By Michael Sol Warren and Rodrigo Torrejon | NJ Advance Media for NJ.com, June 10 2020
It was a nightmare scenario, a last-ditch effort to save dozens of lives in immediate danger.
In late March, the coronavirus was ravaging St. Joseph’s Senior Home in Woodbridge, a fate that would soon befall hundreds of facilities across New Jersey. At St. Joseph’s, COVID-19 rapidly spread between residents and staff, sickening at least 29 people and killing at least three.
The state Department of Health forced the overwhelmed home to close and immediately evacuate all 78 of its residents, all of whom were to be presumed positive cases. In less than a day, the elderly men and women were hurried onto buses and rushed to another facility two counties away.
But for the move to happen, the existing residents of the receiving facility — CareOne at Hanover in Hanover Township — also had to be relocated. Chaos ensued; belongings stuffed into bags, dementia patients thrust into new environments with strange roommates, a family’s FaceTime call with a relative who may have already been dead.
Now months later, the bewildered families of those affected by the hectic moves still wonder: what good did this upheaval do? Dozens of deaths and hundreds of COVID-19 cases have since been linked to the facilities involved in the relocation, and despite similar outbreaks throughout New Jersey, no subsequent evacuations have been ordered.
Interviews with family members paint a harrowing portrait of a hastily arranged initiative that ultimately may have done more harm than good. The incident, they say, is a prime example of the state’s larger, longterm care crisis: an understaffed, under-equipped and poorly managed system woefully unprepared for the havoc the coronavirus unleashed upon New Jersey’s most vulnerable population.
More than 40% of New Jersey’s confirmed COVID-19 fatalities now stem from longterm care centers — above the national average, according to the New York Times.
While it will never be known exactly how much death and illness these moves may have inadvertently caused, the rarity of such evacuations nationwide — despite thousands of facilities being assaulted by the same silent killer — speaks to the irregularity of the state’s decision.
Did New Jersey health officials make the right call? The question haunts the wives and husbands, daughters and sons of those evacuated residents, all of whom are left to consider whether an act of desperation sent their loved ones to an early grave.
Out of control
For nearly two years, Mary Mulhall lived peacefully at St. Joseph’s, a five-star facility and one of the state’s top-rated homes, according to the U.S. Centers for Medicare and Medicaid.
Bob Mulhall, Mary’s son, praised the nuns and staff for how they treated his mother and other residents.
“The servant sisters were loving, friendly,” Bob told NJ Advance Media. “They truly loved my mother.”
Mary, 91, was a first-generation American, born in Newark to Irish immigrants. She dedicated her life to her family — she had seven children — as well as her friends and the church, Bob said.
In late February, Ash Wednesday, Bob and his son Michael Mulhall visited Mary with a special steak dinner from Manhattan. But as the family would be breaking a Catholic rule by eating red meat on the holy day, Bob called ahead to clear it with the nuns.
“The head sister, she laughed and she said ‘Bob, if you can get Mary to eat anything, I’m sure God would sit down at the table and join you,’” Bob said.
The meal is now a bittersweet memory, marking the last time Bob saw his mother in person before St. Joseph’s unraveled.
By late March, the facility was in crisis.
The first COVID-19 case at St. Joseph’s was reported March 16, Woodbridge Mayor John McCormac said, and four days later the facility reached for a lifeline, calling on the New Jersey Department of Health for help, according to DOH spokesperson Donna Leusner. Outside staff from health care and staffing agencies, including CareOne, were brought in to respond, Leusner said.
But the situation was deemed untenable. Immediate action was needed.
On March 24, the state determined St. Joseph’s could no longer safely care for its residents, ordering the facility to close and send its tenants to CareOne at Hanover, Leusner said. CareOne at Hanover, a four-star home located 30 miles north in Morris County, was chosen as the receiving facility because “the department contacted them and they agreed to help,” she added.
The state determined that while St. Joseph’s reported positive cases in only 24 of its remaining 78 residents — some of the sickest residents had already been moved to nearby hospitals — and five staff members, all at the facility had been in contact with the disease, DOH Commissioner Judy Persichilli said at the time. Additionally, three COVID-19-related deaths had been reported in the previous eight days.
