, “because we couldn’t find a home for him,” he said.

Atkinson seems likely to present a similar problem. He was sentenced to 27 years in 1990 for pedophilia, paroled in 2005, and taken back into custody in 2008 for entering a school in violation of his parole. Thanks to credit he earned for good behavior, Atkinson could be released later this year, but his criminal record will likely make it difficult to find an outside assisted living facility or nursing home willing to take him.

Varying Approaches

Dealing with an aging prison population isn’t so complicated, said Texas’ Murray. “Either you figure out ways to get them out of the prison system and on to Medicare, or you choose to take a firm line that those patients have to do their time and you need to fund those facilities and care services that are necessary.”

So far most states have opted for the second approach, which means continuing to add services for an elderly population, including a special dementia unit for prisoners in New York state and housing units just for the elderly at Ohio’s Hocking Correctional Facility.

In 2012, Connecticut contracted with a private nursing home in Rocky Hill to care for elderly and infirm inmates granted parole. But even there, the state is locked in a battle with the federal government over whether the facility qualifies for Medicare or Medicaid reimbursement.

Several states have a mechanism they could use to shed some older prisoners. Louisiana, Ohio and Virginia have “geriatric conditional release” laws that make old age grounds for consideration for an early release. In Virginia, prisoners are automatically considered for release if they are 60 and have served 13 years or if they are 65 and have served five years.

Last year, 505 eligible prisoners were considered for geriatric release, according to Karen Brown, chairwoman of the state’s Parole Board. Only 3 percent were granted release, she said, adding that many of those who were denied had committed violent crimes.

Decisions about aging prisoners and the risk they would pose to the outside world should better reflect their medical conditions, said Brie Williams, an associate professor of geriatric medicine at the University of California, San Francisco, who studies aging in prison. “Health care professionals and criminal justice administrators should be coming together … to evaluate people for release,” she said. “We need to develop different approaches to their parole that are informed by their medical state.”

Virginia, like most other states, also permits the governor to grant clemency to prisoners certified by doctors to have less than 90 days left to live because of terminal illness. Last year, two Virginia prisoners received such clemencies.

Studies have found that older ex-offenders are less likely than younger ones to commit additional crimes after their release. But politicians and the public don’t seem willing to release former murderers, rapists and sex offenders, even though they are decades removed from their crimes and physically incapable of repeating them, said Liz Gaynes, president of the Osborne Association, a nonprofit that works on behalf of ex-offenders.

“It comes down to they did a bad thing and they should be punished,” she said. “Endlessly.”

States will be forced to pay more and more for that attitude, Gaynes said. “What to do about this is going to be the challenge for prisons in the next 20 years.”

June 18, 2020

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Coronavirus: Nursing home deaths spike in O.C., prompting calls for more action

By administratorSenior housingNo Comments

While Orange County Public Health Officer Nichole Quick said the county is doing everything possible to contain the burgeoning number of COVID-19 cases and deaths in nursing homes, advocates for the elderly are calling for more ardent efforts and ask that the county emulate steps taken in other places with large, vulnerable populations.

On Wednesday and Thursday, 18 of the 24 coronavirus deaths in county struck residents of nursing homes and other long-term care facilities, according to county data. By Friday, the county was reporting a total of 118 deaths, with nursing home residents accounting for 45.

Nursing home residents make up less than 1% of the state’s population, according to a recent report by the Public Policy Institute of California.

But nursing homes and other long-term care facilities account for a far larger share of the county’s COVID-19 cases and deaths, with those percentages growing weekly.

At the end of April, long-term care residents and staff accounted for 14% of all county infections. They now account for 19%. And at April’s end, those residents accounted for 27% of all county coronavirus deaths, a share that had reached 38% by Friday. There’s been a single related staff death, according to county data.

“Please know that we are doing everything we can,” Quick said of nursing home infections at a press teleconference Thursday.

She listed a number of initiatives the county has undertaken to stem the rising number of nursing home infections and deaths, including a team of “infection preventionists who conduct an on-site assessment within 24 to 48 hours for any facility that has more than one resident testing positive for COVID-19.”

Additionally, the county has contracted with nursing registries to help fill staffing gaps at the facilities, has established an ambulance strike team for potential evacuations and has taken several other steps to support efforts at long-term care facilities, Quick said.

