SALEM — Jonas Chaves dreaded asking the question. The proud onetime Swampscott fire department staffer, temporarily staying at the AdviniaCare at Salem nursing home for a course of intravenous antibiotics, ached to get home. But Chaves wanted to know; he passed the time watching the news, a constant stream of pandemic talk. So on April 8, the 86-year-old finally asked an employee.
Does anyone here have the virus?
A few people, the staffer said, reassuring him: nobody on his floor.
“I was worried about him from the second he said that,” said a friend, Rosilla Owen of Beverly, who spoke to Chaves on the phone later that day.
With astonishing speed, the virus razed AdviniaCare’s plans to contain it, ripping through the 123-bed facility and leaving wrenching scenes of chaos and grief in its wake. The first resident was diagnosed the first week of April. A month later, 15 were dead and 61 of the 75 remaining patients had caught the virus. Illness and fear drove staffing levels down precipitously, several employees said, leaving residents isolated and depressed, bedsores opening on their fragile skin, their families grasping for news.
Center management said the staffing has always been sufficient to care for patients properly, and that, even as it struggled to deal with the virus outbreak, it scrupulously adhered to CDC guidelines and recommended practices.
But AdviniaCare’s battle with the coronavirus, reconstructed through interviews and e-mails with a dozen people who worked at the facility or had family or friends there, offers a window into the ground-level experience at nursing homes across Massachusetts over the past two months, as the virus has killed more than 3,400 people in long-term care. Terrible as it is, the outbreak at AdviniaCare pales in comparison to the state’s worst; 74 have died at the Holyoke Soldiers’ Home, 60 at Courtyard Nursing Care Center in Medford, and at least 45 at Mary Immaculate in Lawrence.
The crisis, at the Salem home and elsewhere, has been aggravated by festering problems in the nursing home industry that policymakers have long pushed to the back burner, like insufficient Medicaid reimbursements that have led to low pay and chronic short staffing. When disaster struck, nursing homes were ill-equipped and short-staffed.
“This is not anything that one particular nursing home is suffering from or struggling with,” said Chris Hannon, the chief operating officer of Pointe Group Care, the parent company of the facility. “Every nursing home across the country and in this Commonwealth has been managing it the same way.”
But the virus has taken no pity; as nursing homes have struggled to keep up, COVID-19 has inflicted unspeakable trauma on the fragile elderly, their loved ones, and their caregivers. In Salem, many are still in shock.
“I don’t think Jonas thought he was going to die," said retired Swampscott firefighter Kevin Thompson, another friend of Chaves’s. “I don’t think he was thinking he was going to get COVID.”
The first indication of trouble to come was a sign posted in mid-March on the door of the two-story brick nursing home, situated in a quiet part of town across the street from a duck pond. Closed to visitors, it said.
Inside the building, however, AdviniaCare’s staff felt optimistic. As March came to a close, they still had no COVID cases. At that point, the number of nursing homes reporting multiple cases was growing quickly, but only 89 people statewide had died of the virus. Maybe AdviniaCare would escape a bad bout, the Salem employees thought.
But the notice on the door put some families on edge; some already had concerns about the quality of care.
“Even before the pandemic, the nursing homes in Massachusetts, and I’m sure in many other areas of the country, left a lot to be desired,” said Richard Harris, the nephew of Chaves, who oversaw much of his care.
AdviniaCare used to be called Grosvenor Park; from its founding in the mid-1990s, it had been a family-owned nursing and rehab facility that reliably got high marks from state inspectors.
In 2015 Grosvenor Park, like many Massachusetts nursing homes, was purchased by an out-of-state company; the new owners soon faced mounting complaints about substandard care and deaths at its facilities, and paid hundreds of thousands of dollars in fines. Pointe Group Care, a Norwood corporation, purchased the facility last June out of receivership for a bargain price.
Amid the ownership tumult, longtime staff and residents’ families said, the quality of care in Salem declined. Families felt the building was frequently short-staffed. Last September, inspectors cited the facility for the kinds of infection control deficiencies — like failure to develop a water management program and to employ qualified nutrition personnel — seen in two-thirds of Massachusetts nursing homes. (Management said it quickly corrected those problems.)
In mid-March, before any cases were detected, some staff saw danger on the horizon and wanted to take extra precautions. But those who asked for protective gear or brought a mask from home during those early weeks were asked not to wear them so as not to alarm residents, two employees said. Others were told to put a hospital gown over their clothing as protection. CDC guidelines say a cloth patient gown may be worn when no proper isolation gowns are available, but it should not be considered protective gear, since it is unknown how much protection it provides.
