Jose Gonzalez doesn’t know much about the coronavirus. But he does know life has changed at the La Casa Mental Health Rehabilitation Center in North Long Beach, where he lives.
He knows people have to stay in their homes right now because of the virus. He knows it’s why he has to wear a mask. He knows it’s why staff members at the mental health center are bringing him meals instead of serving them in the dining room. He knows it’s why he’s not allowed to leave the facility to visit his family on the weekends, like he used to.
And, he said in a phone interview, he knows his sister is scared for him because of the coronavirus.
Gonzalez, like many of the 205 other patients at the facility, hasn’t seen firsthand how the global pandemic has changed nearly every aspect of daily life for those beyond the center’s walls.
He’s still living in the same room with a roommate. He’s still allowed to be in close contact with other residents. He still shares a pay phone with others who live in his unit to receive calls.
While jails are releasing inmates and nursing homes isolate residents to stem the spread of COVID-19, the disease caused by the coronavirus, families of people like Gonzalez who live in mental health and psychiatric facilities are left wondering what those locations are doing to protect their loved ones.
Long Beach, for its part, issued a health order earlier this month requiring congregate health care facilities, including La Casa, to conduct daily temperature checks for staff and residents, instruct patients to wear face coverings when outside of their rooms and suspend all communal dining and activities, among other regulations.
Still, five staff members and one patient have tested positive for COVID-19 as of Friday morning, said David Heffron, vice president of operations for Telecare, the corporation that operates La Casa. More patients and staff members who were exposed to those with the virus have also been tested; the facility, as of Friday, awaited those results.
Heffron said in a phone interview that staff members are complying with Long Beach’s orders as best they can.
The facility conducts symptom checks daily, he said. Patients are taught about the importance of hand washing. Hand sanitizer is available.
“We offer every client, every day, a mask, encouraging them to wear it,” he said. “Many do. Some don’t.”
Long Beach, for its part, said it is working closely with the facility to manage the outbreak.
“La Casa has been very cooperative,” city spokeswoman Chelsey Finegan said in a statement, “and has implemented strict infection control protocols to prevent additional cases.”
Gonzalez’s sister, Maribel Gonzalez DeTemple, said she knows it’s difficult for these locations in particular.
“If you keep schizophrenic people locked up in a room all day and you bring them their meals and only allow them to go outside for a couple minutes, they’re going to become a danger to themselves or to others. They could become suicidal. They could become aggressive,” she said in a phone interview. “I understand why they’re still letting residents congregate and freely walk throughout the unit, but that’s going to contribute to the spread.”
According to the Los Angeles County Department of Mental Health, there are 76 publicly funded mental health facilities in the county that offer 24-hour or residential care. That’s 76 venues where people with varying degrees of mental illness — many of whom are suffering from conditions that can be exacerbated by loneliness or social isolation — are living together in close contact.
At La Casa, Heffron said the site maintains social distancing, including working to ensure those who share a room remain at least 6 feet apart.
“In any congregate living environment, and of course this is more challenging because folks are here with complex behavior health and mental health conditions, it’s challenging,” he said. “But so far, we are doing, I think, as well as can be expected.”
For DeTemple, Gonzalez’s sister, the solution is simple: let her brother come home.
In normal times, when businesses are open and traffic fills the freeway and toilet paper sits in abundance on grocery store shelves, DeTemple can’t care for her brother as intensely as his condition requires. She has to work. And her job, in community organizing — which includes events on nights and weekends — keeps her out of the house even more than a typical 9-to-5.
That’s why she and her family admitted Gonzalez to La Casa in the first place.
But these days, as people are ordered to stay home except for essential businesses, to keep the coronavirus from overwhelming the hospital system, she has the time.
“This is the time we’re able to help because we’re not going to work,” she said. “We’re working from home. We can watch them 24/7 because we’re home 24/7.”
She has requested permission to bring Gonzalez home through the duration of the pandemic, with medication and support from La Casa — while continuing to pay for their services — but has been told that if she takes him out of the facility, there is no guarantee he will be able to return.
Representatives for Telecare — which, according to Los Angeles County, operates eight publicly funded outpatient facilities and three publicly funded 24-hour or residential-care facilities in the county — said they could not comment on specific people or cases.
But, Heffron said, in general, the company does its best to work with clients’ conservators and families to support their own individual decisions.
“We would work with the family and respect any family’s decision if (pulling a patient out of the facility) is what they chose to do,” he said, “but people do need a lot of support, and we are here to give 24/7 supervision and recovery-based services, including psychiatrists and primary care staff that come in every day.
“So, we feel like we have the services and supports available,” Heffron said. “Regardless, families can and will, I suppose, make their own decisions.”
DeTemple and her three siblings, the offspring of Mexican immigrants, had rough childhoods.
Her mom did her best with the kids, and DeTemple said she believes her mother “did an awesome job” considering their circumstances.
But it wasn’t until DeTemple was in college that she thought her family would finally be OK. She thought they had achieved what she called “the immigrant dream.”
She, along with her brother and two sisters, grew up in South Los Angeles in the late 1980s and early ’90s. Drive-by shootings were commonplace; DeTemple has vivid memories of the glass windows in her home shattering above her head.