But while nursing home advocates applaud any improvements, they say far more needs to be done. That’s particularly true given the spiking numbers in Orange County, where there are now at least 21 facilities in the county with outbreaks — defined as more than one infected resident — up from nine at the end of April.

“We’re going to continue to see this kind of pace of infections and deaths for a few months,” said Michael Dark, an attorney for California Advocates for Nursing Home Reform. “We still haven’t started comprehensive testing of every resident and staff member. And until we do, we’re not going to know the extent of the problem.”

Fixing the problem

While long-term care facilities tend to be densely populated by older people vulnerable to illness, that doesn’t mean they’re predestined to be hot beds of COVID-19 infection, according to Dark.

“At community acute-care hospitals, there are a lot of infected people but you don’t see the same rate of spread,” he said. “The problem in nursing homes is poor infection control and understaffing. You can have a nursing assistant see 10 or 15 residents an hour. It’s hard to take proper infection control measures at that pace.”

As for testing patients and staff at nursing homes, some counties have been more aggressive than Orange County.

By the end of April, Orange County had begun testing all residents at any nursing home that had two or more infections among residents. It offered voluntary testing to staff that wanted it.

But by the time Orange County began mandatory resident testing, Los Angeles County was already underway with a more stringent policy requiring testing of all residents and staff at any long-term care facility with a single infection.

While Dark wants to see mandatory testing of all residents and staff at all long-term care facilities — even where there are no known infections — he said at very least, a single positive test should trigger mandatory testing of all residents and staff at a facility.

“There’s no such thing as a single resident infection,” he said. “They either got it from another resident or from a staff member.”

He noted that visitors, including family members, have been largely banned from nursing homes since the start of the pandemic.

Libby Anderson of the Council on Aging, who serves as ombudsman to nursing home residents in Orange County, also is pushing for universal testing of everyone in the facilities.

“If you have one infected staff member who’s asymptomatic, they can infect one resident after another,” she said.

Help on the way

Statewide, the percentage of COVID-19 deaths in long-term care facilities is even greater than in Orange County, at nearly 50%. But Orange County’s rates are increasingly more rapidly than those statewide.

Helping in efforts to slow the spread of infections in nursing homes is a joint collaboration between UC Irvine and CalOptima, which provides health-care services for the indigent. The effort is being led by Susan Huang, medical director of the UCI Health Epidemiology and Infection Prevention program, and funded with $629,000 each from CalOptima and the county Health Care Agency.

The program is focusing on infection prevention training at 12 county nursing homes that have high numbers of CalOptima patients. It also will develop a training program for 55 other nursing homes. The year-long intensive training began on May 8 and is underway at three facilities so far, with three more about to begin.

“The actual viral outbreaks in nursing homes are being addressed by a (Health Care Agency) response team,” said Emily Fonda, CalOptima’s deputy chief medical officer. “The OC Nursing Home COVID Prevention Program is a separate effort directed at training staff to manage current outbreaks and the expected resurgence of the virus in the fall.”

June 18, 2020

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California nursing homes are examples of how cruel the coronavirus pandemic can be

By administratorSenior housingNo Comments

DINUBA, Calif. — The gravesite still has no marker.

No grass has grown over the dry ground here, in a flat cemetery surrounded by some of the richest citrus groves in the country, where Hortensia Sosa and her husband, Luis, are buried together.

The grave is too new for that. Just dug. Just filled.

After she died of the novel coronavirus last month, Sosa’s body was kept for 10 days in quarantine. At first, family members were not allowed to leave their cars during her burial. They finally received permission to do so, but only if they stood well away from the tiny patch of ground as Hortensia’s coffin was lowered slowly on top of Luis’s casket.

“There was no rosary, no Mass,” said Olivia Lopez, the oldest of the couple’s three children. Her only contact with her 92-year-old mother in the final months of her life was through FaceTime. “I could see for two weeks how badly she was deteriorating just over the phone. But I couldn’t help her. I felt like my hands were tied.”

Sosa is among the 1,058 residents of skilled-nursing facilities who have died in California as of this week as a result of the coronavirus, a quickly escalating toll that accounts for about 40 percent of the state’s deaths from covid-19, the disease caused by the virus. While that data is reported by a majority of the state’s registered nursing homes, the total number of such deaths is probably far higher. Such homes have reported 6,250 infected residents, who because of underlying health afflictions and living in close quarters are particularly susceptible to the virus.

