On Monday, a fitness instructor came to a senior community along the southern tip of Lake Washington called The Lakeshore. Before she could meet residents, she was asked a series of questions that have become standard at that facility, and others like it, in the wake of the novel coronavirus outbreak that has hit older people harder than any others.

One question: Had she traveled to any of the countries where numerous COVID-19 cases have caused federal travel advisories advising caution, including China, South Korea, Italy, Iran and Japan? When it turned out she had a four-hour layover in Japan during a trip to Asia a couple of weeks ago, she was asked to come back in a few weeks, which she readily agreed to do, said Lakeshore Executive Director Lindsey Pelland.

Just about everyone is taking precautions as the number of new coronavirus cases — and deaths — grows by the day. But senior communities are taking more than most given that health officials have said people over 60 and those with underlying health conditions are at particular risk. Administrators have only to look at Life Care Center of Kirkland for an example of what they want to avoid. As of Tuesday, seven of the nine people who died lived at that nursing care facility.

Health officials announced three of those deaths on Tuesday, as well as seven new cases of infection from the coronavirus known as SARS-CoV-2 in King County and two more in Snohomish County. In all, there are now 27 cases in Washington state, and all U.S. deaths have happened here.

“We’re taking care of some very frail people who in many instances have compromised immune systems,” said Kris Engskov, president of Aegis Living, which run 32 senior communities in Washington, California and Nevada. “That’s a huge responsibility. We’re doing everything we can to keep them safe.”

Yet at least one nursing-home doctor fears the precautions don’t go far enough, and The Seattle Times has learned that a former 85-year-old Life Care resident who died of the virus moved to a smaller “adult family home” for seniors before it was known she was infected. It is not known whether she exposed others to the virus.

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Engskov, of Aegis, said discussions around how to protect residents started weeks back as the virus brought parts of China to a standstill. It was obvious, he said, that at some point the illness would make it into the U.S. Front desk staff began asking visitors about their international travel.

Last week, when Seattle became the epicenter of the coronavirus crisis in the U.S., things reached a more urgent level. Front desk staff have been told to evaluate everyone coming in, including nonstaff caregivers like physical therapists and hospice aides, and make decisions on a case-by-case basis, Engskov said. In addition to where people have traveled, staff are asking whether visitors have reason to believe they have been exposed to the virus and whether they are showing any symptoms, like fever and cough.

“We sent a letter to families over the weekend trying to explaining what we’re doing,” Engskov said. He said the message Aegis is trying to impart, difficult though it may be for family members to hear is: “If you don’t need to come, please don’t.”

Even within senior communities, some residents are being asked to consider limiting their visits to others. Emerald Heights in Redmond, home to some 550 seniors, held a meeting Monday for those on the “independent living” side of its 300-acre campus, according to administrators. People showing signs of sickness, who don’t have loved ones in a building housing more vulnerable assisted-living and nursing-care residents, might hold off on going there unless necessary, they were told.

Era Living, which has eight retirement communities in the Seattle area, including The Lakeshore, is giving visitors stickers, marked with green ink, to wear after they have been screened at the front desk. That way, anyone who sees them will know they’ve been cleared to come in. One community on Mercer Island is taking the temperature of all visitors with a forehead scanner that doesn’t touch the skin.

The company has also postponed big events, like regular art galas it holds where residents and neighbors are invited to see new exhibits and, often, meet the artists. Era has also canceled many bus outings, the exceptions being scenic drives where nobody gets out of the bus, and grocery trips.

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And it has stepped up disinfection of common areas with a big machine that distributes cleaning solution more thoroughly than hand-cleaning.

“We’re doing everything we can to avoid worst-case scenarios,” said Albert Munanga, Era’s regional director of health and wellness.

Still, a doctor who works at several nursing homes, who asked not to be named for fear of drawing undue attention to those facilities, said she worries that not enough is being done. One problem, she said, is they don’t have a way of testing residents and staff on-site. If people haven’t been tested, she said, they could be carrying the virus even if they haven’t yet developed symptoms. So just asking people to refrain from visiting if they have symptoms, or relying on residents to self-report, won’t necessarily work.

The doctor noted that poorly paid nursing home staffers often work at more than one facility, so some exposed to the virus at Life Care might bring it into other facilities.

Engskov, of Aegis, said managers have asked all staff whether they have worked at Life Care in the recent past, and none have.

Life Care was not under such scrutiny last Tuesday. And so the son of an 85-year-old resident of the Kirkland facility didn’t think about coronavirus when he visited his mom that evening and she told him she wasn’t feeling well. She tapped her chest, according to the son, who spoke to The Seattle Times on condition of anonymity because of his family’s concerns for privacy as they grieve.

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The next day, because of preexisting concerns about the woman’s physical therapy, the family moved her to an adult family home called Majestic Senior Care in Kirkland. She died that evening.

An 85-year-old woman, a former resident of the LifeCare Center of Kirkland, died at Majestic Senior Care, shown here, also in Kirkland. (Amanda Snyder / The Seattle Times)
An 85-year-old woman, a former resident of the LifeCare Center of Kirkland, died at Majestic Senior Care, shown here, also in Kirkland. (Amanda Snyder / The Seattle Times)

The Centers for Disease Control and Prevention told his family Monday that postmortem testing confirmed she had COVID-19. “We just couldn’t believe it,” the son said.

A woman who answered the telephone at Majestic Senior Care on Tuesday evening declined to comment on the death, saying she was waiting for further guidance from state public health officials. She did not give her name.

Katie Ross, a spokeswoman at Seattle & King County Public Health, said a communicable disease team is aware and responding but could offer few details.

Meanwhile, the woman’s son is waiting to find out if he has the virus himself. He was tested Monday and told to quarantine himself until results come in.

Seattle Times reporter Ryan Blethen contributed to this report.

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