Glenn Osborne, a 66-year-old retired Marine Corps. sergeant and Vietnam veteran, is on a battlefield. Every day, the casualties mount.
From his powered wheelchair at the troubled state-operated Veterans Memorial Home in Menlo Park, Osborne says he has witnessed the suffering of far too many fellow nursing home residents as they lay pale, barely breathing. Some, he said, are left in soiled diapers.
As president of the resident council whose complaints about the veterans home helped trigger state and federal investigations, he also says he has heard from fellow residents about wrong medications they received. Those alleged errors represent yet another danger in a facility where more than 100 people, or one in three residents, died of COVID-19 last year. He said he has received incorrect prescriptions himself.
Twice, he said, he witnessed fellow residents vomiting and convulsing. “His eyes turned deep purple and the rest of his face was white,” he recalled. “He started to foam, cough and shake to the point of collapse.”
He admits being frightened by the sight, and by what happened next. When an employee rushed to the man’s side when he called for help, he recalled her saying, “What do we do?”
“Call the doctor,” Osborne said, recalling the episode.
Glenn Osborne at the New Jersey Veterans Memorial Home in Menlo Park | NJ Department of Military and Veterans Affairs | NJ Advance Media photo illustration
Death, confusion and sub-standard care caused by the coronavirus continue to plague untold nursing homes around the country, but the problems have been relentless in some facilities in New Jersey, by most metrics the worst-performing state for residents in long-term care.
Gov. Phil Murphy, his administration and nursing home owners have jousted over who’s to blame for the thousands of deaths and horror stories. The operators say the state left them vulnerable and without the tools they needed. Murphy called the homes’ response to the pandemic: “Uneven. Disappointing. Lacking in communication, lacking in basic blocking and tackling.”
To date, more than 7,680 residents of long-term care facilities in New Jersey have died during the pandemic, not including more than 600 so-called “probable” COVID deaths that have not been confirmed by lab tests.
That’s not where it ends, though.
Left largely uncounted are those who may have died from neglect and heartbreaking conditions many still face every day. Their stories are told in jarring detail though interviews with residents and their families, and workers.
Many speak of certain facilities overwhelmed and desperately short of staff. At the same time, an examination by NJ Advance Media of mortality data showed nursing home deaths spiked in New Jersey for reasons unrelated to the coronavirus during the worst weeks of the pandemic — what the Centers for Disease Control and Prevention has termed as “excess deaths” beyond what ordinarily would have been expected.
The numbers raise awful questions. Were there hundreds, perhaps thousands, of hidden victims who died in some nursing homes because the quality of care suffered as COVID raged around them?
For example:
- Family members and advocates say many basic human needs of residents were not met in certain nursing homes. They did not get enough food, or there was no one to feed them. They were not bathed; their teeth were not brushed. In some cases, medication was not given out. There also have been allegations of outright abuse.
- Many nursing homes, long understaffed, remain woefully short on help, a concern that is widely acknowledge within the industry. The problems were exacerbated by an infectious disease that sickened 20,000 caregivers and took the lives of at least 140 in New Jersey, which industry officials themselves acknowledge affected the quality of care many received.
- Lockdowns enacted to slow the spread of the coronavirus prevented families from advocating for their loved ones — many of whom sank into deep despair. And in some places, the lockdowns also kept out medical professionals, families say.
- Inspection reports of dozens of long-term care facilities obtained under public records requests revealed incidents alleging neglect or sub-par care.
“From the day the state locked down the facilities, through the difficult months of the pandemic, there was a complete downgrade in the care and treatment their loves ones were receiving,” said attorney Paul da Costa of Roseland, who represents a number of families who have lost parents in nursing homes. “The overall picture is certainly that in April and May, it was a disorganized crisis.”
Tina Santana, who works as a housekeeper in a nursing home in Middlesex County, said it has not gotten much better.