Her father was murdered when she was 12, and her mom was left to raise the children on her own.
Still, the Gonzalez kids worked hard. They all went to college. Elizabeth, the oldest, went to Humboldt State University. Maribel got a full ride to UCLA. Jose attended UC Berkeley, also on a full academic scholarship. And the youngest, Gabriela, followed her in big brother’s footsteps and also headed to Berkeley.
“I remember those years,” DeTemple said, “where it was just a really good feeling of, ‘We’re going to be OK.’ “
Then it started to fall apart.
The summer after his freshman year at Berkeley, Jose Gonzalez came home and began acting strangely. He was paranoid. He thought the smoke detectors in their family home had cameras. He had hallucinations. He heard voices.
“We all thought he was using drugs because of the stuff he was saying. You never think it’s schizophrenia,” DeTemple remembered. “You just think, ‘What did you smoke? What did you try? What did you experiment with and is it still in your system? Do we need to take you to a place to detox?’ And it just didn’t go away, and the erratic, paranoid behavior continued.”
One day, around Thanksgiving during his sophomore year in 2004, when Gonzalez was staying at home with his mother, he went missing.
His mom went looking for him — through the streets of Los Angeles, along Skid Row. She eventually found him at the beach, where he ran into the ocean, fully clothed. His mom screamed.
A lifeguard heard the commotion and stopped by to check on them.
“They just said, ‘This person’s not well,’ ” DeTemple recalled her mother, who has since died, telling her.
Jose Gonzalez was admitted that day to County Harbor-UCLA Medical Center, where he was diagnosed with schizophrenia.
DeTemple knows she cannot provide the services and care her brother needs on her own.
“If I bring him home without his meds, without proper support, he’ll be destabilized,” she said, “and he’ll be running down the streets of downtown L.A. I won’t know where he is, and he’s probably going to get infected anyway.”
DeTemple has gone through enough ups and downs with her brother over the 16 years since his diagnosis to know it only takes two or three days without medication for his symptoms to reappear.
He’s been in and out of facilities before.
“Every time, it’s such a hassle to get him help,” she said. “That’s why taking him out of La Casa is such a big step — because it means he’s going to be destabilized.”
She also knows that if she pulls him out now, there’s no guarantee he can return to La Casa when the pandemic is over.
“I’ve been doing this long enough to know that if my brother loses his bed,” she said, “he’s going to lose his bed for good.”
Heffron, with Telecare, acknowledged the complexities involved with choosing to remove a loved one from a facility like La Casa.
“We at Telecare and La Casa don’t independently make decisions about who gets admitted or readmitted,” he said. “We contract with the L.A. County Department of Mental Health, and we partner with them around those individual decisions.”
Representatives for the county did not respond to requests for comment.
But Heffron said Telecare does its best to support every family, with whatever path they choose to take.
“I can understand every family’s unique concerns,” he said.
“I can’t predict individual client by individual client what those decisions would be,” Heffron said about whether patients could return to La Casa if a family chooses to pull them out for the duration of the public health crisis. “But we certainly will partner with them and support whatever decisions are made around that.”
So, for now, DeTemple is stuck.
She’s stuck worrying about her brother — who has a history of asthma — and whether La Casa can truly protect him right now.
“Congregate facilities are just — everybody knows at this point how dangerous they are,” she said. “We’ve all heard about all of the cases at the nursing home in Seattle or the jail in Chicago. For those of us that have relatives in a facility, we’re just waiting to get the call that there’s been a breach — that the virus came inside.”
DeTemple has now gotten that call.
And if the virus can make its way into the facility, she believes it’s only a matter of time before the number of people who have tested positive there multiplies.
“When the virus is coming inside, it’s not the inmates, it’s not the residents that are bringing it in,” she said. “It’s the staff. They’re bringing it in, and now I need them to help me and get creative and figure out exceptions.”
DeTemple said other types of congregate living facilities are taking unprecedented action to protect the people who live in them.
“Jails all over the country are letting inmates out,” she said. “These are not normal times, and institutions are getting creative and making exceptions and trying to spread out people. Even without an outbreak, they’re trying to spread out people as much as possible.”
She feels it shouldn’t be too much to ask of sites like La Casa to do the same.
DeTemple emphasized that she doesn’t think La Casa is “a bad facility.”
“Far from it,” she said, “La Casa is the best we’ve ever had in Jose’s journey to recovery.”
But it’s because Gonzalez has gotten such good treatment there so far that DeTemple believes La Casa can step up to the current challenge.
“I want them to respond to this COVID outbreak like they’re the best,” she said. “You don’t get to not be the best just because there’s a pandemic. This is the moment to double down on that title.”
And while she knows sites like La Casa are bound by government regulations and red tape, and convincing them to change their policies is an uphill battle, it’s one she believes is worth fighting.
Pointing to her brother’s underlying health conditions, she said the stakes are too high to do nothing.
“I worry about him being able to survive this,” she said, “and I’m desperate.
“I’m making a lot of noise,” she added, “because I think my brother’s going to die.”