AUSTIN (KXAN) – Pictures of Kathleen Laurel line the kitchen counter in her daughter’s home: snapshots from weddings, dinner parties and a “Parents Weekend” celebration from her two daughters’ days as students at the University of Texas.

Those daughters, Lisa Howard and Kelly Pesek, remember their mother as a woman with a vibrant sense of humor and wit.

“She was just so funny and would always make us laugh,” Pesek said. “We were all kind of friends, once my sister and I grew up.”

Her husband, Joe Laurel, describes her as his “best friend.”

Mixed in with the happy memories, however, are the difficult ones: her Alzheimer’s diagnosis, her disease progressing, and an eventual move to a skilled nursing facility in southwest Austin. The hardest memories to process, her family said, are the ones from her final days.

Two weeks before Kathleen died last September, the family said they got word ants had been found in her room at Brush Country Nursing and Rehabilitation – and on her body.

“I went there as soon as I found out that day, and I actually spoke to the nurse that found her the night before. This sweet nurse was pregnant, and she was crying. She was telling me the story that she was the one taking the ants off my mother, and she was getting bitten as she was doing it,” Howard said.

The family took photos of what they believed were ant bites on Kathleen’s arms and legs. Both sisters told Nexstar’s KXAN they were told by leadership at the facility that wounds were a result of heat rash.

“Which seems ludicrous to me, if you see the pictures,” Pesek said. “Then, heat rash begs the question, ‘Well why — where was she in so much heat that she got a heat rash?’”

“It’s something out of a horror story,” Howard said.

There are other cases involving ants in nursing homes, including a lawsuit filed last spring in Arkansas over a woman who died after an attack and a recent report of a Fort Worth-area facility fined over an ant infestation.

Kathleen’s family filed a civil lawsuit against Brush Country Nursing and Rehabilitation and the health care company which owns it, Dynasty Healthcare Management.

KXAN reached out to the company and the law firm representing them. Attorneys for the facility and company told KXAN they could not comment on a pending legal matter, but they filed an answer in Travis County District Court denying all the claims made by the family and demanding proof of their claims of negligence. Their filing also notes, “there are inadequate factual pleadings to state a gross negligence claim against these Defendants.”

The surveyor’s report

The incident is detailed in a report completed by a surveyor with the Texas Health and Human Services Commission, who was on-site at the nursing facility for an unrelated visit. The attorney representing Kathleen’s family obtained the report and provided a copy to KXAN investigators, who verified its validity with HHSC.

The report states the facility failed to ensure a resident “with physical debilities and severe cognitive impairment was checked on as needed throughout the night shift as she was found with active ants crawling on her while she was in bed with ant bites throughout her body causing resident pain, red welts, and hives that required immediate medical intervention and treatment.”

The report cites an interview with a nurse aide who told the surveyor she tried to knock all the ants off of the resident before moving her to the recliner in the room, but that “it was impossible to check on every resident every two hours.”

According to the facility administrator’s interview in the report, he contacted pest control after the incident to “spray inside and outside of her room.” Plus, he said her room had been “deep cleaned” by the housekeeping staff.

The report also noted the administrator and the Director of Nursing at the facility audited all the residents’ rooms and “no additional ants” were found. The report also states the facility implemented “skin assessments.”

Other workers cited in the surveyor’s report detailed other issues they believe were caused by staffing shortages: resident falls, missed meals and the failure to pass out certain medications on time.

One registered nurse told the surveyor, “the lack of care residents are receiving due to being short staff[ed] was heart-breaking.”

Nationwide staffing shortages

Industry leaders and advocates in long-term care have warned of widespread staffing shortages in nursing homes across Texas, but also nationwide, in recent months.

“This is not a new issue. This is not an, ‘Oh by the way, look what COVID caused.’ We were tens of thousands of staff behind before COVID even hit,” said Kevin Warren, the president and CEO of the Texas Health Care Association, representing skilled nursing facilities.

Last fall, his association partnered with a group called LeadingAge Texas to conduct a workforce-focused survey of long-term care facilities, including nursing homes and assisted living communities. They found nearly every facility in Texas reported unfilled Certified Nurse Aide, or CNA, positions. Others had unfilled Registered Nurse roles, along with open dietary staff and housekeeping positions.

Seventy percent of the survey respondents said they could not compete with other employers.

Warren testified before lawmakers in late June about what he hopes could be long-term solutions: loan forgiveness programs for people who go to work in long-term care, more outreach to high school students or early college training programs, and more funding to offer better pay.

“How do we encourage these men and women who are looking at long-term care as an option to say, ‘This is affordable. This is something I want to do and make a career out of,’” Warren said.

Other witnesses told the Texas House Human Services committee they would like to see higher pay for staff as well, potentially in the form of longevity pay or retention bonuses.

The state’s Long-term Care Ombudsman, Patty Ducayet, told stories of residents having to wait for a bath or to get out of bed, poorly maintained HVAC systems affecting staff and residents’ quality of life, and facility vehicles sitting in disrepair – instead of being used for resident activities and appointments.

Lawmakers agreed, saying “most” of the funding “ought to be going to patient care.” Ducayet called for more transparent financial reporting by facility owners and operators to ensure that was happening.  

KXAN investigators asked Warren about that proposal, and he said he believed the nursing home industry was more transparent than many other healthcare sectors when it comes to staffing, finances and quality of care.

He said one thing was clear: “There is a significant delta between the cost of care and what the [Medicaid] reimbursement is.”

In the HHSC surveyor’s report of what was found at Brush Country Nursing and Rehabilitation, the facility administrator detailed its normal staffing schedule, which included three nurses, five CNAs, and three medical assistants during the day shift. The administrator also detailed the facility’s night shift staffing, which included three nurses and four CNAs.

The report reads, “He stated that he believed the staffing was sufficient to be able to care for all the residents appropriately.”

‘Couldn’t ask for help’

The HHSC surveyor’s report details at least four deficiencies found at the facility, including those described as Quality of Care, Sufficient Nursing Staff, Medication Errors and Physical Environment. The report notes the facility cleared up all of the deficiencies in just a few days.

Kathleen Laurel’s family said they saw her condition get worse in the days that followed, and 19 days later, she died. Her death certificate doesn’t cite the ant bites or mention the wounds seen on her body. Her cause of death was listed as “Alzheimer’s disease.”

Howard called it “heartbreaking” to lose a parent, but said it has been even harder to find out these details from her last few weeks alive, “after the fact.”

“She was completely helpless. Like I said, she was nonverbal. She couldn’t ask for help. She had no way of raising her hand and saying, ‘I need help; I’m being mistreated; I’m hungry; I have ants on me,’” Howard said.

Joe Laurel said, in general, he’d like to see minimum staffing standards enforced statewide, to ensure people with similar diagnoses in any facility will get proper care.

Pesek added, “To make sure this doesn’t happen to anyone else.”