“It’s a mess,” she said, complaining that staffing shortages continue. “It was bad before but now. it’s even worse.” Meals are delivered late, she said, and medical issues are not always reported quickly. “If someone is running a fever, you wouldn’t know until two shifts later,” she said. A member of 1199SEIU United Healthcare Workers East —which represents many nursing home workers across the state — she asked not to identify the facility where she works.
Officials at the state Department of Military and Veterans Affairs, which operates the nursing home where Osborne lives, would not respond to questions and declined all comment.
“The overall picture is certainly that in April and May, it was a disorganized crisis...”
Attorney Paul da Costa
Separately, officials in the state’s long-term care industry said they have done the best they can against a deadly foe no one could have foreseen.
“It’s heartbreaking,” said Andrew Aronson, president and CEO of the Health Care Association of New Jersey, which represents the state’s long-term care facilities, talking about the toll that virus has taken. He asserted that nursing home residents did not die because people did not try and care for them.
“They died because a horrible virus hit this community and took far too many lives,” he said.
Even before the pandemic, though, stories of abuse and neglect could be found in the state’s nursing homes, often caused by a shortage of front-line workers.
Long-term care facilities in New Jersey also have not always reported cases of suspected neglect and mistreatment. According to a damning investigation released last year by the U.S. Department of Health and Human Services’ Office of Inspector General, based on 2016 data, state inspectors in New Jersey too frequently missed signs that residents were intentionally harmed. It cited gaping bedsores, head injuries and broken bones.
Once COVID hit , state inspectors did not begin going into nursing homes to make on-site inspections until April 16 — 36 days after New Jersey reported its first death.
Still, after the state expanded its presence, inspections focused only on infection control.
With inadequate supplies of personal protective equipment, or PPE, caregivers in some facilities were resorting to wearing garbage bags to stave off infection from the virus. There was a scramble to separate the sick from the well, as facilities struggled to isolate those who had tested positive for COVID-19.
There were also allegations of outright abuse during the pandemic. In May, a homemaker-home health aide working at an Ocean County assisted living facility was arrested for aggravated criminal sexual contact, charged with groping the breast of an 84-year-old patient.
A month earlier, state Health Commissioner Judith Persichilli, who declined to be interviewed for this story, said deaths and complaints about conditions in the state’s nursing homes were “a tragedy” that “will haunt us for a long time.”
MORE DEATHS THAN NORMAL?
In 2019, some 15,400 people died in New Jersey nursing homes and other long-term care facilities. The numbers do not change much from year to year, records show. It is a vulnerable population and most have health issues.
But a deeper look by NJ Advance Media of deaths in 2019 compared with those in 2020 found the number of people who died in long-term care settings for non-COVID reasons began climbing in March and spiked in April, just as many nursing homes were becoming overwhelmed by the deadly pandemic.
That analysis showed 1,236 people died in long-term care facilities in New Jersey in 2019 during the month of April. Fast forward a year later and the data shows 5,133 people died in nursing homes and long-term care facilities this past April. About 42% of those 2020 deaths were attributed to the coronavirus. The other 2,954 were reported to have died from non-COVID causes — more than twice as many as the previous year.
Ed Lifshitz, medical director of the Department of Health’s Communicable Disease Service, said the spike in non-COVID deaths in April could be due to coding errors and the fact that many nursing home residents were not tested for the coronavirus.
“I know it seems a long time ago but there was not as much testing then as there are now. Potentially those deaths weren’t designated as COVID deaths,” he said. “Were people overwhelmed? I suppose that could have happened. I don’t have the data to formulate an opinion.”
“The healthcare system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope...”
Stephen Kaye
The Centers for Disease Control and Prevention said it takes extra time to code COVID-19 deaths, but reported that deaths in New Jersey for causes other than the coronavirus were more than 25% above normal this year, in data collected through Dec. 14.
Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco, a nursing home expert who analyzed data from the country’s 15,000 facilities, told The Associated Press that for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes.