The lack of proper protective equipment worried one employee so much, she quit: “I told them I didn’t feel comfortable doing that." (Pointe Group Care said there has always been adequate protective gear at the home, including disposable gowns, and that the Salem home always followed public health guidelines.)
The first week of April, COVID-19 arrived like a sneak attack.
The nursing home’s staff assumed that the virus, if it came at all, would arrive with a short-term rehab patient. Mysteriously, it instead showed up in a patient in one of the upstairs long-term care units.
Other patients upstairs began to spike fevers. It was hard to know who had the virus in those early weeks, staff said, because testing was limited and results took days.
A few days earlier, 51 of 98 residents had tested positive despite having no symptoms at AdviniaCare’s sister facility in Wilmington, a shocking indicator of how easily the virus could hide and spread. The positive cases threw off a state plan to relocate what were assumed to be healthy patients out of the Wilmington center and use it as a dedicated COVID-19 recovery facility.
Around the time that AdviniaCare at Salem reported its first COVID-19 case to state public health officials, a woman from Salem whose father lived in the facility began to fret. Although the staff had not issued an alert to families about the presence of COVID in the facility, she heard that another woman’s mother had the virus.
On April 11, the woman tried to deliver groceries to her father, but an employee who greeted her declined to take them. The facility was no longer allowing outside items into the building, she was told. How many people, she asked, had tested positive? How many were being isolated? The worker at the door had no answers.
“[The nursing home] is on complete lock down,” the Salem woman texted her son. “Can’t drop anything off. Asked the woman a bunch of questions & she answered ‘I don’t know’ to all of them.”
“Awesome,” he replied. “So that means it’s spreading like wildfire and they don’t know what to do.”
The next day the home lost its first resident to the virus, according to an employee; one day later, 18 residents had tested positive.
Administrators decided to take bold action. They instructed the staff to move the upholstered chairs and heavy tables out of the upstairs dining room and wheel in residents who had tested positive, creating a makeshift ward. The sunny room, with its tall, arched windows and wood-paneled ceiling, looked like an improvised wartime clinic, full of hospital beds.
Men and women, from both the short- and long-term units, were clustered together in the room with thin hanging sheets separating them. The sight of the residents, lying helpless under the chandeliers, unnerved the staff.
“Seeing our residents in their dining room in beds is heartbreaking,” one employee said.
Nursing home administrators said the dining room, which had not been used for weeks, had always been part of the building’s plan for an emergency. Moving patients there was just one of many decisions made to handle an unimaginable situation, they said, amid shifting guidance from state and federal health officials.
“We’ve never experienced anything like this in our industry before," Hannon, the Pointe Group Care executive, said. “Until you’ve been involved in an environment or an operation like this, you have no idea what we’re up against.”
On April 14, the woman from Salem got bad news. Her father, 95, had tested positive; he was later relocated to the dining room, which she was told was an easier place to monitor COVID patients because it had no walls. He was being treated with morphine for comfort as he suffered from respiratory distress.
For two days, the woman said, she called the nurses’ station at 4 or 5 a.m. Reaching her father’s unit had been difficult, she said, but if she called early enough she knew the overnight nurse would pick up the phone.
Her father’s condition worsened on April 17, and she asked to see him. He was later moved to a private room on the first floor for the meeting. She knew what that meant.
As she sat quietly with her father, who would die later that day, the woman said she’d never seen the staff so busy. Some people were running and at one point she heard someone call all available personnel to help.
“They were busting their butts,” she said. “It was crazy.”
Chaves, the former Swampscott Fire Department staffer who also had a long career with the Federal Aviation Administration, was supposed to have been on his way home that week. After three months in the facility, he had finished two rounds of antibiotic treatments for a bacterial infection and was due to return to his apartment at an independent living facility in Swampscott.
But Chaves was too weak to walk; physical therapy appointments had been canceled after the facility closed to visitors.
That Thursday, April 16, Chaves spoke by phone with Harris, his nephew, who, along with Harris’s sister, oversaw his care. They talked, as usual, about politics. Chaves woke early and tuned in, as usual, to MSNBC’s “Morning Joe.” That day he and Harris discussed the drama du jour with President Trump, like they always did. Everything seemed normal, Harris said.
Harris understood why Chaves wanted to stay at AdviniaCare at Salem; it was close to home, and his friends could visit. But privately, Harris worried; Chaves complained about being chilly, that staff would not always answer the call button, and that his food was sometimes cold. On a visit in mid-February, Harris said, he urged the staff to follow through on their promises to get Chaves a computer he could use and to make sure he got regular exercise. (Management said the facility has “gone above and beyond in all circumstances” to meet residents’ needs, both before and during the outbreak.)