“It was vital that immediate public health actions were taken to ensure that the staff and the residents were safe, and that the residents got the care that they needed,” Persichilli said at Gov. Phil Murphy’s daily press briefing on March 24.
On March 25, the move was done.
St. Joseph’s declined to comment on this story. The Little Servant Sisters of the Immaculate Conception, which operate St. Joseph’s, did not respond to multiple requests for comment.
Under normal circumstances, federal law generally requires 30 days notice before a nursing home resident is moved to a new room, let alone a new facility, said Laurie Facciarossa Brewer, New Jersey’s long-term care ombudsman.
“I can only imagine how bad it had to have been at St. Joseph’s,” she said, adding that such protections have been temporarily removed amid the pandemic.
“Which is concerning to me, but I understand it.”
‘Horrific’
At the Hanover facility, details fell through the cracks amid the whirlwind move-in.
Annette Kociolek, 93, had lived comfortably at St. Joseph’s since 2018, her daughter Dorothy Cassaro said. But in the mad scramble to move her mother, who had tested positive for COVID-19, at least one medication order was left un-transferred with her medical file.
The move was detrimental to Kociolek’s health, said Cassaro. She was placed into hospice care one day after arriving at CareOne, even though she had not been a hospice patient at St. Joseph’s.
“The five days following the transfer were, in my opinion, horrific,” said Cassaro.
On the fifth day, March 30, Cassaro had a FaceTime video call with her mother, whose condition had worsened. She had stopped eating and was unable to swallow medication, a nurse told Cassaro.
When Kociolek’s face appeared on the smartphone screen held by a nurse, Cassaro began to speak to her mother. Annette’s eyes were open, but she was unresponsive.
It was then that a second nurse swiftly entered the room and delivered the painful and shocking news.
“’Oh I’m sorry, she just passed,’” the nurse said, according to Cassaro.
“I said ‘She just passed now?’ She’s claiming that she passed just at that moment.”
Cassaro was told her mother had died in front of her eyes. As the nurse announced Annette’s death, she turned the phone to her to tell Cassaro she was sorry for her loss.
Hours earlier, a nurse told Cassaro’s sister their mother was in stable condition — not near the end of her life. Cassaro believes her mother was already dead when the call started.
“The sense I got is that she was probably long gone,” said Cassaro.
CareOne disputed that the FaceTime call described by Cassaro ever happened.
“Although the family didn’t FaceTime immediately in advance of their loved one’s passing, CareOne has gone out of its way during these extraordinary times to connect families with loved ones via FaceTime and other electronic means,” the company said in a statement. “In this instance we kept in frequent communication with the family. We extend our deepest condolences to the loved ones for their loss.”
Annette Kociolek died from pneumonia linked to COVID-19, according to her death certificate.
The move before the move
Under order by the state DOH, CareOne was suddenly required to lodge 78 new residents. Space needed to be cleared, quickly. Dozens of existing residents of CareOne at Hanover were suddenly moved out to make room.
CareOne did not say how many of its own residents were moved out of the 94-bed facility in Hanover, but the DOH confirmed those who were uprooted were sent to three other CareOne facilities, in Morristown, Parsippany and Livingston.
Ronald Rella lived at CareOne in Hanover for about 10 months before the move, his wife JoAnn told NJ Advance Media. Ronald, a 73-year-old father of three from Livingston, had worked for the American Kennel Club and lived a life that revolved around dogs. But Ronald suffered from dementia and JoAnn, 70, couldn’t care for him alone.
A fellow resident, Frank Andretta, an 81-year-old retired engineer from Whippany, also suffered from dementia and lived in a private room at CareOne at Hanover, his daughter Gina Tartaglia told NJ Advance Media.
Both JoAnn Rella and Tartaglia said their loved ones were treated well by the staff in Hanover, but were dismayed by the unexpected move. Neither was notified until the evening of March 24, the same day the order was issued and mere hours before CareOne Hanover was to be cleared out.
