On June 5, the 37 members of the National Guard who had assisted the staff at Greenwood House for about a month departed. They had been assigned to the facility, a Jewish community nursing home in Ewing, when it was down to a reduced crew due to staff illness. Greenwood House sorely needed the help: 96 residents tested positive for Covid-19 and 29 died as a result, and there were 60 confirmed cases among the staff. Though they all recovered, at one point 26 members of the staff were out at the same time.
“It was very stressful, every day, not knowing who would be infected. It was very intense,” said Richard Goldstein, executive director of Greenwood House. “Now, I feel like we can breathe.”
As Covid-19 ripped through New Jersey, Jewish long-term-care facilities found themselves in the eye of the storm. Staff endured long hours, constant exposure, and limited access to testing until mid-April, while administrators struggled to mitigate the isolation of residents without increasing their risk of disease, and juggle increasing expenses with reduced capacity.
Now that there are indications, at least in New Jersey, that the worst has passed, long-term-care facilities around the state are admitting new residents, a process that has largely been on hold, and cautiously trying to move forward.
After months of being confined to her room, Norma Alter, a resident of Weston Assisted Living Residence, part of the Jewish Community Housing Corporation’s (JCHC) Lester Senior Living Campus in Whippany, is now allowed to see her son and daughter-in-law in person … once a week, outside, with social distancing, wearing masks, and in the company of a chaperone to ensure safety measures. But it’s better than before, when they could only interact through a window. “They are very cautious and careful,” said Alter. “To see my son and daughter-in-law, I have to wait for someone to take me. But I’m very grateful.”
Even so, few are ready to fully exhale.
Harold Colton-Max, CEO of JCHC, worries about a resurgence as New Jersey relaxes its restrictions. “I don’t want us to let down our guard so much that we would allow Covid to get another foothold,” he said. “I think that’s what could lead to another spike…We’re a little bit more comfortable, but…by no stretch of the imagination are we out of the woods.” Weston had nine cases among residents with seven deaths, and nine cases among staff with no deaths.
Likewise, Susan Grosser, executive director of Daughters of Israel, a nursing home in West Orange, is still wary.
“We’re on the other side now and things have definitely lightened up,” she said of Daughters of Israel, which saw 60 confirmed cases of the coronavirus among residents with 19 deaths, and 51 cases among staff with no deaths. “But I’m not quite feeling relief now. This is not over until it’s over. And until I don’t have a single coronavirus case, and until everybody is healthy and everybody is well, I’m not going to feel relief.”
NJJN spoke with administrators and families at four Jewish long-term-care facilities in the state — Greenwood House, Daughters of Israel, Weston, and Freehold Jewish Home for Rehabilitation & Nursing (administrators at Stein Assisted Living at the Oscar and Ella Wilf Campus for Senior Living in Somerset were unavailable at press time, and Regency Jewish Heritage Post-Acute Rehabilitation and Nursing Center in Somerset did not respond to NJJN) — about their experiences during the pandemic and the challenges ahead
We couldn’t control it
Despite following regulations and even preempting the aggressive steps mandated by the state, early on facilities found that they were no match for Covid-19. “At the beginning, I felt we could control it,” said Goldstein. “But it wasn’t really possible to control. This virus is so contagious, and it was in the air all around us before we knew what hit us.”
Agreed Grosser, “It spread like wildfire, no matter what we did.”
Measures like taking the temperature of staff, telling them to stay home if they didn’t feel well, and keeping visitors out were insufficient, as asymptomatic staff members were already caring for residents. “If we would have had testing in March, I think this experience would have been very different,” said Goldstein.
The weeks around Passover were the worst at Daughters of Israel, when the director and assistant director of nursing, along with many other staff, were out sick at the same time. “It was hell,” said Grosser. “We’d be kind of exhausted by the end of the day and not remember what happened [in the morning] because we just kept going at full speed.”
To compensate for the long hours and constant exposure and as a show of gratitude, Daughters of Israel has given every staff member “pandemic pay” of $250 per week on top of their regular pay throughout the lockdown.
After all they went through, Grosser resents the negative coverage of nursing homes, including Daughters of Israel, in the media. “They said nursing homes weren’t prepared. Who was prepared?” she asked.
