The Center for Public Integrity is a nonprofit, nonpartisan investigative news organization in Washington, D.C.

Over a month ago, employees of a North Cape May nursing home say they noticed frail residents coughing and, one after another, growing weaker with fevers.

“This one got it. Then that one got it,” said a worker at the 120-bed Victoria Manor facility.

The worker suspected that residents were coming down with COVID-19 rather than the flu, for which they were being tested.

At the time, New Jersey was quickly discovering coronavirus cases, and by March 12 had started shutting down schools and public gatherings.

But this Victoria Manor worker and a second one, both of whom requested anonymity out of fear of reprisal, told the Center for Public Integrity the facility seemed to downplay the threat of COVID-19, the disease caused by the coronavirus. They complained that all employees in patient care areas, including janitors and food service staff, weren’t required to wear protective masks and gowns until March 26.

When entering rooms of residents who appeared very ill, the second worker said, employees felt like “lambs led to slaughter.” As of Monday, Victoria Manor had 52 coronavirus cases and nine deaths among its employees and residents.

The Victoria Manor experience illustrates how senior care facilities followed federal coronavirus advisories differently, and could have contributed to the spread of COVID-19 through America’s nursing homes, where at least 7,000 have died from the virus. And it shows how employees at these facilities — often poorly paid, female, and people of color — have largely felt powerless as the pandemic has exploded.

Pennsylvania-based Genesis HealthCare operates Victoria Manor and 386 other care centers across 26 states. It would not respond to written questions about the workers’ allegations that symptomatic residents were overlooked. The company said on its website it has followed “recommended protocols and guidelines from the Centers for Disease Control and Prevention (CDC), and Centers for Medicare and Medicaid Services (CMS), often getting out in front of them.”

As Victoria Manor residents were allegedly coming down with fevers, the company’s chief medical officer, Richard Feifer, told investors during a March 17 call: “At this time, we have a single confirmed case of COVID-19 in one of our 387 centers. Rest assured, we are working diligently to minimize any potential spread, but we are also preparing [in case] any more of our facilities experience the coronavirus.”

By this week, Genesis HealthCare had at least 263 positive coronavirus cases and 46 deaths in its six New Jersey facilities, which include Victoria Manor.

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Public-health experts believe delays in manufacturing personal protective equipment and in producing and distributing tests share responsibility for the spread of COVID-19. Further, asymptomatic employees can carry the virus unknowingly into facilities.

“We need to test everybody who works in a nursing home within the next week,” Andy Slavitt, an acting CMS administrator during the Obama administration, said April 13 on MSNBC. Slavitt said testing all nursing-home workers would save lives. But so far, it’s been left to states to test workers caring for the nation’s 1.5 million residents in nursing homes. West Virginia, for example, has ordered testing of all nursing-home residents and employees, but Pennsylvania and New Jersey have not.

Powerless, as deaths rise

It wasn’t until March 31, Genesis HealthCare says, that Victoria Manor officials learned a resident had tested positive and reported it immediately to county and state health officials.

That same day, a Victoria Manor employee contacted Public Integrity with concerns.

“I don't know what to do or where to turn. I don’t doubt I have seen many residents and employees with symptoms,” said the employee, who hadn’t been at work for several days.

At that point, the worker wasn’t aware a Victoria Manor resident had tested positive. (As of mid-April, this worker still hadn’t been tested for COVID-19.)

On the night of April 6, George Lees, 86, became the first known Victoria Manor resident to die from COVID-19. In the weeks before he died, one of the workers who spoke with Public Integrity described a conversation with Lees.

The worker, who cried during the interview, recalled Lees remarking that it seemed “bad out there” because of the virus. The worker tried to reassure him, saying, “If anything, you are in a safe place.”

The day after Lees died, Cape May County announced on its website that 15 Victoria Manor residents and 11 employees had tested positive. Within one week, the county disclosed it had positive test results for 24 staffers tested as well as 26 residents — eight of whom died.

Meanwhile, some of Victoria Manor’s sister facilities in Pennsylvania and elsewhere were experiencing outbreaks, according to news reports, including 49 residents and staff in its Lehigh Center facility in Macungie, Lehigh County. Two residents had died.

