In just one room at the Charlwell House Health & Rehabilitation Center in Norwood last month, an elderly woman fell ill with coronavirus symptoms. She died on a Thursday. Another roommate was dead the following Wednesday. The third remained alone, puttering and confused, “a sitting duck,” a staff member said
COVID-19 has ripped through many of the state’s 800 or so nursing homes and assisted living facilities with astonishing speed. At Charlwell, three staffers told the Globe they believe the virus contributed to 21 deaths in less than two weeks, although not all of those people were tested. When the mail arrived Friday, there were 20 greeting cards for patients who had recently died.
“In the time that they mailed the letter," said one staff member, “these people are gone.”
Despite reports of COVID-19′s rapid spread in a nursing home in Washington state earlier this year, many Massachusetts facilities appear to be overwhelmed and lacked the necessary training, testing, and equipment. State health officials have identified clusters of infection in at least 94 senior facilities, where so far at least 480 residents have tested positive, according to state officials.
Charlwell house alone has had 21 confirmed cases, the Massachusetts Department of Public Health said Saturday.
Poor preparation and communication have led to missteps and hasty decisions. Many residents and their families feel angry, helpless — terrified.
“I’m sad and scared,” said Alexis Hill, whose mother lives at Charlwell House. “And in the face of conflicting information and information that we know for a fact is inaccurate, it’s human nature to assume the worst, and it unnecessarily heightens anxiety, fear, and grief.”
A look at how Charlwell and a second institution, Beaumont Rehabilitation and Skilled Nursing Center in Worcester, have handled the crisis offers a window on the mounting dread in senior care facilities across Massachusetts.
At Charlwell, three staffers blamed poor communication, low staffing levels from so many workers being sick, and questionable mitigation techniquesfor the rampant spread of the virus.
Charwell co-owner Chris Roberts said his staff have followed all state and federal guidelines in an effort to prevent as many deaths as possible in the face of an unprecedented crisis.
“We are not trying to hide something, we need help, and I’m begging for help,” Roberts said Friday in a phone interview.
Meanwhile, Beaumont’s response demonstrates how even well-intentioned efforts can go awry, heightening fear and possibly contributing to the virus’s spread.
Beaumont declined to respond to questions. It released a statement confirming it was grappling with infections and said it was following state guidance.
It hardly seemed things could get worse for Carol Pouliot’s mother, Gloria, an 87-year-old patient with terminal cancer who moved into Beaumont in Worcester just as fears of the coronavirus were rattling its 147 residents.
Then on March 28, the home’s management texted Pouliot that it was moving all residents to other area nursing homes, converting Beaumont to a recovery center for COVID-19 patients discharged from hospitals.
Three days later, movers stuffed Gloria’s belongings into plastic bags and took her by ambulance to another nursing home, according to Pouliot. A day later, Pouliot learned that a resident from Beaumont had tested positive for the coronavirus.
The plastic bag with Gloria’s possessions and $160 she kept in a safe did not arrive to her new room. So Gloria, a retired factory worker, was “forced to sleep in the same clothes she wore all day,” said her daughter. She said she was shocked at the way the Beaumont residents were summarily moved around.
“They were nurses and teachers, they fought in wars,” Pouliot said. “Just because you look at them and don’t see a young person anymore doesn’t mean they can be swept under the rug.”
Matt Salmon, chief executive of Beaumont’s parent company, Salmon Health and Retirement in Westborough, had volunteered to be the pioneer in an emergency state program to repurpose a dozen nursing homes as COVID-19 treatment centers and ease the burden on hospitals, as the number of patients surge in the coming weeks.
In a letter to residents and families, Salmon said he was inspired to help by the vision of his grandparents, who’d started the company seven decades earlier “to care for the frailest members of the community and treat them like family.” But the plan involved the rapid transfer of nursing home residents, many in fragile health, and quickly sparked a backlash.
After about 120 residents were moved, the relocation was halted on Tuesday when a resident who was about to be moved tested positive for COVID-19. Salmon Health later acknowledged that others among the remaining residents were also infected; Beaumont had tested only those residents with symptoms before the move, meaning that some of the relocated could be spreading the virus at their new residences. Salmon Health has declined to say whether it will still accept recovering hospital patients at Beaumont this week.
On Thursday, lab technicians from the National Guard arrived at Gloria’s new residence, Knollwood Nursing Center in Worcester, to test her and other residents sent from Beaumont. They were still awaiting results at week’s end.
Another Beaumont resident, Clara Nelson, 89, had moved into Beaumont three years ago, when her dementia worsened. A Finnish immigrant and a onetime secretary at the Worcester Telegram, Nelson had once loved to garden and cross-country ski; she was considered “a second mom to the kids in the neighborhood,” said her son, Peter Nelson.