“To do that when we were banned [from visiting], with no warning, should be a crime,” Tartaglia said, noting CareOne had already limited visitation at its facilities to slow the coronavirus spread.
Both Ronald Rella and Andretta were moved to CareOne at Morristown on March 25. The breakneck relocation was utter chaos, JoAnn Rella and Tartaglia agreed.
Many staff and residents weren’t wearing masks or protective equipment, JoAnn said. She added that she and her son were able to pack up her husband’s belongings, but others, like Tartaglia, found their loved one’s possessions haphazardly gathered.
“The director of my dad’s building had my dad’s clothes in his car in a bag,” Tartaglia said.
Upon their arrival in Morristown, more vital details were lost in the shuffle. Rella, who was prone to aggressive outbursts due to his dementia and had been living alone at the Hanover facility, suddenly had a roommate, an existing Morristown resident.
“Any time you move people with dementia and mental issues, you’re disorienting them,” JoAnn Rella said. “They were taken out of their home and just dumped with strangers.”
After a few days, JoAnn Rella said, CareOne reorganized the rooming arrangements to keep the residents from the Hanover facility together.
In a statement to NJ Advance Media, CareOne said it understood the move was difficult, but the company stressed that the St. Joseph’s residents were “in imminent danger” in Woodbridge, and that the state’s order forced CareOne to act immediately.
“We understand the sense of confusion and even chaos that the St. Joe’s evacuation appeared to create, but in reality, the transfers went as well as could have been expected,” CareOne said. “Our families should know that their loved ones played a vital and necessary role in rescuing these patients. The St. Joe’s patients could not have been saved without the collective sacrifice of CareOne at Hanover Township community, staff and residents alike.”
‘A higher body count’
Since the pair of moves in late March, dozens of COVID-19 deaths have been associated with the two groups of residents. According to DOH statistics, as of June 8, St. Joseph’s — which has since reopened — has reported 80 cases of COVID-19 among its residents and 35 cases among staff. There have been 36 residents deaths from the virus, though no staff have died.
Meanwhile, CareOne facilities in Morristown, Parsippany and Livingston — where the original Hanover residents were sent — combined for 267 cases and 107 deaths among residents, as well as 102 cases and two deaths among staff.
There are no reported statistics for CareOne’s Hanover home, to which no residents have been returned. Instead, the facility is now designated as COVID-19 positive only.
Ronald Rella died March 31 in Morristown, just a week after being moved out of the Hanover facility and two weeks before his 74th birthday.
JoAnn Rella believes that while her husband was in failing health — he was already in hospice care and died of pneumonia; a COVID-19 test came back inconclusive — the trauma of the move exacerbated his condition.
“My resentment is that somehow CareOne pushed him into a grave within a week,” she said.
JoAnn was unable to visit her husband in his final days. Due to a visitor ban, the only way to see Ronald was to move in with him, staff told her.
She isn’t convinced that any of this was worth it; ending one life, she believes, to save another.
“At the end of the day, I think the whole fiasco contributed to a higher body count,” JoAnn said.
After publication of this story on Wednesday morning, CareOne disputed the characterization that the evacuations directly led to more deaths. CareOne also emphasized that it believes the swift action saved lives, and noted that the company was praised by Murphy and Persichilli following the moves.
Tartaglia said her father, Frank Andretta, was free of the coronavirus throughout the move, but on April 20, he was diagnosed with COVID-19 while in Morristown. Andretta has since recovered from the disease, but his dementia has taken a sharp turn for the worse.
Weeks after the move to Morristown, Tartaglia was finally able to visit Andretta. It was bittersweet; visitors to the facility are only being allowed if the resident is near death.
Tartaglia wishes her family would’ve had more notice before her dad was uprooted.
“If we had warning, my mom maybe would’ve pulled him out,” Tartaglia said of her father. “We were not given the choice.”
‘No one will convince me otherwise’
The state’s response to the overarching crisis in Garden State nursing homes has been widely excoriated, and numerous failings have been exposed, including an NJ Advance Media investigation published in May. At the start of June, a group of anonymous DOH employees sent a letter to state lawmakers describing New Jersey’s handling of the coronavirus in nursing homes as “an unmitigated failure.”
