Consider This from NPR - 'Where Are We Going?' Inside The Deadly Decision to Evacuate An Entire Nursing Home

Episode Date: December 28, 2020

On a crisp morning in late March, health care workers in yellow hazmat suits arrived at St. Joseph's Senior Home in Woodbridge, New Jersey. They were responding to an outbreak of COVID-19 at the facility. But that response would make St. Joe's different than every other long-term facility in the state: it was the only such facility in New Jersey to be completely evacuated.NPR Investigations correspondent Dina Temple-Raston has been digging into why that happened — and whether some residents of St. Joe's might still be alive if it hadn't. More from her reporting is here.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Last March, as the coronavirus pandemic was just starting to make its way through the U.S., officials in New Jersey learned of a COVID-19 outbreak in a long-term care facility, and they did something unusual. They decided to evacuate 78 residents and move them someplace new. Medical personnel and protective gear were busy Wednesday morning, wheeling out nearly 80 residents who live at St. Joseph's Senior Nursing Home in Woodbridge. That day, March 25th, Eva Casaba watched it all from a parking lot across the street. There were, you know, the large ambulance buses, helicopters overhead. There were yellow hazmat suits with, you know, the face shields. Cassaba was watching to see if her mother, Anne Gentile, was one of dozens of elderly

residents being moved from the facility. But she didn't actually see her mom until later on the evening news. The residents who are in their late 80s and early 90s will be... Her hand was on her forehead, like her fingers spread. And, you know, you can interpret it as, oh my God, what's happening? Where are we going? What's this all about? I mean, that picture tells a thousand words. And now this place is blocked off by law enforcement, waiting to be sanitized and disinfected. What no one knew back in March is that within days, nearly half the people being loaded into ambulance buses

outside St. Joe's would be dead. Consider this. Some deaths at this one nursing home may have been preventable. They show the panic that drove decisions in the earliest days of the pandemic. And it's a story even all these months later with more questions than answers. From NPR, I'm Ari Shapiro. It's Monday, December 28th. This message comes from NPR sponsor, AT&T. There's a lot that's different about this school year, but one thing that hasn't changed is AT&T's commitment to education. They're focused on keeping students and teachers connected to learning. It's why AT&T has connected over 200 million students with tools and technology for distance learning. Learn more at att.com slash remote learning. At Planet Money, we are also grappling with what's going on in the world. We just don't know, and you're still going to have to decide.

So we call up economists like Emily Oster. It's like we're fighting the pandemic by having a bake sale or something. I mean, all due respect to bake sales. Listen and subscribe to Planet Money from NPR. It's Consider This from NPR. We know that people in long-term care facilities are especially vulnerable to COVID-19. Outbreaks at those facilities have been a constant story of the pandemic. St. Joe's in New Jersey is an orange brick building surrounded by manicured bushes.

It's about half an hour south of Newark. When COVID-19 arrived there, the virus tore through the facility like so many others. But what made St. Joe's different is how state officials reacted to it. It was completely evacuated. No other long-term care facility in the state was emptied out like that. Correspondent Dina Temple Raston of NPR's investigations team has been digging into why that happened and whether some residents of St. Joe's might still be alive today if it hadn't. Dina picks up the story from here.

Days before the evacuation, 93-year-old Annette Kocielik was in her room at St. Joe's eating Polish donuts with her eldest daughter, Bernadette. Her little raspberry jellies, which she loved. Annette's friends called her Tony, and they say she loved lots of things. Brooches, beads, barrettes, and she loved St. Joe's, the daily masses, the gardens, the fact that the nuns spoke Polish to her. And we just thought it was a really good fit. Bernadette Soler said her mother may have been 93,

but she was still the Tony everyone knew. You know, whenever I'd walk through the door, she'd always say, Bernie, and make a big deal, and this is my daughter to all of the workers there. So, you know, little did we know, less than two weeks later, everything would change. What changed was COVID-19. On the 17th was the first day that we were notified by St. Joe's

that one patient had contracted the virus. The 17th of March, in the earliest weeks of the pandemic. It just happened so, so very fast. You know, from when there were sniffles to when one person had it, six people had it. And then her mother had it, though she didn't seem to be showing many symptoms. Once again, in my mind, my mom is resilient, strong as a bull. And, you know, even though she was in a wheelchair, she was a fighter. The staff at St. Joe's did what they were supposed to do. They quarantined,

they called in reinforcements, and they asked the state if it would help too. Just four days later, the state's response was harsh. It ordered an evacuation. The state wanted the entire facility to be completely emptied, which is a bigger deal than it might sound. When you evacuate a facility, you're moving residents who are medically fragile. And anytime you transport them into unfamiliar environments, places a lot of stress on the individuals and can jeopardize their health and safety. That's Christopher Newarth, and he's a former New Jersey Health Department Assistant Commissioner in charge of emergency preparedness. And when he first heard about St. Joe's, he remembers thinking two things. First, why was the state involved? Evacuations are usually handled locally.

And second, that the whole operation, which involved transferring the residents to a new facility, Care 1 Hanover, it all seemed oddly rushed. You know, this wasn't a flood or a fire where they had to evacuate within a matter of minutes or hours. Newworth no longer works for the state because, he says, he filed an ethics complaint against a high-ranking official and was fired. He has since filed a whistleblower complaint, and the suit is pending. But he isn't alone in thinking that the evacuation of St. Joe's was problematic. It wasn't just the push to move everybody out quickly.