Nelson’s four children, regular visitors, stopped visiting about two weeks ago when Beaumont, like other senior care facilities across the state, barred family and friends from the nursing home.
Nelson was scheduled to be relocated Tuesday, but her move was delayed because the resident who’d tested positive lived on her floor. On Thursday, Peter Nelson learned his mother had also tested positive, and would remain in isolation at Beaumont for now.
Peter Nelson asked a clinician to bring a computer to his mother’s bed for a FaceTime visit. “I said, ‘I need to see my mother,’” he said. “You have patients who are basically hostages at this point.”
“My fear," he said, “is she’ll die alone in a facility where no one will be able to see her.”
At Charlwell, three current employees, who declined to be identified for fear of retribution, described an atmosphere of disorganization and poor communication.
“They’re not talking to the staff, they’re not telling us what’s going on, they’re not isolating patients,” the first staff member said.
One woman had come to Charlwell for a short stay to recover from hip surgery. While there, she contracted the virus and died, staff said, leaving an adult son who is disabled, and now living in the facility.
Many families can’t understand why more testing hasn’t been done; only 20 tests had been administered before the weekend. Peter McCree said his brother, who died of the virus at Charlwell House last week, suffered from dementia but was otherwise healthy. Had all residents been tested and positive residents isolated, he said, his brother might still be alive.
Charlwell is a one-story facility that houses about 100 residents, some long term and some short term. Staff describe a homey place where they interact with residents like family. A solarium with large windows lets light in. Fish dart around a tank.
But in recent weeks, COVID-19 has distorted the daily hum of activity; residents are isolated in their rooms, scared and confused.
“I don’t know who has passed away and who hasn’t," one resident, Christine Edwards, whose roommate died of the virus, said in a telephone interview. “I haven’t been up and down the corridor and out of my area to see who is missing.”
Staffers who have not been infected, or have recovered, do extra work to keep the facility running, even as they fight back tears over the loss of patients who had become dear friends.
“To know people I’ve cared for, and watch them suffer and die in this manner because we didn’t have a plan in place, it kills me," said a second staff member who felt Charlwell should have taken more sanitary measures, provided staff with more protective equipment, and isolated infected patients.
With many employees out sick, staff said residents have been left naked in bed or on sheets soiled with urine and feces; workers without appropriate training have been asked to bathe patients. A barebones crew of cleaning and laundry staff is juggling essential sanitary duties.
Even under the best of circumstances, employees said, controlling infection is a formidable challenge in a nursing home full of older and sick patients. People hug, they share food, they share bathrooms.
But employees are worried about protocols Charlwell’s administrators have set. Administrators have instructed workers to keep patients who display COVID-19 symptoms in rooms with those who seem healthy. (Managers say they’re following CDC guidelines, which recommend that nursing home roommates be kept together even if one tests positive, as it’s likely they’ve all been exposed.)
Staffers asked to wear masks as a precaution when news of the spreading virus first hit, but were told it would alarm residents, according to the three employees. Now protective gear is encouraged, but some employees do not change their gowns when they pass between the rooms of sick and healthy residents, the employees said.
The most shattering aspect of the tragic scene, staff said, is patients dying alone, without their loved ones nearby. Family members call for updates, but overburdened staff cannot return every call. Some relatives try to come as close as they can.
“They’re just watching their parents die through the windows and crying and standing outside on milk crates,” the first staff member said.
The only concrete information families said they have received is a letter sent a week ago that only disclosed that an unspecified number of staff and residents had tested positive. Many had no idea that anyone had died until they read news reports about the deaths.
The Charlwell House was purchased last fall by Revolution Healthcare, based in upstate New York. Roberts, the co-owner, said his team is doing its best to manage the crisis.
He disputed some of the employees’ contentions; saying, for example, that staffwide meetings were held to discuss which residents were suspected of having the virus. He said he’d maxed out three personal credit cards to pay for extra protective gear.
Roberts disputed the staffers’ estimates of COVID-19 related deaths: The disease was confirmed or suspected in 11 of 21 recent deaths, he said, while the others were due to other conditions.
Roberts said he is trying to secure more tests; ideally, he said, everyone at Charlwell could be tested. On Saturday, three other residents were tested by the National Guard, he said.
“This is terrifying," Roberts said. “We will do whatever we are directed to do to make sure that our residents are cared for in the best manner as we learn more about this and are given more information."
On Saturday, Massachusetts officials said they are checking with Charlwell multiple times a day and are urgently trying to secure more staff for it. The state has also sent protective equipment to the facility.
But the staffers interviewed staff say Charlwell House shows why nursing homes have to be militant at the very first sign of an outbreak, or risk grievous losses.
“If there is an outbreak in your facility, you need a better plan in place,” one staff member said. For Charlwell, she said, “it’s too late.”