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Brian Lehrer:

Brian Lehrer on WNYC. And today is phase two reopening day in New York City. Are you ready to go back to your office building now reopened? It's going to be so interesting to see. We'll open the phones on this later in the week, when you've had a chance to actually go back and have some experience with it, how some of the places with open office plans and things like that are actually reconfiguring offices for social distancing. So offices reopening today, at least they're allowed to under the law. Are you ready for in-store retail shopping? Are you going to be the first person online at the barbershop or the nail salon? You can do that again today officially.

Brian Lehrer:

And New York can do this because while cases are spiking in other parts of the country now, New York actually has the lowest infection rate of the 50 states. It can come back however. So even this, even as gradually as they're doing this, is a big experiment.

Brian Lehrer:

Now this is also the first weekday without a Governor Cuomo coronavirus briefing. He took a victory lap on Thursday and Friday in his final two daily briefings and announced they are no longer necessary and claimed his policies worked against the virus in New York as he compared New York to other states in this clip.

Andrew Cuomo:

You now see states that have dealt with it politically versus states that have dealt with it on a science fact basis. And you see the virus spreading in states that have an unmanaged reopening.

Brian Lehrer:

So the governor claimed his policies worked against the virus in New York. And many of them did. But Cuomo may also be responsible for one of the deadliest coronavirus outcomes, the toll in New York's nursing homes, where it killed around 6% of its 100,000 nursing home population, the state's nursing home population. In New Jersey, even worse, 12% of the 43,000 nursing home residents at last count died as a result of the virus. But in other states around the country who may not be doing some things as well, those percentages hover around only 1% to 2%.

Brian Lehrer:

So what made New York's and New Jersey's nursing homes so dangerous? One possible answer could lie in an executive order that came from the governors of both states on whether to transfer COVID-19 patients back to the nursing homes that they came from after being in the hospital and with what safeguards.

Brian Lehrer:

Joining me now to discuss New York Governor Andrew Cuomo and New Jersey Governor Phil Murphy's approaches is Joaquin Sapien, reporter for ProPublica, who has a big article on this. Hi Joaquin. Welcome to WNYC and thank you for your in depth reporting.

Joaquin Sapien:

Hi Brian. Thanks for having me.

Brian Lehrer:

How do New York and New Jersey's death rates in nursing homes compare to the rest of the country? I gave some of those stats, which are pretty shocking. Do you want to fill it in any more?

Joaquin Sapien:

Sure. I can talk a little bit about that. So in New York, as you said, we saw about 6% of its total, more than 100,000 nursing home residents succumb to the virus. And in New Jersey it's about 12%. In other states it had somewhat similar policies. We see similar figures with Michigan losing 5% of its roughly 38,000 nursing home residents. Whereas in Florida, where such transfers were barred, you had just 1.6% of its 73,000 nursing home residents die of the virus. So it's a pretty big ... And in California, where they had initially moved toward a similar policy before very quickly reversing it after getting some input from the industry, it lost about 2% of its 103,000 nursing home residents.

Joaquin Sapien:

I mean, I want to be careful here as were in the article to say, it's really very difficult to trace exactly how and why so many nursing home residents here died of the virus. But when you have a policy in place that will introduce a virus that we know to be extremely dangerous to the most vulnerable among us being the elderly, we do know from experts that more people are apt to die that way. And the March 25th directive does just that. It introduces COVID positive patients into a facility where people may not yet have been exposed, but are very vulnerable to the virus.

Brian Lehrer:

Why did they do that?

Joaquin Sapien:

Well, early on, it was in part a reaction to this fear that the hospitals across the state would be overrun and that we would need the hospital capacity in New York to care for the sickest people. And so in order to clear out those beds, you would have to put these folks somewhere in nursing homes, since some of these people came from nursing homes to begin with, and many of them were nursing home eligible seemed like an appropriate fit.