It was the stress that such a move would put on the residents of St. Joe's. Just ask Pamela Cacione. She studies older adult care at the University of Pennsylvania School of Nursing. And she says evacuations like this are rare for a reason. The literature shows that these acute evacuations are very dangerous for older adults. But according to three current and former health department officials who were there when the evacuation was discussed, the trauma associated with this kind of a wholesale move

didn't seem to figure into the state's calculus. They said leaders at the Department of Health seemed to be reacting to the outbreak as if it were a natural disaster, as if an evacuation was the only viable option. A health department spokesperson told NPR that just wasn't true. In a written response, she said that the state spent two days trying to find reinforcements for St. Joe's. Two days. As far as the New Jersey Department of Health was concerned, that was long enough. Thank you, Governor. Good afternoon,

everyone. During a press conference, the state's health commissioner, Judy Persichelli, said the outbreak at St. Joe's couldn't wait. More residents and staff are symptomatic. So we made the assumption that residents and staff of St. Joseph's had all been exposed to COVID-19. But the thing was, we don't know if they'd all been exposed. The health department claims they confirmed two dozen residents had tested positive before the evacuation. But according to contemporaneous emails at the time, families understood the number was half that much, about a dozen, a dozen out of 78. So the real problem wasn't how many people had the virus. The problem St. Joe's was facing was more fundamental. The nuns needed some temporary help, just to tide them over.

The nuns asked for out-of-state nurses or for the deployment of the National Guard. But what they got instead was this evacuation. And in case there was any resistance to the idea of letting all their residents go, there was also what some saw as a thinly veiled threat from the New Jersey Commissioner of Health. This may result, unfortunately and ultimately, in the closure of that facility. Persa Kelly said later the sisters at St. Joe's asked for the residents to be moved. And while the sisters declined to talk to NPR about the evacuation, the families say the nuns told them at the time that the evacuation came as a complete surprise.

They only had 12 hours notice. There's another reason why the state's decision to evacuate everyone at St. Joe's all at once was puzzling. Even in the best of circumstances, these kinds of large transfers are fraud. People get lost in the shuffle. Meds get missed. There's no continuity of care. And in this case, the residents of St. Joe's would arrive at Care One all at once as strangers. Just consider Toni Kocielik. Her middle daughter, Dorothy Casaro, worried people at Care One would just see her mother how she was when she arrived after that bus ride from St. Joe's.

She was going to be presented on a stretcher. She's going to look weak and feeble. And I guess I felt that there would be judgments made. As soon as her mother was admitted, a doctor at Care One recommended that she be put into hospice, essentially compassionate care for people in those last stages of life. She was admitted on Wednesday, and I believe it was Saturday she went into hospice.

Cassara wanted the nurse to take her mother's vitals so she could figure out how much time her mother might have left. And I guess the nurse to take her mother's vitals so she could figure out how much time her mother might have left. And I guess the nurse's station was kind of busy, so she makes a comment saying, oh, they're really busy here. And I said, okay, well, that's okay. Why don't you go in? We'll do this FaceTime call, and then you can catch me up on the vitals afterwards. So the nurse went in with the phone. She's very cheery, and she has my mother on FaceTime. I'm like, hey, Ma, how you doing? I said, you don't look any worse for wear today or say something to her. But the FaceTime camera was only showing her from the nose up. So I said, can you do me a favor and

move the camera down? And she moves the camera down. And I was like, oh, because it was, to me, what I would refer to as the death gap. CARE-1 denies this ever happened. But Casaro has a time-stamped screenshot, and NPR has seen it. Moments after she took it, another nurse walked into the room off-camera. Casaro could only hear her voice. And she goes, oh, yeah, no, your mother's near the end. She's gone. And I said, she's gone right now? She goes, oh, yeah, no, your mother's near the end. She's gone. And I said, she's gone right now?

She goes, oh, yeah, yeah, she's gone. The nurse turned the camera on herself and told Casaro, I'm sorry for your loss. And then the line went dead. The mother who loved brooches, beads, and barrettes died at Care 1 Hanover on March 30th, five days after the evacuation. I know that the day before the evacuation,

my mother was still vocal, my mother was still vocal, my mother was still coherent. And now she was gone. There's something else a little odd about the whole St. Joe's affair and its administrative. All 36 of St. Joe's residents who died after the move are listed as having died at St. Joe's, not Care 1. The New Jersey Health Department told NPR in a statement that during outbreaks, deaths are counted based on the association with an outbreak facility, not the actual location of the individual's death. What that presupposes, though, is that no one got the virus at Care 1 after the transfer. For Coach Alec's youngest daughter, Angie, all of this was more

than she could take. And my mom was 93. It's realistic to think that she probably wouldn't have lived more than a few more years. I get that. But she wasn't able to die with dignity and comfort. That's the thing that hurts the most. And remember Eva Casaba, that woman who watched the evacuation from across the street? She lost her mother too, and she believes the stress of the move, which she saw on her mother's face in that evening news footage, contributed to her death. Casaba's mother tested positive for the coronavirus five days after her arrival at Care 1. She was dead two days after that.

Whether Anne Gentile caught the virus at St. Joe's or at Care 1 is unclear. For Kasaba, who's a nurse, the more fundamental problem was the state's decision to evacuate St. Joe's in the first place. No other facility was ever evacuated after that. And I'm sure they realized what a mistake that was, because if it wasn't a mistake, they would have done it with other facilities, and it wasn't done. Last November, there was a surprise party for Ann Gentile at St. Joe's. She was singing, dancing, full of life. In a video, Casaba's mother is wearing a pretty

sweater and there are balloons and cupcakes. Sing your song. And everybody was trying to get her to sing. My mom used to sing on the radio. She would be on every, I think every Saturday. Gentile would have been 90 in November. That report from correspondent Dina Temple Raston of NPR's investigations team. For more on her investigation into what happened at St. Joe's, there's a link in our episode notes. You're listening to Consider This from NPR. I'm Ari Shapiro.