Days later, a report for which the state paid $500,000 concluded that New Jersey’s nursing homes were unprepared for the pandemic.
In an attempt to slow the rate of illness and death, the DOH launched surveys at problem sites. In May, Gov. Phil Murphy deployed National Guardsmen to several long term care facilities to assist staff. Medics from the U.S. Department of Veteran’s Affairs have been reinforcing staff at the state’s veterans homes. The state has also launched investigations into New Jersey nursing homes that report disproportionately high numbers of deaths, and ordered all long-term care facilities test every one of their residents and staff for COVID-19.
Leusner said that DOH has since curtailed admissions to nursing homes that are unable to cohort residents into separate COVID-19 positive and negative groups, and nursing homes that face staffing shortages.
No other nursing home evacuations have been ordered in New Jersey.
Nationally, nursing home evacuations have remained rare even as the coronavirus takes a heavy toll on the facilities’ susceptible populations.
A home in Worcester, Massachusetts moved out its 146 residents on March 28 — not because the facility had a COVID-19 outbreak, but because the state ordered it emptied so that it could take in patients with the virus from elsewhere, according to Boston NPR station WBUR. In that case, the evacuation was done over multiple days.
Then in early April, more than 80 residents were forced out of a home in Riverside, California after the coronavirus took hold in the facility and staff stopped showing up for work, according to the Washington Post.
While the coronavirus pandemic is certainly unprecedented, a deadly 2018 viral outbreak at Wanaque Center for Nursing and Rehabilitation — where an adenovirus killed 11 children — was a stark warning that the state was ill-equipped to deal with similar crises.
A follow-up investigation by the U.S. Centers for Medicare and Medicaid Services, or CMS, revealed that neither the Passaic County facility nor the state responded quickly enough.
In response, Murphy signed into law last August a bill that would require certain long-term care facilities to submit outbreak response plans to the DOH. One of the required components of the plans was to have clear policies for the notification of residents, their families, visitors and staff in the event of an outbreak.
But Facciarossa Brewer, whose office received calls from families of both homes after the moves, said she’s not surprised such protocols vanished amid the panic.
“If a facility is in a situation where things are starting to go downhill, one of the first things that’s going to go out of the window is communicating with families,” Facciarossa Brewer said.
The law Murphy enacted also requires facilities to have policies to conduct routine monitoring of residents and staff to quickly identify signs of a contagious disease that could develop into an outbreak. But that law only applied to facilities with ventilator beds, Leusner said, meaning that St. Joseph’s and the four CareOne facilities in this operation were not required to submit plans.
While family members feel they were given short notice about the fateful moves, some experts say that sometimes an immediate evacuation is the only option.
“Studies have shown that moving frail residents during an emergency can have negative health consequences, but COVID-19 poses such a serious threat to our residents (perhaps a 20% mortality rate) that providers must weigh what’s in the best interest of each specific resident and their capability to care for them during this pandemic,” the American Health Care Association and National Center for Assisted Living said in a statement.
In the weeks following the moves, St. Joseph’s was cleaned and prepared for reopening at the state’s expense, Leusner said. It reopened April 16 and by May 4, 58 St. Joseph’s residents had been moved back in, Woodbridge Mayor John McCormac said.
Mary Mulhall wasn’t one of them.
Mulhall died on March 29, just days after being placed on the emergency transport bus and shipped off to CareOne at Hanover. She had tested positive for COVID-19 before the evacuation, but Bob believes that the sudden moved was devastating to her health.
“She was dying,” Bob said. “But this move, no one will convince me otherwise, that this move did not kill her.”
Mulhall died from pneumonia and complications from the disease. Bob was never able to see her in person at the Hanover facility — he had to settle for visiting through a first-floor window.
Above all else, Bob is most upset with the state for a decision that he believes ended his mother’s life.
“No one from the state of New Jersey … called my family to say they were taking my mother away. That is unconscionable,” Bob said. “I know things are hectic, [but] you don’t walk into a place and take people.”