Several hours after their morning chat on April 16, Harris heard from Chaves again. He seemed a bit confused.
An hour later, a nurse practitioner called to recommend that Chaves be taken to the hospital immediately — his blood oxygen saturation and blood pressure had plummeted. By evening Chaves had tested positive for COVID-19 and pneumonia. Two days later — just 10 days after he had dared to ask about COVID-19′s presence in the building — he was dead.
The day Chaves died, Harris and his sister learned that about 40 residents and 20 staff were now coronavirus positive.
Employees began to crack as the number of staff dwindled. Their bodies ached from the physically arduous work and the long hours. They longed for a respite, but those who stayed feared that if they did not care for the residents, no one would.
Day after day, they witnessed the virus moving in and taking hold with shocking speed. One day a resident was alert, laughing; the next his or her skin went gray and his or her eyes took on a staring, vacant look.
An internal medicine practice whose doctors and nurse practitioners care for patients in the facility performed more than 1,000 bedside visits during the crisis, an “extraordinary” number, said Hans Jeppesen, the facility’s medical director, in a statement to the Globe.
Hannon, the COO, acknowledged that staffing is always a problem in his business, and, as a former physical therapist, he said, he has great empathy for his front-line workers.
“I am very well aware . . . . of the impact that it not only has, that they are experiencing, but really the expectations that I have as the operational leader,” he said.
Residents felt their small worlds shrinking; the empty hallways, canceled activities, life confined to bed. Those not ill with the virus became sick with depression and fear.
“What can I do? Nothing!" one resident said, an employee recalled. “We don’t see anyone, we don’t have fun anymore, so what’s the sense of trying to fight this [virus]?”
With fewer workers, routine tasks fell by the wayside, worrying the employees even more. There was barely time to change residents and give them their medications, several employees said, much less get them out of bed or rub lotion on their fragile skin. Some residents stopped eating, some began to develop bedsores, others wailed so loudly staff could hear them from outside the building.
Management said all patients received the support they needed, and that doctors took care to notice if they became depressed and followed through with treatment. Doctors and nurse practitioners provided hundreds of medical updates to discuss test results and care plans in phone calls to relatives during the crisis, Jeppesen, the medical director, added.
But as the staff hurried around the units, the phone at the nurse’s station rang incessantly. Employees knew there were family members on the other end, desperate for information about their loved ones, but some staffers said they avoided picking up, not trusting themselves to reassure families when the situation was, in fact, dire.
In late April, the number of sick patients became too many for the dining room to hold. Administrators reversed course, and ordered workers to wheel sick residents back into rooms, though many times not their own, and brought healthy ones to the dining room. AdviniaCare’s management said the room was deep cleaned, but some staff questioned whether it was sanitized sufficiently.
On the last Friday of April, state Representative Paul Tucker, who represents Salem, heard about possible problems at the nursing home and spoke with AdviniaCare at Salem’s administrator, Chris Cavarretta, who said he needed additional staff to fill weekend shifts. Cavarretta told him most workers were scheduled to return to work on Monday, he just had to make it through the next two days.
Tucker said he put the nursing home in touch with the state’s COVID-19 Response Command Center. It sounded bad, Tucker said, but he got the sense that the home was just one of many in such a bind.
“I’m not sure if AdviniaCare is any different than any place across the state,” he said.
Salem Health Agent David Greenbaum also said he has been in regular touch with AdviniaCare at Salem’s management throughout the crisis. Greenbaum said Cavarretta told him the situation at AdviniaCare was improving after a “rough patch” in mid-April.
Hannon, the Point Care executive, said if there is a silver lining to the crisis, it has been that government agencies have been brought a bit closer to the day-to-day struggles of nursing homes.
“I think that they’re clearly able to see what challenges we have had prior to the pandemic,” he said. “And now this, the impact that it’s had on our industry since the pandemic. I do think they realize that, and my hope is that they realize that, because it puts us in a better position coming out of this.”
As the weather in late April stayed stubbornly chilly, the situation inside the building gradually improved. Staff received more protective gear. A staffing agency sent reinforcements. Sick and well residents were split up between the two upstairs units and staff were instructed not to pass between them.
A month and a half after the doors had been shut, AdviniaCare at Salem began sending updates to families about the virus. For Mother’s Day, one note said, the residents would have “a wonderful meal” delivered to their rooms. There would be homemade gifts for the mothers and bags of chocolate donated by the Lindt chocolate company.
The update said staff were trying to schedule phone calls and video chats with family members. It said there were no new infections or deaths, and that 25 of the 61 remaining infected residents had recovered.
“We are hopeful that number will grow to 40,” the note said.