The disease also has ravaged front-line workers at skilled-nursing homes, the majority of whom earn little more than minimum wage. According to state public health statistics, at least 23 nursing-home workers have died of covid-19 and more than 3,600 others have been infected.

Such homes have proved to be the most vulnerable of the state’s health-care facilities and are examples of the dangers seen nationwide, from the first crush of cases and deaths in a nursing home in Washington state in late February to the widening nationwide crisis afflicting the elderly and those caring for them.

Three months since the novel coronavirus hit the United States, regulators still have few ideas for how to protect the uninfected, especially in nursing homes. And a shortage of protective equipment, cramped facilities and understaffing — due in part to the loss of workers who fall ill because of the virus — set the facilities up for tragedy and has made them the cruelest venues of this pandemic.

Workers at the Redwood Springs Healthcare Center in Visalia, Calif., listen to the prayers of well-wishers during a break outside the nursing home early this month. (Melina Mara/The Washington Post)

In New York state, there have been more than 2,800 confirmed deaths of nursing-home residents related to the virus. In Minnesota, 47 residents died in a suburban Minneapolis nursing home two weeks ago. No state is immune. Earlier this week, 14 residents of a nursing home in Stanislaus County died of the virus, among the largest single outbreaks in Northern California.

The death toll is so high in California’s nursing homes — including 27 other residents who died along with Hortensia Sosa in the Redwood Springs Healthcare Center in nearby Visalia — that privately run nursing facilities are seeking immunity from lawsuits once the virus passes. Gov. Gavin Newsom (D) has yet to comment on the request, which is ardently opposed by advocates for the elderly. The staff of New York Gov. Andrew M. Cuomo (D) inserted a similar immunity provision for nursing homes and hospitals in the state budget.

At the same time, state health officials are trying to free up hospital beds, offering nursing homes, many of them severely understaffed, up to $1,000 a day to take less serious coronavirus patients. That proposal, too, runs counter to the care that advocates say the elderly should receive.

“We’re really not yet even seeing the epic scope of this in this state’s nursing homes,” said Mike Dark, a staff attorney for the nonprofit California Advocates for Nursing Home Reform (CANHR) who calls the death and infection rates being reported to the state “tremendously unreliable.” “When we look back on this in 10 years, we will view it as more than anything a plague on the nursing homes.”

Job-jumping, little testing

There are more than 1,100 licensed nursing facilities in California, and according to the 83 percent of them reporting to the state right now, 6,600 residents are infected with the coronavirus. All have been closed to visitors — family or otherwise.

State regulations say that those infected should be quarantined within the building and that infected residents are to be cared for at the nursing home for as long as possible, keeping them away from hospitals.

“For a lot of these seniors, they are really isolated in there, and that is also not good for anyone’s health, especially if you already have other conditions,” said Long Beach Mayor Robert Garcia, who estimates that a majority of his city’s 27 deaths have come within nursing homes. “It’s really sad to see.”

Nearly every care home is looking to add staffers. A banner hanging above the Brighton Care Center in Pasadena, where dozens of residents have been infected, advertises a “sign-on bonus” for front-line workers. All shifts, the banner notes, are available.

Pasadena, a relatively wealthy city northeast of downtown Los Angeles, has 16 skilled-nursing facilities, all in proximity. That means the job-jumping that many care workers do to make ends meet in an expensive area creates exposure and spread concerns.

On April 12, Pasadena issued a health order that states that “facilities should avoid, by any means possible, utilizing employees who have worked at another facility.” Other cities have done the same.

Of Pasadena’s 28 coronavirus deaths reported by the last week of April, all had come from within care homes.

“Nobody has prioritized testing for people in skilled nursing, and so what happens is people are unknowingly spreading the virus from building to building, many because they don’t know if they’re asymptomatic,” said Deborah Pacyna, director of communications for the nonprofit California Association of Health Facilities, which represents about 900 skilled-nursing homes in the state. She said having jobs in multiple facilities is a “common practice” in the industry. “Our caregivers are exceptional people, and it’s true that they are not getting paid enough.”

In Antioch, a city in California’s East Bay, where a number of nursing homes have seen outbreaks, the Lone Tree Convalescent Hospital has recorded zero coronavirus infections among nearly 100 patients and staffers. Phylene Sunga, the administrator, put stringent “infection control” rules in place very quickly after the virus began to flourish and stepped up the care home’s cleaning routine.

