Palazzo Apartments

The Palazzo’s assisted-living neighborhood, Naples.

As America’s battle with the novel coronavirus has raged, the Jewish community has suffered its share of losses. No age group has been as widely affected as the elderly, making nursing homes, assisted-living facilities and senior residences ground zero in the battle against the virus.

While states in the Northeast — New York, Massachusetts, Connecticut, New Jersey and Pennsylvania — were hit hard at the beginning of the pandemic in March and April, cases of infection lessened significantly after months of social distancing and lockdowns. Some hoped that the virus would subside as the weather warmed, but that did not happen, and now, swaths of the U.S. South are seeing daily infection rates that rival the worst days in New York City.

JNS and the Jewish News spoke with Jewish nursing-home administrators in Miami, Pittsburgh and New York and senior living facilities in Greater Phoenix to hear from those on the front lines about how they have coped and are still coping, in addition to the lessons learned and efforts to protect the elderly going forward.

(Statistics below from Worldometers.info and azdhs.gov, dated 7/21/2020)

Phoenix (Arizona)

Governor: Doug Ducey (R-Ariz.)

Statewide mask mandate: Not required

Cases citywide (Maricopa County): 98,988

Cases statewide: 148,683

Deaths citywide: 1,556

Deaths statewide: 2,918

Height of cases: June and July

At Kivel Campus of Care, a Jewish assisted-living facility in Phoenix, President and CEO Ira Shulman said communication and preparedness have been key to keeping the community safe for the last four months.

“We’re still locked down, meaning no visitors except for iPads or iPhones or something like that — Zoom kind of things. Residents are still eating in their rooms, no big activities,” Shulman said. “But they seem to be doing OK, we keep them as busy and entertained this we can.”

Even at the beginning, when supply chains broke down and supplies were limited, Kivel managed to find enough masks, gloves, toilet paper and towels to last until the shortages abated.

“We learned to be prepared, and obviously that’s incredibly important,” Shulman said. “Luckily, we had PPE stuff — not as much as we needed, but we certainly had enough for the beginning, and then we ordered, obviously, a lot more.”

The Palazzo, a senior living facility in Phoenix that houses the Jewish Family and Children’s Service Center for Senior Enrichment, also shut down when COVID-19 reached Arizona in March: activities scaled back, the dining room closed and meals were delivered directly to residents’ rooms.

In May, after Gov. Ducey’s stay-at-home order expired and the state started Phase I of the reopening, The Palazzo considered opening up more socially distanced activities and dining options within the complex. But as cases surged, those plans went on hold.

“That reality quickly went away, and it was very obvious, based on the surges in the state and all around us, that then was not the time to open anything up,” said Mark Aronauer, marketing director for The Palazzo.

Now, the main challenge is keeping residents from feeling isolated.

“There’s that balance that has to go into place, being safe from the virus versus mental stability or mental comfort in not being isolated for too long,” Aronauer said. “Now, four months later, [the isolation] is starting to really hamper people’s mindset, so we’re trying to find that balance of ‘let’s stay safe, always wear a mask,’ but what can they do by leaving their apartment and getting out a little bit and seeing a friend?”

The challenges are also different for those in independent and assisted-living at Kivel, Shulman said.

“Independent-living [residents] — although we prefer they don’t — they can go where they want. We do ask them to wear masks and we have hand-washing stations, sanitizing stations throughout the building, but they can go where they want. They have no restrictions, technically,” Shulman said. “Assisted-living [residents] have to be inside pretty much. No visitors, no family, no nothing. That’s the big difference.”

At The Palazzo, the freedom that independent-living residents have to move around the facility and meet up with friends means that education has been key to helping residents stay safe.

“For a while the residents were reluctant to always wear a mask, and not even reluctant, they didn’t necessarily know how to wear it safely,” Aronauer said. “So there was an education period of ‘What does wearing your mask safely mean?’ It’s great that you have it around your chin, but it’s not helping … Now, our residents are phenomenal. They get it, and I would say 98% are completely compliant.”

The pressures of keeping residents safe also mean missed shifts, frequent testing and added stress for staff.

“Staffing has been a very big issue since this started,” Aronauer said.

While visitors can be kept out of the community and residents taught to wear masks and stay in their rooms, caregivers and staff still go home at the end of the day. And for some, the risks associated with a positive test are too great: When an employee at The Palazzo tested positive, Aronauer said, a few other staff members in other departments resigned.

