Amanda Roy and her mother, Anna Littlejohn, at Amanda's college graduation in 2012. Littlejohn is now a resident at Maplecrest Rehabilitation and Living Center in Madison and has become infected with the coronavirus as part of an outbreak at the facility. Credit: Courtesy of Amanda Roy

Early on in the coronavirus pandemic, Amanda Roy and her siblings considered bringing their 61-year-old mother, Anna Littlejohn, to live in their homes rather than in the Madison nursing home where she has spent nearly three years after developing a bone infection from a cyst on her knee.

With other health problems including diabetes and high blood pressure, Littlejohn was especially vulnerable to COVID-19, an illness that has caused many of the state’s virus deaths as it has spread through long-term care facilities. But ultimately, Littlejohn’s children couldn’t make the logistics work to move her out of Maplecrest Rehabilitation and Living Center.

Now, Roy said, they are “devastated” by the decision.

Beginning sometime in mid-August, COVID-19 began circulating through Maplecrest after an employee caught the disease from a parent, who had in turn caught it from another child who attended an Aug. 7 wedding in the Millinocket region, according to state health officials.

Now, that wedding has sparked Maine’s largest outbreak of the disease, with at least 176 cases tied to it as of Tuesday. A large chunk of those cases have been detected more than 200 miles to the south at the York County Jail, where the virus swiftly spread among inmates, workers and their families after an employee attended the wedding.

But the grimmest outcomes have so far been in Madison, where six elderly residents of Maplecrest have now died after becoming infected with COVID-19, bringing the total number of deaths tied to the wedding to seven. In total, the disease has been detected in at least 24 residents and 15 workers, according to the Maine Center for Disease Control and Prevention.

One of them is Littlejohn. After she first tested negative for the disease in August, she received a second test late last week that came back positive, according to Roy.

So far, she has not shown any symptoms that were distinguishable from her other health problems, including a separate skin infection. Roy and her siblings, including a sister who has worked as a certified nursing assistant in nursing homes, are in regular touch with their mother over phone and text.

Now, Roy said, she is “angry” with the couple who chose to go ahead with their Aug. 7 wedding, which included a ceremony at Tri Town Baptist Church in East Millinocket and a 62-person reception at the nearby Big Moose Inn that violated several state restrictions meant to prevent the spread of COVID-19, including a 50-person limit on indoor functions.

The couple, Spencer and Mariah Ross, have not made any public statements about the wedding and have declined multiple requests to be interviewed.

“I’m glad they got the greatest day of their life,” Roy said. “But it made a nightmare and probably the worst days of some other people’s lives.”

Anna Littlejohn, a resident of Maplecrest Rehabilitation and Living Center in Madison, recently tested positive for COVID-19 after an outbreak at the facility connected to an Aug. 7 in the Millinocket region. Here she is in May 2018, helping to plant flowers at the center on Mother’s Day. Credit: Courtesy of Amanda Roy

Roy, who lives in Lincoln and normally works as a caseworker for people with intellectual disabilities and mental health challenges, also raised some concerns about the way Maplecrest has handled the outbreak.

The Maine CDC advises nursing homes with an active COVID-19 outbreak to create separate units for infected or possibly infected residents, and designate workers who have been infected or possibly infected to help those residents exclusively. That strategy, known as cohorting, is meant to reduce the risk that workers could carry COVID-19 to residents who are not thought to have it.

But Roy said that an administrator of Maplecrest told her that workers were alternating between units for patients confirmed to have COVID-19 and those who had tested negative. She now thinks that practice caused her mother to catch the virus.

“I believe that she got it because there were staff working on the COVID-positive units and they were coming into her unit,” Roy said. “I feel like if you have positive cases on one unit, and you have staff who are going between units, I feel like that’s going to encourage the spread of the virus.”

A representative from Maplecrest referred questions to North Country Associates, the company that manages the 58-bed facility in Somerset County. Mary Jane Richards, North Country’s chief operating officer, has not responded to multiple voicemail messages or a set of emailed questions.

On Monday, Maplecrest representatives told the Maine CDC that it is now separating residents with proper physical barriers and designating workers to see them, according to Nirav Shah, director of the Maine CDC. But Shah referred questions about what sort of cohorting the facility did during the first few weeks of the outbreak to Maplecrest’s administrators.

Shah also said that Maine’s congregate-living facilities have generally done a good job of implementing cohorting after the discovery of COVID-19 outbreaks, even though it is “very difficult to accomplish.” While stringent isolation is the goal, he said long-term care facilities may not have enough physical space to spread residents out or enough workers to easily meet their minimum staffing levels. It can also be difficult to move some types of residents to other units, depending on their health needs.

In addition to her concerns about the staff crossing between units, Roy said that Maplecrest should be more “transparent” with the families and the larger community about the outbreak. It now holds weekly conference calls for family members of residents, and staff will also speak one-on-one over the phone to relatives.

A pedestrian walks past the Maplecrest Rehabilitation and Living Center shown in Madison on Aug. 19. Credit: Rich Abrahamson/The Central Maine Morning Sentinel via AP

But she is “very disappointed” that the facility has not acknowledged the deaths from the outbreak or provided much other information on its Facebook page. “Just from a family that has a family member there…it would mean a lot” if they wrote a statement, she said.

Roy appreciates the difficulty all long-term care facilities face in finding adequate staffing. She also knows that the workers at Maplecrest truly care for the residents and want to do what’s best for them.

But she decided to speak out about the outbreak in part to educate other families about the need to advocate for their relatives who live there and find out what’s happening to them. For Roy and her siblings, that advocacy has included arranging for their mother to be taken straight to a larger hospital rather than to Redington-Fairview General Hospital in nearby Skowhegan if her condition worsens.

“I have to think of my mom and how to best protect her and put her first,” she said.

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