Joaquin Sapien:

The important part was that there was meant to be safeguards for those folks who moved back into the nursing homes, but it was never particularly clear who would be responsible for enforcing those safeguards, if it was the state, if it was the nursing home itself. There's a lot of confusion around that. And what we found in our story is that, wow, at Downstate, New York there were certainly issues with hospital capacity. We never got quite over the brink, but pretty close to it here. It may have made a little bit more sense to have that kind of policy in place.

Joaquin Sapien:

But the nursing home that we looked at was called Diamond Hill and it was up in Rensselaer County and the hospitals in that area in the capital region never came close to being overrun. So it didn't make a whole lot of sense to the people who worked in that county health department to move COVID patients into nursing homes in that area when there was plenty of hospital capacity. And at Diamond Hill where a total of 18 people died in a 120-bed facility and 58 residents were infected and 50 staff were infected, all of the infections came after the March 25th order.

Joaquin Sapien:

So, again, we're not entirely sure whether the virus was introduced by that order. It seems as though at least one patient got it during a routine, or was found positive to have it during a routine medical issue who had lived there a long time. But again, in that particular area, the order put people who were not in hospitals that were overrun into nursing homes where they'd be exposed to other folks who were quite vulnerable to this virus.

Brian Lehrer:

And Diamond Hill, that nursing home up in Troy, I guess, was a textbook case of how the virus spreads because by this month they had 18 deaths, 58 residents infected, and at least half of its staff had gotten ill. And you traced the virus back to one patient.

Joaquin Sapien:

Well, we were able to identify the first patient that had a positive coronavirus case. And that was a resident who had lived there for several months, at least before the March 25th order. And she was removed from the facility for ... That patient was taken out of the facility for another medical issue, a routine medical issue, but while there tested positive.

Joaquin Sapien:

There's a very troubling series of events that occurred at the home after that, in which the staff, particularly a nurse manager named Stephanie Gilmore, who I spoke to quite a bit, was instructed by the administrators of the home not to disclose the fact that they had their first COVID positive patient in the facility. The administrators did not want her to tell the staff. She found that very alarming and confusing and called the state health department immediately, which then prompted the administrators to circulate a memo informing the staff, and also prompted the county to notify the state, which then began testing residents inside the facility and found many more positive cases.

Brian Lehrer:

It's unbelievable. It's China worthy, right? If they had an outbreak, the beginning of an outbreak in this nursing home, and one of the resident, one of the ... I'm sorry, one of the staff members wanted to make that known and the management wanted to cover it up, you've got to be transparent about that.

Joaquin Sapien:

Well, not only that. She informed the county and the county wanted to know how many people would have been exposed to this particular patient, patient zero at Diamond Hill, the names of all the staffers so that they could get in contact with those staffers and begin contact tracing, getting people in quarantine if they needed to be in quarantine. And Stephanie was on this list that she had provided to the county because her bosses wouldn't give the county the list. So she gave her the list themselves and she herself was on it.

Joaquin Sapien:

And so the county asked her to quarantine herself for a period of 14 days, which she did. And during those 14 days, she was getting repeated requests from her bosses to come back to work because they were so overwhelmed. Then when she came back, she was fired the following day. And she was told that she was anti-management and that she was raising too many ... Because at that time she was raising a lot of alarms about other things that she was seeing inside the home, the way that COVID patients were being treated, where they were being placed, sharing rooms with patients who were not found to be positive. So she blew the whistle and she came back and then she lost her job.

Brian Lehrer:

My guest, if you're joining us, is Joaquin Sapien, reporter for ProPublica. His latest piece is titled Fire Through Dry Grass: Andrew Cuomo saw COVID-19's Threats to Nursing Homes. Then He Risked Adding to It. And listeners, I wonder if any of you out there right now can help us report this story. Are there any nursing home employees listening right now, any of you with loved ones in nursing homes? Obviously this has been maybe the biggest scandal nationwide, along with meat packing plants and jails and prisons with respect to the death toll of the virus and how people in these concentrated places were treated and mistakes that were made, innocently or not.