The staff quadrupled the times “high touch” areas are disinfected each day. Nine staff members work at other care homes, as well. But before coming to Lone Tree they must change their clothes and shoes and wash as much as possible. One staff member who was infected at another care home was taken out of the rotation at Lone Tree.

“I told her not to come back, it wasn’t worth it,” said Sunga, assuring that the job is waiting for her when she recovers. “It’s working — so far.”

A thinning staff

Lisa Cook sent a catered barbecue dinner to the front-line workers at the Stoney Point Healthcare Center in Chatsworth, a valley town in northern Los Angeles County, to show her appreciation for the care they have given to Bruce, her husband of more than three decades.

Bruce and Lisa, high school sweethearts, were senior managers at a baby-supply store called the Juvenile Shop, working there together until Bruce suffered a stroke in December 2018. He was just 60 years old and lost function of much of the right side of his body.

Lisa Cook’s travels through a complex, expensive health-care system began — a trail well marked by the piles of legal documents, letters to and from hospitals, and legal pads of research that sit along the fireplace of her Northridge home. There is a box of rubber gloves on the kitchen table, a mask nearby.

Last fall, Bruce ended up at Stoney Point Healthcare, a 110-bed care facility about a half-hour drive away. The two could communicate through FaceTime, though Bruce needed help from an orderly to push the right iPhone buttons.

“I felt like he was getting really good care,” Cook said. “It was when this covid-19 thing hit that it got out of control.”

The biggest loss, immediately, was access to Bruce. Cook got a call from the administrator on the morning of March 14 telling her she would no longer be able to visit, because the care home was in lockdown.

Workers started to get sick — more than two dozen have been infected in recent weeks, five of whom have recovered and returned to their jobs.

“We see now who really matters in this country, who really makes it work,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “People who stock the grocery shelves, the people who are delivering the mail, the people who are picking up the garbage — those are the people that matter.”

As the Stoney Point staff dwindled, Cook had almost no way to check on her husband. He had not been infected, but had he been placed in a safe room, away from those who had the virus? Was the TV she bought him hooked up if he had been moved?

“So many of these places have become more like warehouses and less like health-care facilities,” said Dark, of CANHR. “As you lose staff, your infection control goes out the window. But traditionally if you get a citation here, it was always just the cost of doing business.”

Pacyna, the spokeswoman for the state’s skilled-nursing homes, said she would like to see some of the large venues that some cities have opened as emergency hospitals to be used to help separate noninfected patients such as Bruce Cook from those with the coronavirus.

Los Angeles County, for example, turned its large convention center into a field hospital, which has been only lightly used. Neither the convention center nor the USNS Mercy, the 1,000-bed Navy hospital ship deployed to the Port of Los Angeles, takes coronavirus patients.

“What you’re doing now is trying to create an area or a space where you can accommodate everybody,” Pacyna said. “But you’ve been in these buildings: They’re old, they’re small. Many were built in the 1950s. We’re just pushing right now for more creative alternate ways to protect these people.”

As of last week, six Stoney Point residents had died of covid-19. Under the testing rules in place at Stoney Point, and in other care homes across the state, patients are tested only if they show symptoms or if they choose to be.

“His care just appears to have deteriorated so quickly,” Lisa Cook said. “We know people are dying in this facility, and we just can’t get any information.”

In a statement, Stoney Point administrator Timothy Mason pledged to “evaluate all protocols and procedures from this pandemic in the not-too-distant future to see how we can improve upon all aspects of our communications with family members, patients, and staff.”

Waiting too long

The cluster of roses in the wide vase on top of Hortensia and Luis Sosa’s grave are from Olivia Lopez’s garden. She changes them a few times a week. And on a bright Sunday, the grassy cemetery attracting only a few families, a brother and sister talked about what the carved stone on their parents’ grave might say.

“It has to mention her laugh,” said Joseph Sosa, a mental health counselor for troubled youths, recalling that he could hear it blocks away walking home from school.

“Everyone has some thoughts,” said Olivia Lopez, his big sister. “So we’ll have to get a lot of opinions.”

Luis, who picked grapes in the San Joaquin Valley his whole working life, died in the Redwood Springs home in Visalia just before Christmas.