Back in Cape May County, Peggy Kelly, director of field services for United Food and Cannery Workers Local 152, a union representing many Victoria Manor workers, says the company told the union on March 31 that a Victoria Manor resident had tested positive.

Kelly said she learned of subsequent positive tests among residents and employees not from Genesis Healthcare but from news reports.

“I shouldn’t have to turn on the news to find this out. The employees have a right to know about positives,” Kelly said.

In a statement, Genesis HealthCare said the union and the company agreed "to have approximately one call per week [on COVID-19 developments], and those communications have occurred as planned."

The two Victoria Manor workers told Public Integrity they were concerned that fellow employees were still working while showing cold-like symptoms in early March. They say they discussed, with coworkers, the possibility that residents were ill with the virus. One worker contacted the union in early March with concerns, the worker says, that COVID-19 “could be in the building.”

Kelly told Public Integrity she had heard such concerns from workers well before the company disclosed the March 31 positive test. That same day, Kelly said, the company also told her without explanation that it had replaced Victoria Manor’s top administrator.

The company declined to discuss the matter with Public Integrity.

Dire warnings to nursing homes

In mid-March, the CDC issued a stark warning for nursing homes to be “proactive” in response to COVID-19 because asymptomatic workers and visitors could spread coronavirus to other area nursing homes where they worked. “Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members and visitors, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures,” the CDC report warned.

Genesis HealthCare says it began alerting its facilities in January that it was preparing for a potential coronavirus attack.

“When we first recognized symptoms at Victoria Manor, we requested testing kits from our laboratory partner,” spokesperson Lori Mayer said in a statement. “It took many days to get access to those kits. At this time, patient and resident testing has improved as we have been able to partner with a new lab to provide a 24-hour response time.”

New Jersey law, according to the state Department of Health, “mandates that long-term care and other institutional facilities immediately report any known or suspect communicable disease outbreak, by phone to the local health department (LHD) with jurisdiction over the facility.”

Public Integrity asked Genesis HealthCare if it told county health officials that staff had observed respiratory problems among residents before March 31, when the company confirmed its first positive test.

It didn’t answer the question, offering instead in a statement by Mayer that “we are required to report confirmed cases to the Department of Health.” County officials did not respond to inquiries about the precise date the county learned of illnesses at the care home.

Company steps

Genesis HealthCare did point to numerous steps it said it took to thwart the virus. The company says that by early February, it began increasing its supply of protective equipment. By March 10, it says, anyone entering its 387 facilities was required to have temperatures taken and it imposed a “no visitation” policy in facilities in regions with “community spread” and began restricting “communal” activities.

Then, on March 23, it ordered “universal mandatory use of face masks and eye protection in outbreak hot spots.”

But Cape May, at the southern tip of New Jersey, was not considered a hot spot at that time, according to Mayer. Asked to explain how the company reached this decision, Mayer said by email that the decision was “based on the [New Jersey] department of health” but did not respond to requests to elaborate.

In the weeks before the company mandated masks and gowns for all staff, workers had to ask for gowns, Kelly said. The two workers also said not all staff used masks, either.

“We weren’t protected when they [the residents] were getting fevers and pneumonia, and we were going into their rooms,” one said. “Whatever they had out, that’s what you wore.”

There are now signs on rooms at Victoria Manor with known coronavirus-positive residents inside, and staff wear N95 masks and gowns, a worker said.

‘Testing, testing, testing’

In line with national practices, Victoria Manor isn’t required to test its own employees for coronavirus.

Like other nursing-home workers across the country, Victoria Manor employees must seek tests with private providers or at county testing sites, with costs covered by their health insurance.

Genesis HealthCare said Victoria Manor has provided workers notes to give to their personal physicians explaining that “they are a health-care professional and could have been exposed to COVID-19.” But the company’s statement says: “Many community physicians will not test despite the note. The New Jersey Department of Health is not testing employees at this time.”

The two Victoria Manor workers said they wish testing had been more widely available and come sooner. “We should have been testing, testing, testing,” one said.

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