Brian Lehrer:

So if you're associated with a nursing home in any way, is it better now? And do they have protocols in place that leave you willing to trust that it's safe, a) to work there, or b) to have one of your loved ones there. 646-435-7280, 646-435-7280. Or maybe some of you even have personal stories about people you know who were in the hospital with coronavirus and transferred back to their nursing homes while they were still positive perhaps ill-advised. 646-435-7280, 646-435-7280 for Joaquin Sapien from ProPublica. And Joaquin, this is a New York and New Jersey story. We've been talking about Governor Cuomo in New York. Did they have the same policy in New Jersey under Governor Murphy?

Joaquin Sapien:

Yeah, there was a similar policy there, and it seemed to have a similar effect, at least in terms of the percentage of people who had died inside the homes. The Cuomo administration's defense on this has been that science will show what the effect of this was inside these nursing homes. It's pretty difficult to trace exactly the first patient to enter one of these homes with coronavirus. And if that's what inspired the infection that then led to deaths. But when you speak to epidemiologists about it, I mean, it's pretty clear what the potential consequences of this are. I mean, if you're COVID positive and you move into a nursing home where other people are vulnerable to that virus, they're likely to catch it.

Brian Lehrer:

Now Cuomo finally revoked the order on May 10th. It took from March 25th, was it, the original order date until May 10th to not have a policy of sending COVID positive patients from the hospital back to their nursing homes. May 10th. What about New Jersey?

Joaquin Sapien:

So New Jersey had ... It was in a similar timeframe that they had revoked their order too. I want to say it was right around that week. One of the interesting things about that was that around the time that they had revoked it, they never really explained why exactly they revoked the order. But there was a lot of blame that went toward the CDC guidance on this issue. And essentially, Governor Cuomo was blaming the Trump administration and saying that, well, the CDC guidance suggested that we do this.

Joaquin Sapien:

But when you take the CDC guidance and you show it to experts and people who work in this industry, they don't quite see that connection. They don't see that there's any directive not to test new residents coming into the home for coronavirus for instance. They don't see anything that says that a nursing home must accept new patients with or without testing. So it's a little bit unclear as to why the CDC guidance has been brought into the center of this.

Brian Lehrer:

Lauren in Fort Green, you're on WNYC. Hi Lauren. Thank you for calling in.

Lauren:

Hey there Brian. I called you a few weeks ago to tell you that my grandma was surviving COVID. She'd been in a nursing home. It's called Alaris in Kearny, New Jersey.

Brian Lehrer:

Mm-hmm (affirmative).

Lauren:

Since February we'd been calling them. I raised it after hearing what happened in Seattle asking, "Are we going to fill out visitors? Why are people still out in the home when all of this was starting?" And she actually survived with COVID without any symptoms for about two weeks. Just when we were in the clear, she actually fell off her bed because they were having such staffing issues, I believe, and they were totally overwhelmed with what's going on. She had emergency surgery and ended up passing away from complications a few days later.

Brian Lehrer:

Oh, I'm so sorry.

Lauren:

And I would just say in general, the response to what was happening and this risk that we all knew, like old people were older people, senior citizens, more vulnerable, they were slow acting. It was impossible to get information about my grandma after we found out she actually had tested positive for COVID. They were only testing them every week or so. And we were pushing like, "Why aren't you testing more often?"

Lauren:

And then of course the staff probably completely overwhelmed, me feeling empathetic for them, not able to provide the right standard of care for my grandmother that ultimately COVID, she survived COVID without any symptoms, but had this accident. So it's just been a really crazy few months. And unfortunately like two weeks ago, we ... A week ago ... Was it a week ago? Yeah, about a week ago in New Jersey we were able to have the service for her. But I would just say in terms of looking for advocacy online for senior citizens, because people wanted to send flowers. And I was just asking donate to someone who can ensure in the future there's just better care. And even as a family that was advocating, it was almost impossible in this situation to advocate correctly, obviously we did so a little bit unsuccessfully. So just-

Brian Lehrer:

I'm so sorry. And I remember you. I remember your original call, about the home in Kearny.

Lauren:

Yeah. I call you a lot Brian. I'm a big fan, but, yeah-

Brian Lehrer:

I'm glad you're on.