He was 92 and in poor health, but Olivia Lopez was unhappy with the care he received toward the end of his life. She wanted to move him into another care home. As the coronavirus began to emerge, though, there were no beds available nearby.

Her mother had checked into Redwood Springs with him in April 2019 — also 92 and suffering from dementia.

The mother and daughter FaceTimed almost daily, but in late March, after Hortensia was diagnosed with the coronavirus, she visibly weakened. Officials from Redwood Springs told Lopez to put her mom in hospice care, essentially to wait out her death.

Instead, Lopez demanded that her mother be admitted to a hospital. She received a call the following day from Redwood Springs, telling her an ambulance was on the way to get her mother and take her to Kaweah Delta Medical Center. Lopez met here there, still sealed off from actually seeing her.

“The doctor looked at me and said, ‘What took you so long to bring her here?’ ” Lopez said. She added that a nurse echoed those comments later the same day.

The next day — April 10, Good Friday — Hortensia Sosa died. Lopez discouraged friends and family from attending the viewing, where only 10 at a time would be allowed to see her mother, encased in a coffin and placed safely beneath a plexiglass dome to seal off the possibility of infection. There were few at the burial, and no reception followed.

“We will, though, we will have a Mass right here in town when this is over,” Lopez said.

In a statement, Redwood Springs administrator Anita Hubbard said the company has been vigilant and was an early adopter of local, state and federal guidance for the care of the frail and vulnerable residents in their care.

“This incident underscores the service and sacrifices made by our dedicated team every day,” Hubbard said. “We’re grateful for their continued efforts. Our top priority remains the health and well-being of everyone in our facility.”

The complex is festooned now with purple-and-white banners and yard signs that read “Heroes Work Here.” The public has expressed almost unequivocal support for the nursing and orderly staffs at even the most virus-plagued care homes, including Redwood Springs.

But the Lopez family has another worry ahead.

Lopez’s husband, Richard, has a brother in another care home where the coronavirus has broken out. Porter Lopez is 79 years old and suffers from Parkinson’s.

“There’s not much we can do,” said Richard Lopez, a retired county probation officer. “We’re just praying he doesn’t get it.”

A sign at the Redwood Springs Healthcare Center early this month. (Melina Mara/The Washington Post)

June 18, 2020

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More Than Half of All Coronavirus Deaths in LA County Are Mostly at Nursing Homes

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The number of people in Los Angeles County who have died from the coronavirus in institutional settings, primarily nursing homes, represent 51% of all deaths in the county, officials said.

Over 800 coronavirus deaths have been reported at more than 270 LA County facilities, including at juvenile and adult detention facilities, data shows.

NBCLA profiled one such facility in Calabasas that has been hit hard. More than 40 cases, including three deaths, have been reported among employees and residents at Silverado Calabasas Memory Care Community.

“All of the residents at Silverado are memory-impaired and not capable of understanding they are at risk” a spokesman for the home said in a statement. “This presents us with unique challenges in caring for residents as we are unable to isolate them in their rooms, which would be considered an illegal restraint.”

At a daily briefing on Thursday, Barbara Ferrer, director of the county Department of Public Health, stressed the lethal nature of the coronavirus, calling it vastly more deadly than the flu.

“Last year, 125 people died from influenza, and the year before, about 300 people died,” Ferrer said. “On average, we lose about 250 lives to influenza every year, and you can understand why the mortality rate of COVID-19 is so worrisome, because it far exceeds what we’re normally used to seeing with a virus or a communicable disease.”

Ferrer also stressed that the coronavirus can be lethal to people of all age groups, particularly those with underlying health conditions. Of the people who have died in the county, 92% had underlying health conditions.

“Fully 40% of the people who have died are in fact 65 years of age or younger, which means that there are a lot of people with underlying health conditions in different age groups who … become seriously ill from COVID-19 and also lose their lives, unfortunately,” she said. “Now that many people will be out of their homes more as we’re on our recovery journey, this means there’s a likelihood more people can become infected, and that means more people can infect other people.

“So if you have a chronic health condition … please take a moment to try to make sure that you will be able to continue to stay at home as much as possible.”

June 18, 2020

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As coronavirus deaths mount, L.A. County is far behind on promise to test everyone in nursing homes

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A month after vowing to test all nursing home residents and staff for the novel coronavirus, Los Angeles County health officials have completed the effort in only about a third of homes and have dramatically scaled back testing plans.