“The healthcare system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope,” he said.
Translation? There have been as many as 7,700 COVID-19 deaths in the state’s nursing homes, or almost 1 in 7 residents from the beginning of 2020.
Laurie Facciarossa Brewer, who heads an independent state agency that advocates for the rights of people living in long-term care, told NJ Advance Media that her staff has been deluged with complaints in recent months about serious staffing shortages.
Pleas for help go unanswered, she said. Residents, already traumatized by the pandemic, are treated roughly. Showers and personal grooming are frequently forgotten.
“Imagine being unable to remove yourself from your bed. Perhaps you are wet, or you are hungry, or you are in pain and calling for assistance and being ignored or having your call light turned off without anyone actually helping you,” Brewer, the New Jersey Long-Term Care Ombudsman, told a legislative committee in September.
“Residents are spending far too much time in their own beds as their opportunities to move around the building are severely limited,” she said.
It is a story that has played out across the country.
Robyn Grant, director of Public Policy and Advocacy at the National Consumer Voice for Quality Long-Term Care, a Washington-based advocacy group that has raised concerns about substandard care in nursing homes, said the lockdown and staff shortages meant some were not getting even the most basic care.
“We have heard of residents not being bathed in months. Of some not getting the assistance they need in eating,” Grant said in an interview.
Others have been so affected by the inability to see their families, they now suffer from depression.
“Some of us refer to it as a second pandemic,” she said. “That they are dying as much from the impact of isolation as they are from COVID.”
A MOTHER LEFT ALONE
The cause of death was listed as COVID. But Regina Discenza of Forked River believes the lack of staff, coupled with the long-running lockdown at the New Jersey Veterans Memorial Home in Menlo Park, was ultimately what contributed to the death of her mother, Madeline Constantino, who died in October at the age of 84.
“You had 300 people totally dependent on others for their care and no one was coming to work,” she said. “She was left alone.”
Discenza said her father, Charles, in April had also died at Menlo Park of COVID-19.
Madeline Constantino as a young woman, and at the New Jersey Veterans Memorial Home in Menlo Park, where she died in October at the age of 84. Courtesy of Regina Discenza | NJ Advance Media photo illustration
Officials would not discuss patient care or respond to questions regarding allegations of neglect. But staffing of nurses and support employees at the veterans homes led to the deployment of the National Guard several weeks after the pandemic began. Emails obtained by NJ Advance Media through public records requests show there were complaints of short-staffing at the state facilities at least into August.
Before the pandemic, Discenza’s mother had been able to move about, but in time had become bedridden. She said her mom developed a massive pressure ulcer that just grew bigger and deeper. Ultimately, she developed sepsis, a life-threatening response to the body’s fight against infection. At the same time, the lockdown kept her from seeing whether her mother was receiving the care she needed.
“FaceTime calls did not cut it at all,” Discenza complained. She said her mother was unable to hold her head up and was too weak to speak. “I don’t know if she was eating or drinking,” she said.
With many nursing homes short-staffed even before COVID-19 hit, the pandemic made those staffing shortages even worse, as too many caretakers themselves contracted the virus, or were too sick or too scared to return to work.
“Did it affect quality of care?” asked Francisco J. Rodriguez, a personal injury attorney who also represents a number of families who lost loved ones in nursing homes. “Like major time.”
An examination of quarterly staffing data collected by the state Department of Health shows there were fewer nurses and aides to take care of residents at the height of the pandemic. Staffing shortages meant nurses and aides were doubling up on assignments.
More detailed weekly data reported to the Centers for Medicare & Medicaid Services revealed that even as late as June as the first wave of the coronavirus outbreak was winding down, just over 14% of the state’s nursing homes did not have enough certified nurse aides on the job. CMS was not reporting that data previous to June, when the numbers anecdotally were even higher.