Lauren:

A few months, but you make it better.

Brian Lehrer:

Oh. But it sounds like your grandma died indirectly from COVID-19 because maybe the staff was so overwhelmed that they couldn't pay close enough attention and she had that accident.

Lauren:

Exactly. Exactly. And you know, she was infected with COVID-19 too, because Alaris is a huge company. I am looking into what the next steps are for our family, but they were not responsive or responsible. I would FaceTime my grandma and she would have the mask hanging off her face, even before she was tested positive. And she only speaks Portuguese, so it was just hard to make ... I could just see, like on Facetime I see you with your masking off your face. There's no way that they're upkeeping the right standard to keep our loved ones healthy, so.

Brian Lehrer:

I'm sorry again.

Lauren:

It's just a huge mess.

Brian Lehrer:

And thank you so much for sharing your story. I think people can learn from it and keep calling us. Let's just go right to another caller. Lisa in Queens. You're on WNYC. Hi Lisa. Thank you for calling in.

Lisa:

Hi, Brian. Thank you for bringing this up. I just have a few things to say a little bit in defense of the nursing home system, at least my experience. I worked in Manhattan and many, many years ago on Roosevelt Island. But the facility that I worked in Manhattan, they were a very caring staff and we had so much in-servicing about all different situations and they really had us go over protocol. So they did excellent training with their staff, but I think people, especially people who've never been in a nursing home too, these people are some of the most ...

Lisa:

They are the most vulnerable people. There's no place else for them to go. There's no other facility or staff really trained. They can't stay in their homes and be safe. When you're in the hospital, their job is to stabilize you. But the people that live in a nursing home, they need so much more. They need to be fed sometimes. They need to be turned. If they have dementia, someone has to always watch them. There's so much more hands-on and intimate care that I don't think hospitals are ... They're not set up to provide that for them.

Brian Lehrer:

So do you have any thought-

Lisa:

I feel-

Brian Lehrer:

With your experience, do you have any thought about what an alternative might have been? And I think we all realize it was a horrible possibly no-win situation where nursing home patients who got transferred to the hospital because they had COVID and then were well enough to return and they needed the hospital beds for other sick people. And then as you're saying, the hospitals aren't really equipped to do the hands-on day to day care of a lot of the nursing home patients also. And yet, transferring them back to the nursing homes where their COVID could spread like wildfire was a risk that turned out to be really deadly. Is there any other alternative that they could have pursued occur to you?

Lisa:

I can't think of any. I mean, just because there's so many shared spaces, even if you are in your room, you're never alone in your room, even if they try to. And in my experience where I worked, they did try to keep the same staff to the floor or the same staff to the patients as much as they could, but you're still ... You have to then just ... You're kind of like at the mercy of, okay, those people are going to show up for every shift. I'm sure they were afraid too.

Brian Lehrer:

Oh absolutely.

Lisa:

They had families too. They got sick too. So-

Brian Lehrer:

A lot of people on the staffs, yes, got sick as you say, and died as well. We talk about the patients. It's the workers too. Lisa, thank you so much for your call. And Joaquin Sapien from ProPublica in that no-win situation, if nursing homes were expected by Governors Cuomo and Murphy to take back their residents, were they at least given any sort of directives on how to best manage them with the virus once they returned?

Joaquin Sapien:

So a couple things on that. One is not all of these patients are returning patients who had already lived in the nursing home before they got COVID. Some of them were moved into the nursing home after they became infected with it. Right. And so there's that to contend with. And then in terms of precautions, I mean, yeah, there were some guidance that was issued about wearing masks and trying to establish a separate unit for COVID-19 patients and keeping them in isolation. A lot of people that I talked to in the nursing home industry said that those guidelines were changing a lot and were difficult to keep up with. And as you'll recall, early on in the crisis, there was a shortage of that kind of equipment everywhere, particularly in nursing homes.

