Jewish Nursing Homes Facing a Covid ‘War’

At the New Jewish Home, with the staff under siege and coronavirus cases mounting, they are on a war footing against the disease.

“There is no business as usual,” said Dr. Jeffrey Farber, president and CEO of the New Jewish Home, a health system that includes a nursing home in Mamaroneck in Westchester County and eldercare facilities in Manhattan. “It’s war. This is all hands on deck.”

As the number of coronavirus cases in New York State appears to be leveling off, nursing homes and long-term care facilities have emerged as the new hot spots. At the beginning of this week, the state said there were 5,650 confirmed Covid-19 cases in 340 of its 613 licensed nursing homes — and nearly 2,000 nursing home residents had been killed by the virus.

New York Gov. Andrew Cuomo said Tuesday that the number of nursing home deaths in New York “has been an increasing issue. … That is the vulnerable population in the vulnerable place. And we have been worrying about nursing homes since day one. The percentage of loss of life is getting higher in the nursing homes compared with hospitals.”

Nursing home administrators are keenly aware of that fact.

“We are doing everything we can to help save lives,” Farber told The Jewish Week. He declined to provide figures on the number of Covid-19 cases his facilities have had or the number of deaths, saying simply, “We have lost some, we have staff who are home sick. … The prevalence is great.”

The State Department of Health said on Monday said there were 172 virus-related deaths in nursing homes in Westchester County alone.

Nursing home residents are primarily in their 80s, and experts say people over the age of 60 and those with an underlying health condition or a compromised immune system have a greater chance of developing a serious illness when they contract Covid-19.

Dr. Howard Zucker, the state’s health commissioner, has said the state is not releasing information it collects about Covid-19 cases in specific nursing homes “to protect [the] privacy of individuals.” who in many cases live there.

The speed with which the coronavirus spreads through nursing homes is perhaps best demonstrated by what happened at a nursing home in Commack, L.I. The nursing home, the Gurwin Jewish Nursing and Rehabilitation Center, complying with directives from the New York State Department of Health, accepted its first Covid-19 patients from three area hospitals on March 27 at a time when hospitals were running out of room because of all the Covid-19 patients they were treating.

In an interview a week later, Stuart Almer, Gurwin’s CEO and president, said he had accepted seven Covid-19 patients from area hospitals and that five residents of the nursing home had also tested positive. Last week, the total number of Covid-19 cases in the facility rose to 25, including the seven who were transferred from area hospitals.

Almer said his nursing home initially set aside one wing of the second floor for formerly hospitalized Covid-19 patients. That wing had 11 beds in seven rooms. But he said because the number of seniors contracting Covid-19 “is exploding in the community, we keep expanding our barrier [quarantined Covid-19 unit] and anticipate needing an additional unit so we will have a total of 40 beds in 22 rooms.”

By this week, the unit had expanded to encompass all of the projected 40 beds, and some residents in other parts of the nursing home were also infected with the coronavirus. They have been placed in clusters to make it easier for hospital staff to care for them. Some have died and some were moved to hospitals where they died.

“Coronavirus in a nursing home can be like fire through dry grass,” Cuomo said last month.

A Gurwin spokeswoman said her nursing home’s original plan was to “move them [Covid-19 patients] to one unit, but the disease spread so easily. … We’re working hard to contain it and minimize the spread.”

She stressed that some have recovered after contracting the virus.

“The ones who came in from the hospital are mostly getting better,” she said. “They are no longer so critical and the expectation is that they will do well. Nursing homes…are not death traps.”

When Covid-19 patients were first transferred to Gurwin from area hospitals, Almer posted the state directive on Gurwin’s website and relatives of many residents expressed concern.

“They wanted to know where they could complain,” he recalled. “Relatives were confident in Gurwin but afraid these patients could infect residents.”

A few even took their relatives out of Gurwin.

“It was a risky move because it meant they then had to have caregivers coming into their homes as needed, and for many people that meant on a daily basis,” said Almer. “We are working with families who have heightened concerns. My father lives here and I share the same concerns.”

Sourcing Supplies

Among the steps nursing homes nationwide have implemented since mid-March to safeguard residents have been to bar all outside visitors (except for those visiting hospice patients), cease all group activities and screen all staff members entering the building for fever or respiratory symptoms.

“If there are any concerns, they must be checked by a physician and maybe even tested” for Covid-19, Almer said. “We have had several staff who tested positive and are [not working until they get better] — primarily nurses and nursing assistants.”

All clinical staff working with residents must wear face masks, and those working with Covid-19 patients must wear masks, gloves, a face shield and a gown.

Asked if he had experienced difficulty getting the safety equipment, Almer said it had been a challenge, “but we now have sufficient supplies.”

“We belong to a few trade associations, and as a member of UJA-Federation of New York we get important updates from them regarding regulatory information,” he said.

Among the trade organizations Gurwin belongs to is the Association of Jewish Aging Services. Its president and CEO, Don Shulman, said his organization — which represents 95 Jewish-sponsored nursing homes, housing communities and outreach programs in the country — started a buying consortium for its members about three weeks ago because of the difficulty in buying supplies.

“We have acquired $3 million in equipment from around the world,” he said Monday. “Some has already been shipped and hopefully all of it will be in the homes in the next five to seven days. We are paying higher prices, but not crazy prices.”

Farber of the New Jewish Home said he has “struggled to procure adequate equipment for our staff. It isn’t easy. We have been looking outside our regular vendors and been subjected to egregious price gouging.” The home recently paid $100,000 for 100,000 surgical masks, when in normal times a mask goes for less than 3 cents. Staff there are also sanitizing PPE [personal protective equipment] that normally would be disposed of after first use.

Shulman said most of the PPE — including hard-to-find disposable isolation gowns — are manufactured in China and that the Chinese government is now handling its distribution.

Farber said his facilities began preparing for the pandemic in late February, “but no one knew the extent of what we would be facing.”

The toll on his staff has also been great, he observed.

“This is the challenge of a lifetime,” he said. “The staff has gone through so much, like phases of grief — denial, fear, anger and conflicting and evolving guidance, which all contributes to the anxiety. There are actually two pandemics — the virus and fear .…These days have been getting harder and harder and they will continue getting harder and harder. And a major problem is we don’t know when this will end.”