And the pressure is also coming from other communities. It’s common for caregivers and service workers to work shifts at more than one senior living facility, a pattern that increases the risk of the virus spreading from one community to another.

“Now, a lot of communities or other jobs are saying, if you’re working in your community or if you’re working in another senior community, you can’t also work here,” Aronauer said. “So there was that added stress on top of everything else for them.”

Covering shifts for staff who take time off, whether because they’re experiencing symptoms or because they or a member of their household tests positive, is difficult but not impossible, Shulman said.

“There’s a couple of agencies we’re in contact with. Some staff will work extra shifts,” Shulman said. “Luckily, we’ve been able to cover everything; we’ve never had to run short.”

For now, senior living facilities in Arizona are doing their best to wait out the storm as the virus rages across Greater Phoenix.

“The state’s going crazy with the number of cases and so all we’re doing is the best we can to keep it out of the community as much as we possibly can,” Aronauer said.

Miami (Florida)

Governor: Ron DeSantis (R-Fla.)

Statewide mask mandate: Not required

Cases citywide (Miami-Dade County): 89,557

Cases statewide: 389,834

Deaths citywide: 1,325

Deaths statewide: 5,207

Height of cases: July 12 (15,000 new cases)

Miami Jewish Health is comprised of a 370-bed nursing home, an assisted-living facility that is home to 80, and an independent-living facility for 60. It is the largest nursing home in Southeast Florida, according to president and CEO Jeffrey Freimark.

The system has had 57 COVID-19 cases since early March, with 10 residents having died as a result of complications from the virus.

“We mourn, but the majority of the folks … have returned to their home units fully recovered and in good health … most of that return has been in recent weeks,” said Freimark.

In its assisted-living facility, two residents contracted COVID-19, and both died. Staff members have also tested positive, though no deaths ensued. No one in its independent-living facility has contracted COVID-19.

Because Miami Jewish Health is part of the state’s Program of All-Inclusive Care for the Elderly — a nonprofit to assist seniors — its mandate includes taking patients recuperating from hospitals. And since its facilities include hospital-like wings with “the right airflow to treat COVID-19 patients,” they have accepted medically stable COVID-19 patients released from hospitals, according to Freimark.

“These units are totally isolated; there’s no herding of COVID-19-positive with anyone else,” said Freimark, adding that employees who work on these units do not interact with uninfected residents.

Communal dining has also ended as residents have been in “complete lockdown mode.”

“We closed the campus down in advance of the close order; some people were upset by that,” acknowledged Freimark. “But we have started drive-by visits” in which residents’ families can talk with loved ones from their cars at least 10 feet away.

As of June 8, they reported only one COVID-19 positive case in the facility.

Freimark said the effort to provide residents and staff with PPE has been “front of mind” from the start — masks, gowns, gloves and booties have been bought in huge quantities and reused only after being disinfected and sanitized.

“We work with the University of Miami to do the disinfecting and sanitizing,” he said. “An employee is never asked to wear the same PPE without it having gone through the disinfection process.”

With help from the Greater Miami Jewish Federation, Miami Jewish Health raised $1 million in a campaign to acquire PPE and to provide additional pay for staff in the facility’s COVID-19-positive areas.

“Nursing-home workers who are going in to deal with COVID-19 are no less heroic than any of our country’s health-care workers,” he noted.

The virus, however, is surging through the state: Florida reported 15,000 new cases on Sunday, the highest number yet in any state in a single day.

And now heading into hurricane season, Freimark is hoping for the best while preparing for the worst.

Between the tsunami of contagion from overseas, the “breakdown in the supply chain” for PPE, and the March 25 mandate, he feels his counterparts in New York got hit with a “perfect storm” in the spring.

But now, he and his colleagues are at the center of the storm.

“We could find ourselves at the crossroads of a hurricane and a COVID-19 environment with the supply chain again an issue,” he cautioned, “and that would certainly be a challenge.”

New York City (New York)

Governor: Andrew Cuomo (D-N.Y.)

Statewide mask mandate: Required

Cases citywide: 224,000 (as of July 13)

Cases statewide: 435,718

Deaths citywide: 22,795 (as of July 13)

Deaths statewide: 32,599

Height of cases: March and April

According to figures released in a report this week by state health officials, some 6,500 nursing-home residents have died of COVID-19 out of a total 100,000 nursing-home residents in the state’s 613 facilities. Jewish institutions have not escaped significant loss.