One of the biggest takeaways for Colton-Max is the connection between physical and mental well-being that he believes the pandemic conditions revealed. Since March, residents have been alone in their rooms with limited interaction with staff, and meals are left hanging on their doorknobs. “The connection between somebody’s social life and family life and ability to interact with others and their physical health is quite significant,” he said. “That they can’t get a hug from a daughter or a grandson or other loved one, and [the fact that] they can’t interact with their neighbors can and does lead to physical problems….We’ve had people who feel their family members may have given up.”
Among them is Ilyse Link, whose mother lived at Weston. Recent vision problems amplified her mother’s isolation, as she couldn’t see well enough to use the buttons on a TV, computer, or phone. Link and her three sisters called regularly, and “Each day we could hear the sadness and desperation in our mom’s voice,” she said. Then her mother stopped answering the phone, and later refused to eat. She died on April 6.
Their family’s struggle to reach staff at Weston to talk about their mother’s condition made matters even more difficult. The nursing home had set up an emergency line to the nurses, Link said, but even though she called and left messages, she didn’t get a call back. “At the end, when we all knew that there was something wrong and we were saying, mom’s dying…we kept calling that number, and we couldn’t get anyone to talk to us.”
Added Link, “She should not have died alone.”
Reached by phone, Colton-Max said he felt “awful” about the situation with Link’s mother and that they are “investigating the claim that they could not reach anyone, as we have systems in place for residents and family members to reach someone on the JCHC staff in case of emergency.” Colton-Max said the expectation is that if it’s a true emergency, the staff will respond as soon as possible, if not within 24 hours.
Colton-Max said they are reexamining ways to improve communication with residents and families, and that the facility will provide families with a contact chain of command: If someone cannot be reached at one staff level, they’ll have a name and number of someone on a higher level, all the way up to Colton-Max, who noted that residents and their families are always welcome to contact him.
Sharon Cohn of West Orange, whose mother recuperated from Covid-19 at Daughters of Israel, is particularly sensitive to this issue. Cohn pulled her mother from one of the hospitals where she was being treated because of her difficulty getting information from the staff there. “You’re at the mercy of calling, to find out how they’re doing,” Cohn told NJJN. At Daughters of Israel, the nurses were responsive. “When we called, they answered.”
Said Yehuda May, executive director of the Jewish Home in Freehold, whose comments to NJJN were relayed through a spokesperson, “We recognize this has been an incredibly stressful period for families with a loved one in a communal living environment, particularly a skilled nursing facility.” To broaden lines of communication, the Jewish Home started using Zoom, Skype, and a new activities platform called LifeLoop to keep families informed.
As mandated by Centers for Medicare & Medicaid Services, a federal agency, all four of the facilities have been sending out regular reports regarding residents, staff, or even outside vendors who have tested positive, and some instituted regular calls with families.
Filling the ‘comfort gap’
Staff at various facilities tried to come up with creative solutions for residents, providing packages with coloring pages, crossword puzzles, and the like. Doorway Bingo was an innovation at Daughters of Israel — residents played inside their open doors, while staff walked up and down the hallway calling out the numbers. JCHC started the Friendly Callers program, matching community volunteers with residents to call.
“One of our key focuses throughout this challenging time has involved addressing the psycho-social well-being of our residents, who are missing in-person visits with their families,” said May. A dozen residents of the Jewish Home tested positive for Covid-19 and six died, and 16 staff members tested positive, with all recovering.
In trying to address what he calls the “comfort gap,” staff facilitated residents’ use of FaceTime to communicate with families. They also established an internal video channel over which they could hold “live” events like paint nights, “travel” days, and yoga. They plan to continue using it even after the pandemic ends to benefit residents who cannot leave their rooms.
Looking ahead, many see the biggest challenge at long-term-care facilities will be maintaining restrictions even as the state begins to reopen, and all the residences NJJN spoke with said they would be closely following guidelines from the CDC and the state. Most will continue to restrict visitors indefinitely, though perhaps eventually they would allow limited visits, similar to Norma Alter’s long-awaited reunion with her family at Weston. Her son, Ben Alter, said that, at least for now, he’ll take it.
“Seeing my mother face-to-face with regular conversation,” he said, “that’s a big step forward.”