A sixth resident of the Spokane Veterans Home who was diagnosed with COVID-19 died in a local hospital Thursday, according to the Washington Department of Veteran Affairs.

The outbreak at the Spokane Veterans Home has spread to 45 residents, impacting more than half of the 86 residents who lived there at the beginning of April. Twenty-three employees have also contracted the novel coronavirus.

Three residents have died this week, following two deaths in April and one last week.

“It’s never easy to say goodbye to a veteran or family member in our Veterans Homes,” said Lourdes E. “Alfie” Alvarado-Ramos, director of the Washington State Department of Veterans Affairs, in a statement. “Each resident in our care brings their unique story, history and personality that make our Veterans Homes, a true home. To the family and friends of each resident who passes, we offer our most sincere condolences.”

More than 30 positive residents were transferred to the Mann-Grandstaff VA Medical Center starting about two weeks ago to offer a higher level of medical care if their conditions worsened and separate them from negative residents.

The Spokane Veterans Home provides short-term rehabilitation, long-term care and end-of-life care to veterans, spouses of veterans and Gold Star parents.

Spokane County Health Officer Dr. Bob Lutz said Dorothy MacEachern, a state health department infection preventionist, was at the nursing home this week to work with staff.

Some residents who were transferred to Mann-Grandstaff could return to the Veterans Home soon, if they test negative for COVID-19 twice in a row.

Some residents have died after being transferred to Mann-Grandstaff, while others have been transferred to local hospitals for treatment.

The reason some have apparently pursued treatment and other have not could be due to advance-care directives or end-of-life care plans, according to Heidi Audette, communications director at the Washington Department of Veterans Affairs.

“Everyone coming to a nursing home has a right to make decisions on what type of care they choose if their health declines and they require lifesaving actions,” Audette said in a statement to The Spokesman-Review.

“Each individual determines whether they choose to be resuscitated, transferred to a hospital or placed on a ventilator,” Audette continued. “Medical providers follow these advance directives closely and adhere to resident rights rules to honor the wishes of each individual regarding their own personal care.”