Even in the best of times, nursing homes struggle finding certified nurse aides, or CNAs — those on the front lines who help provide basic daily health care, such as assisting residents with bathing, feeding and comforting them, and changing those who are incontinent. When the coronavirus struck, it was even harder to fill those positions.
“There was not staff to fill the nursing homes,” Aronson said. He noted the growing spread of the virus also made it impossible to call in per diem contract workers and nurses.
“Of course quality of care suffered,” he acknowledged. “With that said, the staff that did work in that time were nothing short of heroic.”
‘HELP ME! HELP ME!’
They could hear her screaming in pain from the nursing home courtyard just outside their mother’s open window.
“Help me! Help me!” Bettejane Jaeger cried out. It was her chest. Her neck. It hurt everywhere, her daughters heard her say.
From the window, Janine Dowler peered in to see her frail, 75-year-old mother in a hospital bed — a petite, deeply religious woman who has always loved music and liked to dance in the house, often to Whitney Houston. Now she lay helpless in an Andover nursing home, her oxygen somehow yanked off and the call button on the floor, as she writhed and pulled at her clothes, struggling with each breath, said Dowler.
Days earlier, the family learned, Bettejane’s hospice care had stopped its daily visits to the facility, as cases of COVID-19 began to soar inside.
Family photos of Bettejane Jaeger. Courtesy of the Jaeger family | NJ Advance Media photo illustration
Andover Subacute and Rehabilitation Center did not respond to specific questions about Jaeger or her hospice care. In a statement, Chaim Scheinbaum — an owner of Andover Subacute — said in the early days of the pandemic, “healthcare professionals took proactive steps to prepare for the crisis,” including increasing social distancing and separating sick patients, addressing staffing issues, and ensuring adequate medication for ill patients.
Dowler said of her mother’s hospice care, “at some point they were not coming in anymore.” Finding it hard at times to talk about it, she remarked, “We thought they were still taking care of her.”
Family members were largely shut out once nursing homes and long-term care facilities in New Jersey were locked down and no longer able to advocate for their mothers and fathers or other loved ones. The lockdown, which began in March in an effort to slow the spread of the coronavirus, kept families strictly separated from their loved ones for more than 150 days.
But it was not just families being kept from going into nursing homes. At the height of the pandemic, many were concerned that their loved ones were not getting care from doctors and other clinicians.
Nursing home industry officials do not dispute that the quality of care was affected by the pandemic. But Stuart H. Shapiro, a former Philadelphia Health Commissioner who led the city’s response to the AIDS crisis in the 1980s and until recently was the interim president of the Health Care Association of New Jersey, said doctors were going into nursing homes and caring for residents on a daily basis. He said he has heard no reports of residents not being properly fed.
Some facilities were not able to transport patients to hospitals during the pandemic because they were not accepting them or on divert status. But there were far more remote “telehealth” visits, he said, providing doctors with more access to their patients.
“The nursing homes did the best they could,” Shapiro said.
Still in some places, it seemed hard to get medical attention. Even hospice care.
Bettejane had been in failing health and after her husband also took ill, a social worker suggested to the family that she could be better cared for, at least in the short time, in a nursing facility. Andover had a bed open.
“We took her out daily,” said Mary Jaeger, one of three daughters, who did not live far away. They would get her hair and nails done “We would take her home for sleepovers. We did not have her shower there,” Jaeger added.
But in time, her sister said it appeared their mother’s health continued to decline. “She needed the extra care,” said Dowler. “She couldn’t dress herself anymore.”
They sought hospice and palliative care through the nursing home. But when Andover went into lock down because of COVID-19, Dowler said hospice care was no longer made available to her mother anymore, who by then had contracted the virus.
The long-term care facility in Sussex County days later would become the focus of national headlines after the virus swept through the center and its two units, leading to the Easter Sunday discovery of a makeshift morgue crammed with 17 bodies at one of the largest nursing homes in the state.
The sisters remain angry.
“My mom that Sunday, screaming in pain, could not get morphine,” Dowler said.
Three days later, she was gone.