The abrupt change — which calls for testing only a small sample of residents in nursing homes that have not had an outbreak — is outlined in a letter county health officials sent to nursing homes last week, as the death toll continued to mount at facilities across the county.

Health officials defended the decision as the most efficient way to get a quick handle on what is happening in the homes. But some experts fear the move could allow the virus to continue to spread undetected, resulting in more fatalities among a vulnerable population that is already the hardest hit by the pandemic.

The COVID-19 death toll at county residential facilities topped 1,000 this week, with the vast majority at nursing homes.

“More people will die than necessary based on this policy,” said Dr. Michael Wasserman, president of the California Assn. of Long Term Care Medicine, which represents doctors, nurses and others working in long-term care facilities.

Since the start of the pandemic, most nursing homes have been testing only residents and staff who show symptoms. But in late April, as the COVID-19 death toll approached 300 in L.A. County facilities, health officials announced their aggressive new plan to test everyone in an effort to turn the grim tide.

The point of testing everyone is to catch people who are infected but show no symptoms — including employees who work at multiple nursing homes and could spread the disease from facility to facility.

But as of Monday, county officials had managed to test everyone at only 141 skilled nursing facilities, health officials acknowledged. That’s about a third of the nearly 400 facilities in the county.

All of the facilities where everyone has been tested have had outbreaks, according to county officials.

Facilities with no known cases of COVID-19 have been instructed to test 10% of residents every week, in the hope that will be sufficient to catch and control an outbreak before it gets out of hand.

“I think this was a wise move. It really was meant to allow us to do as much as possible as quickly as possible,” county health director Barbara Ferrer said at her daily briefing Thursday. She added that everybody would be tested at any nursing home if a case turned up in the sample.

Ferrer promised the first round of universal testing would be complete at homes with known outbreaks by next week.

Wasserman, who is also medical director at a nursing home in Reseda, said the new approach doesn’t make sense.

“Let’s say you have 100 people in a facility and you test everyone and find that five are positive. Well, you can do something about that,” Wasserman said. Residents would get quarantined, and employees would get sent home or assigned to work only with residents who have also tested positive.

But if you test only a small sample of residents and don’t bother to test staff, you are bound to miss positive cases, Wasserman said. Staff members with the virus will “keep coming to work and you are going to have a big outbreak on your hands,” Wasserman said.

Charlene Harrington, a professor emeritus at UC San Francisco’s School of Nursing who has studied nursing homes since the 1980s, said: “It is not good just to test those where there is an outbreak because it is too late by then — the virus will have spread throughout the facility.”

The county “needs to mandate testing twice a week in all homes that don’t have the outbreak, too, in order to isolate the employees and residents before it spreads.”

It’s not clear why the county changed its approach. Experts say fear of bad publicity and the cost of the tests could have been factors.

The first round of testing all staff and residents is being conducted by the county at no cost to the nursing homes, according to the letter. The facilities were advised to contract with commercial laboratories for ongoing testing — presumably at the nursing home’s expense.

That’s a concern for facility owners. Tests cost about $150 each, according to a recent estimate by American Health Care Assn., which represents nursing homes. It would cost $36 million to test more than 240,000 nursing home residents and staff in California, the group said.

Dr. Manuel Eskildsen, who teaches in the Division of Geriatrics at UCLA and works as a clinician for a network of nursing homes, said there has been noticeable progress in testing even in the last week.

Nursing home operators were initially concerned about the stigma of discovering a COVID-19 case and winding up on the county’s list of outbreaks. A single, asymptomatic case could get a home branded as a COVI-19 facility, which upset family members and made employees anxious.

It also hurt business.

“I have one facility in mind that had a really tough time with referrals after they turned up four or five positives,” Eskildsen said.

That’s actually “a triumph,” Eskildsen said, because it allowed the home to isolate the cases and control what could have been a huge outbreak without the testing. “But they still had that whiff about them,” Eskildsen said, referring to potential negative publicity.

The hesitance of nursing home operators to perform testing, and of public health officials to demand it, has left advocates for the elderly pleading for swifter action.

“It’s disgraceful that the county would take a step backward on testing at a time when dozens of nursing home residents are dying from the coronavirus almost every day,” said Michael Connors, a spokesman for California Advocates for Nursing Home Reform. “Without universal testing, the virus will continue to rage through nursing facilities and kill many more residents.”

June 18, 2020

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