Stuart Almer, chief executive of Gurwin Healthcare Systems in Commack, New York, a 460-bed nursing home with other facilities, explained that it stocked up on Personal Protective Equipment and created an “isolation unit” in February in anticipation of coronavirus cases.

“We knew [similar infections] had happened in Seattle, so my instruction was, ‘Let’s get as many masks, gowns and gloves as we can,’ ” recalled Almer. The home also purchased Plexiglass panels to create the COVID-19 isolation unit.

As of March 25, when New York State’s health department under Gov. Andrew Cuomo ordered nursing homes to admit COVID-19-infected elderly from hospitals, Gurwin had one COVID-19 infected resident.

Since then, 60 Gurwin residents have died from COVID-19 in its nursing home, and 13 have died in its assisted-living facility. In the nursing home, 150 residents have recovered, and the facility has now reported zero cases of COVID-19.

Of 1,200 staff members, including nurses, health aides, administrators, and janitors, 130 tested positive for COVID-19, and one “beloved member of the housekeeping staff” has died, said Almer.

A disproportionate number of deaths at Gurwin took place among the “dementia population,” said Almer. Despite tremendous efforts by Gurwin’s staff, infection spread there partly because “they are more challenging to direct,” noted Almer. “Our staff did all they could … I’m very proud of them.”

At present, all staff is screened daily upon entrance with temperature checks. Additionally, Gurwin tests every employee weekly for COVID-19.

Almer is thankful to UJA-Federation of New York and the Association of Jewish Aging Services for helping to supplement Gurwin’s supply of PPE, and said additional support for more PPE and more testing — the costs of which he describes as “astronomical” — would “go a long way” to help ensure the facility remains COVID-19-free.

Family and friends from outside the facility have been prohibited from visiting residents “for months,” according to Almer, who in solidarity with families didn’t see his 89-year-old father, who lives in the facility, for three months.

Almer said he accepted the March 25 mandate because “we had an isolation unit, and the mandate was clear.” But he added that in the future, nursing homes need better representation in such fast-evolving situations.

In case of a future surge, vacant buildings, he said, including in nearby Suffolk County, could be secured by the state as dedicated COVID-19 treatment facilities. “There could be a [designated] COVID-positive facility in each county,” he suggested, emphasizing that discussion of the issue is not a matter of blame, but an opportunity for all parties to learn, which he noted is a Jewish value.

Dr. Jeffrey Farber, president and CEO of the New Jewish Home, a health system that includes a nursing home in Mamaroneck, New York, and multiple elder-care facilities in Manhattan, the Bronx and Westchester, New York, stressed the importance of advances in testing to prevent a repeat of the COVID-19 spread in New York’s nursing homes.

In total, the New Jewish Home lost 58 residents due to COVID-19, with nearly 300 recovered. Two remaining COVID-19-positive residents are in the process of full recoveries.

Farber says he doesn’t blame Cuomo’s March 25 order for the spread of coronavirus in New York’s nursing homes.

Citing this week’s report by the New York State Department of Health, he pointed to communal spread among New York’s population, including nursing-home workers, as a likely cause of infection.

“The latest numbers are 20 percent. In communities with more density and reliance on public transportation, 30 or 40 percent” of New Yorkers have had exposure to the virus, “including asymptomatic disease,” he said.

To prevent another uptick in cases and deaths, Farber stressed that continued testing is key. He also suggested that facilities seek out any available aid to conduct as much testing as possible, including “point of care” tests.

“If you have those kinds of tests, then you can really do what we were unable to do and keep [the virus] out of the building,” he advised.

In addition to regular testing of staff and residents, other measures the New Jewish Home is taking to protect residents include suspending visitors for the time being.

Farber said his facility has “largely been on its own” paying for and securing PPE for staff, that “price gouging continues,” and that he has six employees working full-time on sourcing and procuring PPE.

All employees wear N-95 masks, gowns and gloves, but “we didn’t and don’t have anywhere near adequate PPE to discard PPE after every patient [interaction],” he acknowledged.

Instead, PPE is carefully managed so that individual workers can reuse their own N-95 masks after they sit for five days, considered more than ample time for the virus to die.

Asked what help he and others would appreciate from the Jewish community, he said that assistance in procuring and buying more PPE “would free up more employees to focus on patient care.”

He repeated that PPE — and more testing — at elder facilities remains crucial to put in place before, he cautioned, “the next wave.” JN

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