In his statement, Scheinbaum said “despite all our efforts, the virus made its way into our facility,” as it did in the majority of long-term care facilities across New Jersey.
“Our healthcare professionals and staff worked around the clock providing quality care to our residents in the face of extraordinary challenges, risking their own health and well-being to serve our most vulnerable,” he said.
Dowler, still haunted, said her mother died alone.
“The whole lockdown. Nobody was dressing her. Taking care of her. Giving her her meds,” she said, based on what she learned after talking to those responsible for her care, and what she saw herself. “We’ll never have closure as far as what happened to her.”
‘WE DROPPED THE BALL…’
Surveys conducted at long-term care facilities throughout the state — copies of which were obtained from the Department of Health through public records requests — found that state inspectors went into about 500 nursing home and long-term care facilities from June 3 through Nov. 11 — 12 weeks after the state’s first death tied to the pandemic. Although most of the inspection investigations remain open and not available under the state public records law, 51 facilities were visited after a complaint was filed. Many were cited for infection control issues, mishandling of food or incomplete records. But for some, inspectors noted deficiencies related to possible neglect or deficient care.
At the Allaire Rehabilitation and Nursing in Freehold, a resident’s medical appointments — canceled in March because of the pandemic — had still not been rescheduled six months later, state inspectors found in September. “We dropped the ball,” the facility’s administrator admitted in response to questions by inspectors regarding the missed appointments, according to one of the reports released to NJ Advance Media report.
A state report following a Freehold nursing home inspected in September. NJ Department of Health
At Arbor Ridge in Wayne, inspectors reported that a resident unable to get around without assistance, went without physical and occupational therapy for six months. An administrator told the inspectors, “I don’t know why I missed it.”
In August, a resident of United Methodist Communities at Collingswood reported that a staff member threatened a resident. “I could take this bag and wrap it around your neck,” the individual, who was overheard by another employee, told the resident. Yet the employee remained on the job for additional 12 days.
Officials at Allaire said the citation by the Department of Health was a matter that caused no harm and posed no significant risk to any residents. “To focus solely on this deficiency instead of focusing on the heroic efforts of our staff is simply unfortunate,” said Judah Orbach, Allaire’s administrator.
“Throughout this crisis our nurses, doctors, aides, housekeepers, members of the dietary teams and other staff have truly worked tirelessly, and heroically...”
Nathan Miller, administrator of Arbor Ridge
Arbor Ridge officials said there was no finding that the individual had been receiving therapy that was inappropriately discontinued — only that new assessments were not performed.
“Throughout this crisis our nurses, doctors, aides, housekeepers, members of the dietary teams and other staff have truly worked tirelessly, and heroically attempting to prevent the spread of the pandemic throughout the facility and in helping to heal those that have become ill,” said Nathan Miller, the facility’s administrator.
Jim Clancy, the executive director of United Methodist Communities at Collingswood, said as soon they learned of the reported threat, they alerted the Department of Health.
“The employee was suspended while we conducted a thorough internal investigation, ultimately resulting in the termination of this employee and other disciplinary action,” he said.
BAD DECISIONS
At the Veterans Memorial Home at Menlo Park, Glenn Osborne — the Marine who serves as president of resident council there — said early on as the pandemic rampaged through the facility, he routinely saw behavior that concerned him.
“The nursing staff was putting themselves at risk along with the residents,” he asserted.
As a retired pharmaceutical quality control manager who once oversaw a staff of 50, Osborne has an eye for detail. He noticed that employees wouldn’t wear gloves when they delivered meals and said he could see the dirt under their fingernails.
“I asked them to wear gloves and they said it is not needed. They wash her hands,” he said.
More than once, Osborne would learn that a resident would return from the hospital, to be put back in the room with where he had been, incredulously with a roommate who was perfectly healthy.
“Then they would both would get sick, with high fevers — dying weeks later,” he said.
