Syracuse, N.Y. — Onondaga County’s nursing home residents, the people most vulnerable to the coronavirus, are not being adequately protected from the deadly disease.
New York state health officials and many nursing homes have failed to aggressively test these sick and elderly people.
The state’s response has been plagued by weak direction, inaccurate data and poor communication. Just Thursday, Onondaga County officials were surprised to learn of 19 nursing home deaths in the county that the state had not told them about.
“We are like the forgotten stepchildren,” said Dr. Elaine Healy, a vice president of the New York Medical Directors Association, a group representing nursing home doctors. Healy faults the state health department for not making sure nursing homes have what they need to fight the coronavirus, also known as Covid-19.
“Here’s a vulnerable population we should focus on, and we did not,” Dr. Sharon Brangman, a geriatrics expert at Upstate Medical University, said of nursing homes.
The state did not clearly state its nursing home strategy. But people in the field say the state has increased testing in nursing homes with outbreaks and is beefing up supplies of test kits as best it can.
Brangman and other experts say residents of all nursing homes, even those without symptoms, should be regularly tested.
To keep the virus out, all nursing homes have banned visitors. Many have confined residents to their rooms and halted communal dining. Employees caring for infected residents are required to wear masks and other protective gear. Before employees start their shifts, nursing homes take their temperatures and screen them for symptoms.
But those precautions alone aren’t protecting residents from the virus.
That’s because many frail elderly people and employees who are infected don’t initially show any symptoms and are spreading the disease. If these silent carriers are identified through testing, they can be isolated to protect their peers.
But that’s not happening in all of Onondaga County’s 14 nursing homes, which say they don’t have enough tests and often test only people with symptoms. Testing is inconsistent at local nursing homes. Some test aggressively, while others do it sparingly or not at all.
For weeks, the county government has been sending teams of nurses into other collections of the elderly: retirement communities, assisted living centers and other senior citizen housing facilities to proactively test asymptomatic older residents to stop the disease from spreading.
But county officials say they cannot do that in nursing homes because those facilities are regulated by the state Health Department. County Executive Ryan McMahon said the county has teamed with the state to test in a few nursing homes here.
“The state has made it clear we just can’t go in and do this ourselves,” he said.
Dutchess County, however, recently announced plans to test every resident in each of its 13 nursing homes. And Maryland and West Virginia recently ordered mandatory testing of all nursing home residents.
Brangman praised those approaches.
“If you can get them while they are asymptomatic, that should be the focus,” Brangman said. “If we don’t get a handle on it we won’t get control of the virus.”
Dr. Bruce R. Troen, chief of geriatrics at the University of Buffalo medical school, agrees.
“There should be 100 percent testing of residents and staff,” Troen said. “A nursing home is a perfect cauldron for this disease.”
In the absence of a proactive state approach, nursing home officials are left to make their own calls as best they can. At times, that leads to decisions that frustrate and confuse the families of residents.
Take some examples at one nursing home, Central Park Rehabilitation and Nursing Center, where nine residents have died, state records say:
- The Central Park medical staff refused to test a man with Covid-19 symptoms, saying it wouldn’t matter in his treatment. The man’s family and the county health commissioner asked for him to be tested, but the nursing home refused, a syracuse.com investigation showed. The family of Robert Botindari believed his death should’ve counted toward the pandemic’s toll and that others he came in contact with should’ve been warned.
Robert Botindari in a photo taken shortly before the coronavirus pandemic started, when nursing homes were allowing visitors.
- Another resident did not get tested until he went into cardiac arrest after getting a dialysis treatment. He was positive for the virus, and he died two weeks later.
- A 94-year-old woman fell while walking into the bathroom, and she was wheezing. She died the next day, without ever being tested for the virus. She had a roommate throughout this, the family says. After she died, the family says, it got a call from the home’s medical staff: She had Covid-19.
A scattered approach
When asked if New York is considering mandatory testing in nursing homes, the state Health Department was evasive.
In a statement, the department said it is working to increase testing in nursing homes. “In some cases, the testing is being conducted by NYSDOH and also by local health departments, nursing homes and local hospitals,” the department said.