Joaquin Sapien:

One of the things that I learned in reporting this story was that, at least in the case of Diamond Hill and many other nursing homes, a lot of these places are not like the home that caller just described that sounds reasonably resourced and staffed. Many of these places operate on a short staff and in short supply of essentials on a day to day basis. And so when you add coronavirus to the situation in a place that is already straining to provide proper care, it really creates a much bigger risk.

Joaquin Sapien:

At Diamond Hill, you had as few as four aides and two nurses looking after as many as 80 people on a single floor. And all of them had a wide range of ailments from dementia to incontinence to Alzheimer's to a variety of issues that all kind of screamed for the attention of the staff, even before COVID hit. That was something that Stephanie and other nurses that I spoke to there were concerned about long before this virus arrived. And Diamond Hill is not alone in terms of having kind of a checkered record.

Joaquin Sapien:

Some of the New York lawmakers that I've talked to who want to see an independent probe into not only Governor Cuomo's policy, but also the long history, what they say is a long history of a failure to properly regulate and supply nursing homes to do their jobs effectively.

Brian Lehrer:

So let me take one more caller who has, I think, a political and structural critique here and wants to focus on a particular point per my screener. Sal in Patterson. You're on WNYC. Sal, thank you so much for calling in.

Sal:

Brian good morning. Thank you very much for taking my phone call. I'm familiar with the reporter. He does a good job. He has to investigate how these nursing home in Northeast, they get their license. They're all politically connected. That is the nursing homes in Northeast do not have rules and regulations. And right now in New York and New Jersey, there is a legislation is going to push through quietly to get all these nursing home, which is all political appointees and political goons to get liability against coronavirus. They're going to use the coronavirus aid package to put this stick in regulation so all the nursing home, which is their political appointees.

Sal:

Let me just tell your reporter check Carl Paladino in Buffalo, New York. He owns six nursing home, and he used to run against Cuomo and he was his buddy in Buffalo, New York when his father was the governor.

Sal:

So this is the problem with the nursing home in Northeast. It is not that. If I was the people that have somebody in nursing home, I'd start suing each person. And you will find out, most of these people are political appointees or political bosses, like two guys in North New Jersey. I don't want to mention their names. They own the nursing homes because they know I'm investigating them. So you'll be, people should look at how these people, they get their licenses. And when you find out, you will find out, hey, my God, Carl Paladino owns a nursing home. How does he become qualify to own a nursing home?

Brian Lehrer:

Sal I'm going to leave it there. He's raising structural issues that matter, isn't he?

Joaquin Sapien:

Absolutely. And there has been some reporting that's been done on the political influence of some of these nursing homes. And there is a effort to shield them from liability in the wake of coronavirus in Albany. So it'll be interesting to see how that turns out.

Joaquin Sapien:

What I found covering nursing homes and other systems of care for the vulnerable is that oftentimes the people that are employed, the nurses, the aides, the staffers get into this business because they genuinely want to help people. And some of them are quite good at it, and they do it under very difficult circumstances. Unfortunately, a lot of the time, the folks that run these places, the administrators are primarily focused on doing ... on keeping what's called heads on beds. When you have a head occupying a bed, that means you'll get paid through Medicaid or through an insurer or whatever. And so the emphasis often, unfortunately, is to make sure that the facility is full to run it at a profit. And to protect those profits you do see quite a bit of influence in government, not just in New York, but in states across the country.

Brian Lehrer:

We will have to leave it there. This is one of the biggest tragedies, maybe the biggest in the whole COVID-19 era, what has happened in the nursing homes, New York and New Jersey, worse than many other states percentage wise. And perhaps it had something to do with policies, not just that we were the epicenter. And this is one of the things that I will certainly be asking Dr. Fauci about when I interview him on tape this afternoon. We'll play that on tomorrow's show and we will have to see as a city, as a state, as a region, as a country, if we can fix, that we must fix going forward.

Brian Lehrer:

My guest has been Joaquin Sapien, reporter for ProPublica. His article is titled Fire Through Dry Grass: Andrew Cuomo Saw COVID-19's Threat to Nursing Homes. Then He Risked Adding to It. Joaquin, thank you so much.

Joaquin Sapien:

Brian, thank you.

 

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