Glenn Osborne addresses a Veterans Day vigil at Meno Park via Zoom, as family members who lost loved ones during the pandemic gathered outside the nursing facility. Patti Sapone | NJ Advance Media for NJ.com
Diagnosed with ALS, the nervous system disease amyotrophic lateral sclerosis known as Lou Gehrig’s Disease, Osborne found himself “shaking due to hypothermia” because his room was too cold. It took a phone call from his neurologist from the VA Hospital for this problem to be addressed, he said. He reiterated the complaint in a letter to state officials.
Unlike the nurses and aides who help move and bathe him and double-up on PPE, employees who work in the housekeeping, recreation and maintenance continue to wear only paper masks when they come inside his room. No gowns, gloves or other protective gear, he said.
Others, including workers and union representatives at other nursing facilities have voiced similar concerns.
Osborne said he did his best as a sounding board for residents and their families.
“I got to know a lot of family members. When the pandemic hit, they asked me to check on their father or mother,” he said. “Everyone was left in the dark.”
Senior management responded to his complaints by offering to move him to the veteran’s home in Vineland. He refused.
“I do not want to leave my home,” he said.
THE VIRUS RETURNS
Today, the virus is again casting a dark shadow over the nation’s nursing homes.
In New Jersey, 436 of the state’s nursing homes and other licensed long-term care facilities — including assisted living communities, residential health care facilities and residential dementia care homes — reported active viral outbreaks this week. In early October, it was only 149.
Amid a drumbeat of headlines over the mounting death toll along with angry accusations from families and elected officials of mismanagement, Elizabeth Schiff-Heedles, the CEO of the Menlo Park, was fired in October as part of a wide-ranging shakeup of the veterans homes by the governor in response to the deaths.
A spokesman for the state Department of Military and Veterans Affairs would not comment on the allegations raised by Discenza or Osborne. He also would not respond to questions about staffing, whether there were reports of medication errors, or whether residents were getting routine medical care.
Discenza said she is still waiting for Menlo Park officials to return items that had been in her parents room at the nursing facility before their deaths.
“I’ve been asking the nursing home to return remaining personal items to no avail, both by phone and by certified letter,” she complained.
Staffing levels have improved somewhat since the first wave of the pandemic ended, but on weekends and holidays, front-line staff still remain scarce, according to Osborne.
“We call it ‘half-staff holidays,’ it still happens,” Osborne said. “We are used to eight nurses; we are lucky to get four or five.”
Across the state, nursing home industry officials these days say they have much better tools to deal with the virus than they did in the spring.
“We have much more testing, which helps keep it out of the building. We have stockpiles of PPE. We have more experience in handling people who have COVID,” Aronson said. “A lot has changed in our buildings.”
Still, Brewer’s office has been receiving new complaints that staff are not consistently using the proper PPE, or that facilities are not responding to inquiries from family members.
“Many family members who were approved as essential caregivers are now learning that they cannot visit the facility because the facility is in outbreak status,” said the state ombudsman.
And it remains a dangerous space.
Osborne said he tested positive for COVID-19 on Dec. 11. At the time, he said his breathing was shallow but his fever was mild as he was moved quickly to the quarantine wind.
“I’m staying strong,” he said then with a chuckle.
Today, Osborne said he has recovered and is s grateful the virus has been largely contained from spreading throughout the facility. But he said Menlo Park residents still complain that they spend all of their time in their rooms, seldom seeing staff or each other. There is a lack of entertainment and activities for the residents over this past nearly year “of this horrible, horrific virus,” he said.
And of course, he said when there is a holiday or a snowstorm like the one that just pounded New Jersey, he said there is often a lack of nursing staff. Nursing aides do not come into work, leaving veterans in their beds for days over the weekend, with little care and changing of their clothing.
It’s a depressing and isolating existence, he said.
The New Jersey Veterans Memorial Home at Menlo Park, where Osborne lives Ed Murray | NJ Advance Media for NJ.com
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