The push to increase testing comes two months after the pandemic began. Covid-19 has killed 5,053 New York nursing home residents as of May 6, about a quarter of the state’s 20,828 Covid-19 fatalities.
The department did not reveal how many or in which nursing homes it has conducted testing.
But Van Duyn Center for Rehabilitation and Nursing in Syracuse is one of them. The 513-bed facility on Onondaga Hill has had an outbreak of the virus among residents and staff. Neither the nursing home nor the state has disclosed how many residents and staff have tested positive. Eight Van Duyn residents have died of the virus, according to the state.
Amy Mahoney, Van Duyn’s administrator, said in an email the nursing home has tested a “great number” of residents under the direction of county and state health officials.
A recent study in the New England Journal of Medicine showed the coronavirus spread rapidly through an unidentified nursing home in Washington state because more than half of its infected residents were asymptomatic. The study found symptom-based screening alone failed to detect a high proportion of infectious cases and was not enough to stop the spread.
In an editorial, the journal called for mass testing of all nursing home residents.
New York’s testing protocol says people should be tested if they have symptoms such as fever, cough or trouble breathing, have underlying health conditions or have had close contact with people infected with the virus.
Many nursing homes only test residents if they have symptoms. Loretto, a 583-bed nursing home at 700 East Brighton Ave. in Syracuse, is among them. It declined to disclose how many residents it has tested.
Julie Sheedy, a Loretto official, said the home has not tested many people because few of its residents have had symptoms. Loretto had one patient die from coronavirus after being transferred from a hospital into its coronavirus unit.
Michael Connor, a spokesman for the Centers at St. Camillus, said it does not test residents.
Bishop, a 440-bed Syracuse nursing home, has tested over 150 residents and would do more if it could get more tests, said Edward Farbenblum, who owns the facility.
“We are testing as aggressively as we can as quickly as we can get tests,” Farbenblum said.
He would like to see mandatory testing of all nursing home residents, including people who are asymptomatic, but said New York probably does not have enough tests to do that.
New York has more than 101,000 nursing home residents, more than any other state.
There have been two coronavirus deaths at Bishop.
Farbenblum said the nursing home has about 30 residents who have tested positive. About half of them got infected at Bishop and the other half already had the virus when they were transferred from hospitals to Bishop’s 38-bed coronavirus unit.
That unit, which has its own entrance and is sealed off from the rest of the nursing home, has a negative pressure ventilation system which prevents airborne viruses and other contaminants from drifting to other parts of the nursing home. Bishop is creating another negative pressure unit to accept more coronavirus patients from hospitals.
An April 28, state Health Department inspection of Bishop found no deficiencies in its infection control procedures designed to prevent the spread of the virus.
Missteps by the federal government early in the pandemic created a severe shortage of tests for nursing homes, hospitals, home care agencies and other health care providers.
The federal Centers for Disease Control and Prevention distributed defective coronavirus test kits in February that did not work, significantly delaying efforts.
As limited supplies of tests became available, the CDC said hospital patients should get them before nursing home residents. That left many nursing homes here and nationwide scrambling to get tests and facing long waits for test results.
It wasn’t until April 27 that the CDC revised its guidance and said nursing residents should get the same priority as hospital patients for coronavirus testing.
Bad numbers
Inaccurate data and the state’s lack of transparency make it impossible to know how much damage the virus is doing to nursing homes patients in Onondaga County and statewide.
On May 4, the state reported five confirmed nursing home deaths in Onondaga County. Later that day, the state released data that showed there had been 17 coronavirus deaths — 12 confirmed and 5 presumed — in four Onondaga County nursing homes. The county’s nursing home death toll now stands at 21.
The state Health Department said the numbers changed after the state checked deaths that had been reported inaccurately and inconsistently by nursing homes. That resulted in more than 1,700 previously undisclosed deaths statewide being reported for the first time as coronavirus cases.
The state’s revised fatality data still understates nursing home deaths because it does not include deaths of nursing home residents that occur in hospitals.
Onondaga County officials initially thought the state’s nursing home death numbers were included in the coronavirus death tally tabulated by the county. But McMahon said Thursday that was not the case.
