When COVID-19 tore through Donald Wallace’s nursing home, he was one of the lucky few to avoid infection.

He died a horrible death anyway.

Hale and happy before the pandemic, the 75-year-old retired Alabama truck driver became so malnourished and dehydrated that he dropped to 98 pounds and looked to his son like he’d been in a concentration camp. Septic shock suggested an untreated urinary infection, E. coli in his body from his own feces hinted at poor hygiene, and aspiration pneumonia indicated Wallace, who needed help with meals, had likely choked on his food.

“He couldn’t even hold his head up straight because he had gotten so weak,” said his son, Kevin Amerson. “They stopped taking care of him. They abandoned him.”

As more than 90,000 of the nation’s long-term care residents have died in a pandemic that has pushed staffs to the limit, advocates for the elderly say a tandem wave of death separate from the virus has quietly claimed tens of thousands more, often because overburdened workers haven’t been able to give them the care they need.

Nursing home watchdogs are being flooded with reports of residents kept in soiled diapers so long their skin peeled off, left with bedsores that cut to the bone, and allowed to wither away in starvation or thirst.

Beyond that, interviews with dozens of people across the country reveal swelling numbers of less clear-cut deaths that doctors believe have been fueled not by neglect but by a mental state plunged into despair by prolonged isolation - listed on some death certificates as “failure to thrive.”

A nursing home expert who analyzed data from the country’s 15,000 facilities for The Associated Press estimates that for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes. Those “excess deaths” beyond the normal rate of fatalities in nursing homes could total more than 40,000 since March.

These extra deaths are roughly 15% more than you’d expect at nursing homes already facing tens of thousands of deaths each month in a normal year.

“The health care system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope,” said Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco, who conducted the analysis. “There are not enough people to look after the nursing home residents.”

More virus, higher mortality rates

Comparing mortality rates at homes struck by COVID-19 with ones that were spared, Kaye also found that the more the virus spread through a home, the greater the number of deaths recorded for other reasons. In homes where at least 3 in 10 residents had the virus, for example, the rate of death for reasons besides the virus was double what would be expected without a pandemic.

That suggests the care of those who didn’t contract the virus may have been impacted as health care workers were consumed attending to residents ill from COVID-19 or were left short-handed as the pandemic infected employees themselves.

Staffing challenges

Chronic understaffing at nursing homes has been one of the hallmarks of the pandemic, with a few homes even forced to evacuate because so many workers either tested positive or called in sick. In 20 states where virus cases are now surging, federal data shows nearly 1 in 4 nursing homes report staff shortages.

On New York’s Long Island, Dawn Best saw that firsthand. Before COVID-19 arrived at Gurwin Jewish Nursing Home, she was pleased with the care her 83-year-old mother, Carolyn Best, received. She enjoyed activities, from tai-chi classes to visits from a pony, and was doted on by staff.

But when the lockdown started and the virus began to spread in the home, Best sensed the staff couldn’t handle what they had been dealt. The second time her mother, a retired switchboard operator, appeared on screen for a scheduled FaceTime call, she looked awful, her eyes closed as she moaned, flailed her arms above her head and just kept repeating “no.” Best insisted a doctor check her out.

A few hours later, the doctor called, seemingly frantic, saying she only had a moment to talk.

“The COVID is everywhere,” Best remembered her saying. “It’s in every unit. The doctors have it, the nurses have it and your mother may have it.”

In the end, 59 residents at Gurwin would be killed by the virus, but Best’s mother never contracted it. She died instead of dehydration, her daughter said, because the staff was so consumed with caring for COVID-19 patients that no one made sure she was drinking.

“My mom went from being unbelievably cared for to dead in three weeks,” said Best, who provided medical documents noting her mother’s dehydration. “They were in over their head more than anyone could imagine.”

Representatives for Gurwin said they could not comment on Best’s case. The home’s administrator, Joanne Parisi, said “COVID-19 has affected us all” but that “our staff at Gurwin has been doing heroic work.”

West Hill Health and Rehab in Birmingham, Alabama, where Wallace lived prior to his Aug. 29 death, said he was “cared for with the utmost compassion, dedication and respect.” Wallace’s son provided medical documents outlining the conditions he described.

Nursing home numbers

The nursing home trade group American Health Care Association disputed that there has been a widespread inability of staff to care for residents and dismissed estimates of tens-of-thousands of non-COVID-19 deaths as “speculation.”

Dr. David Gifford, the group’s chief medical officer, said the pandemic created “challenges” in staffing, particularly in states like New York and New Jersey hit hard by COVID-19, but added that, if anything, staffing levels have improved because of a drop in new admissions that has lightened the patient load.

“There have been some really sad and disturbing stories that have come out,” Gifford said, “but we’ve not seen that widespread.”

Another industry group, LeadingAge, which represents not-for-profit long-term care facilities, said staffing challenges are real, and that care homes are struggling in the face of federal inaction to provide additional stimulus money to help pay for more workers.

“These incidents, stemming from the challenges being faced by too many committed and caring nursing home providers during this pandemic, are horrific and heartbreaking,” said Katie Smith Sloan, LeadingAge’s president. “I hope that these tragedies will wake up politicians and the public.”

When facilities sealed off across the country in March, advocates and inspectors were routinely kept out too, all while concerning reports trickled in, not only of serious injuries from falls or major medical declines, but of seemingly banal problems that posed serious health issues for the vulnerable.

Mairead Painter, Connecticut’s long-term care ombudsman, said with dentists shut out, ill-fitting dentures went unfixed, a factor in mounting accounts of malnutrition, and with podiatrists gone, toenails went untrimmed, posing the possibility of painful conditions in diabetes patients.

Even more widespread, as loved ones lost access to homes, was critical help with residents’ feeding, bathing, dressing and other tasks. The burden fell on aides already working tough shifts for little pay.

“I don’t think anyone really understood how much time friends and family, volunteers and other people spent in the nursing home and supplemented that hands-on care,” Painter said.

See related story in tomorrow’s Times News.