When the coronavirus outbreak hit one of the largest and most troubled nursing homes on the US east coast, coughing and feverish residents were segregated into a wing known as South 2. The sick quickly filled the beds there, so another wing, West 3, was also turned into a quarantine ward.
But the virus kept finding frail and older residents, and one culprit became clear: The workers themselves were likely spreading it as they moved between rooms and floors, outfitted with little or no protective equipment. The nursing home, Andover Subacute and Rehabilitation Center II in Andover, New Jersey, which has 543 beds, was chronically short of staff and masks, and over the past two years it had received poor grades from federal and state inspectors. Residents were crowded three to a room, and as the outbreak worsened, so did sanitary conditions. Spilled food littered the floors.
Workers said they hurriedly made their rounds, dispensing medicine, changing bedsheets, feeding those who could not feed themselves and doing other tasks that brought them into close contact with residents. Some workers bought rudimentary face shields from a recreation supervisor who purchased a box online for $160 (€147). By last week, employees were pleading for help from the government and for donations of personal protective equipment in Facebook posts.
But it was too late. After receiving an anonymous tip last Monday, police found 17 bodies in bags in a small holding room at the Andover facility. The startling discovery illustrated the toll that the coronavirus outbreak has taken on the nation’s nursing homes and other congregate facilities that house society’s most vulnerable, including older people and those with mental and physical disabilities.
The whole thing is just shrouded in suspicion"
By Sunday, at least 70 Andover residents had died and dozens of the 420 remaining residents and staff members had either tested positive for the virus or were sick with fevers, coughs or both, according to county officials. The coronavirus crisis has killed more than 7,000 people at nursing homes across the country, the New York Times has determined, and has even ravaged facilities with sterling reputations. But it has been especially devastating at nursing homes such as Andover that have long come under criticism for quality of care, inadequate staffing and questionable business practices. This examination of what happened at Andover is based on interviews with current and former workers, administrators and relatives of residents, as well as a review of property records, financial filings and inspection reports. Federal and state officials said they were investigating. Relatives of residents, as well as a union that represents some workers there, have called on the state to take over the home. The state has not responded to such a request, but governor Philip D Murphy said on Saturday that he was considering sending in National Guard medics to nursing homes around the state, after having previously deployed them to two homes for veterans. Earlier in the week, Murphy had called the deaths at Andover "not just outrageous, but unacceptable".
The owner and operator of Andover said in statements that they had dealt responsibly with an unprecedented crisis that was harming nursing homes across the region. But relatives of residents who died at Andover said they were angered at the way the home had responded. After an outbreak was declared at the home on March 29th, one of the first to die was 76-year-old Albert Roberts. His nephew, Brian, said an Andover worker called his mother the morning of April 1st with the news. His uncle had not been tested for the virus, and the worker seemed to go out of her way to mention that Roberts never had a fever.
"Why is that the first thing you're saying?" Brian Roberts said. "The whole thing is just shrouded in suspicion." His uncle's body, which went straight to a funeral home, is awaiting cremation. As of Sunday, about 40 per cent of the 4,202 coronavirus deaths in New Jersey had been linked to long-term care facilities, and health officials have begun to focus on the role that workers have played in the spread of the outbreak. "We have found that staff going from facility to facility, and then within facilities, have lent itself to some of the problems that we're seeing," Judith Persichilli, the state's health commissioner, said on April 7th. Many workers at Andover discussed conditions inside the home only on condition of anonymity because they did not want to violate healthcare confidentiality or were concerned about losing their jobs. The workers said they were devoted to the residents but were ill-prepared for the outbreak, with little training and even less protective gear. They said they felt all but abandoned by the home's management and state and federal officials. "The staff are sick, and the residents are sick," said a long-time worker at the home. "It's an overwhelming thing." Andover's management has blamed the pileup of bodies on "after-hours holiday weekend issues" over Easter and Passover, as well as the high number of deaths. Workers said the bodies were placed on the floor and on gurneys inside a small air-conditioned room routinely used as a temporary morgue.
Four of the bodies were taken away by a funeral home after being discovered, and the others were moved to a refrigerated truck, Andover's police chief, EricDanielson, said. Located in a rural area of New Jersey, 88km (55 miles) northwest of New York City, Andover consists of two related facilities that are across the street from each other with separate staffs. A smaller one, Andover Subacute and Rehabilitation Center I, houses mostly older people and has 154 beds.
The larger one, Andover II, has long been a place of last resort, taking residents with advanced dementia as well as some people who had been imprisoned or discharged from psychiatric wards. The 70 deaths amid the outbreak occurred there. One government survey found that 46 per cent of long-term residents at Andover II were receiving anti-psychotic medication, versus the state average of 9.5 per cent for nursing homes. It is one of just eight long-term care facilities in New Jersey with less than 200sq ft of space for every resident, according to a Times analysis of nursing home data collected by regulators. Beds are spaced about 4ft apart, separated by a cloth curtain, workers said.
Andover has struggled in the best of times. It has had two owners in less than four years. In 2017, a former owner agreed to a $880,000 fine for billing Medicaid for providing “materially substandard or worthless nursing services”. Before the outbreak, Andover II received low ratings on federal and state inspection reports, which cited serious staffing problems. Each resident receives an average of 46 minutes with a skilled nurse a day, according to the federal nursing home report card. The New Jersey average is 100 minutes.
It is not known how the virus first entered Andover, but by late March, residents were falling ill and testing positive, and tensions were rising over how it was being handled. As the outbreak worsened, signs began appearing on doors in every hallway warning: Covid-19 patient. A worker wept openly after a long-time resident died. Housekeepers stopped coming in because of the danger, so recreation staff members were asked to clean rooms.
Workers said management at first provided masks only to registered nurses, not to others who also interacted with residents, including housekeepers, recreation therapists and nursing assistants. Late last week, the state attorney general began an investigation into Andover. Federal and state health officials also launched inspections. State officials said they issued several citations and ordered the owners to create a corrective action plan by Monday and to make hires for three key roles: an infection prevention specialist, a chief nurse and an administrative manager. One Andover employee who is home sick said she was worried that the official intervention may be too little, too late. “The state should have been looking at that place for a long time,” she said. “It shouldn’t have taken a global pandemic for them to realise: Something’s wrong.” – New York Times