“Certainly, the communication with the state health department related to nursing homes has been problematic,” McMahon said. “We’re a little surprised we did not know this information.”
The state also has refused to identify nursing homes with positive cases, even though many other states do this.
Critics say the state may have compounded the coronavirus problems March 25 by ordering nursing homes to accept patients with confirmed or suspected cases of coronavirus. After getting heavy criticism, the state changed its position and said nursing homes did not have to accept coronavirus patients if they were incapable of caring for them.
“I think that policy exacerbated the spread of Covid-19 in nursing homes,” said Richard Mollot, of the Longterm Care Community Coalition, a Manhattan-based nursing home resident advocacy group.
The personal cost
Carmella Porpiglio, 96, had been a resident at the Onondaga Center nursing home in Minoa since 2018.
Her daughter, Marie Vertigan, was concerned when she noticed on Facetime visits her mother was either asleep or looked listless, and wasn’t eating or drinking.
Vertigan said she asked the nursing home April 29 to test her mother for the coronavirus. The center declined, Vertigan said. Porpiglio died May 1.
In a statement to syracuse.com, the nursing home said a patient must exhibit symptoms as defined by the state health department to get a test. “This was not the case with Ms. Porpiglio,” the statement said.
The home pointed to another reason: The state doesn’t require testing.
“Additionally, to date, there has been no formal mandatory testing requirement for nursing facilities as stated by Onondaga County and no testing has been formally scheduled,” the home said.
Seventeen of Onondaga County’s nursing home deaths have occurred at Van Duyn and Central Park Rehabilitation and Nursing Center. The nursing homes are owned by CPRNC LLC, a private for-profit company in New York City. Its owners are Lawrence Koenig, Uri Koenig and Efraim Steif.
Steif and Uri Koenig own 16 nursing homes in New York. Six of the nursing homes have had a total of 37 coronavirus deaths.
The Koenigs and Steif did not respond to phone messages from Syracuse.com|The Post Standard.
Patrick Calli, Central Park administrator, did not respond to phone calls and emails.
- Glorida Morrock. Provided photoProvided photo
Rosann Leyden said she visited her mom, Gloria Morrock, every single day for the past six years at Central Park.
On April 15, she said she got a call from a social worker at Central Park saying her 94-year-old mom had fallen while walking into the bathroom. She was wheezing. She would receive a chest X-ray.
Later that day, Leyden received another call, she said. Her mother had pneumonia.
“I didn’t even have time to think — didn’t even think it could be Covid,’’ Leyden said.
Leyden received permission to see her mother the next day, she said. Dressed in full gown, a mask and gloves, she said her final goodbye during a half-hour visit. Her mother’s roommate remained in the room, Leyden said.
An hour later, Leyden received a call in her home in Clay, she said. Her mother had died.
Leyden said she received her mother’s death certificate May 1. It attributed her death to oxygen deprivation due to bilateral pneumonia, presumed COVID-19 and advanced age.
Mark Sitar, 59, who had severe kidney disease, moved into Central Park early this year, his brother Tim said.
Sitar told his brother in an April 1 phone call that he didn’t feel well, Tim said. On April 6, Sitar went to a dialysis center in Syracuse for a routine treatment. The center staff became alarmed that Sitar had trouble breathing, Tim said. An ambulance took Sitar to St. Joseph’s hospital.
There, Sitar went into cardiac arrest, was revived, moved to the intensive care unit and put on a ventilator, Tim said. The next day, April 7, Tim learned Sitar tested positive for coronavirus at the hospital. Tim said he called Central Park officials to tell them.
“He had a roommate and I didn’t know who he was, but I thought I should give Central Park a heads up,’’ he said.
Sitar died April 20.
Tim and his siblings wonder why Sitar wasn’t tested for coronavirus at Central Park and why the nursing home did not send him to a hospital.
“Maybe,” he said, “if he’d been sent to the hospital earlier he’d still be alive.”
If you or a loved one are a resident of an Onondaga County nursing home and want to tell us how it is handling coronavirus, contact Elizabeth Doran at (315) 470-3012 or edoran@syracuse.com
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