Nobody Knows Exactly How Hard The Coronavirus Is Hitting America’s Assisted Living Facilities

When Sandy Schnaithman lost her mom to COVID-19, she wanted to know how many other residents at her mother's assisted living facility in New York had died —there wasn't an easy answer.

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When Darien Schnaithman’s breathing grew labored and she started having trouble walking in late March, doctors at a hospital in Yonkers suspected she had coronavirus. They administered a test and then discharged the 70-year-old back to her assisted living facility, the Bronxwood Home for the Aged.

Darien, who had lived there for three years, was given strict instructions to isolate while she awaited the results; according to her daughter, Sandy Schnaithman, that never happened.

Darien’s roommate at Bronxwood, who she affectionately called “D,” wasn’t initially moved to a different room. Aides came in and out without wearing masks or other protective equipment and took Darien downstairs to meet a doctor, where other residents could’ve been exposed.

Her health continued to decline. On March 26, she was transferred to intensive care at the nearby Montefiore Medical Center, where she was confirmed positive for the coronavirus. She died five days later, alone, just hours after FaceTiming with her daughter one final time.

“They weren’t taking the proper precautions with my mom for the coronavirus,” said Sandy. “I feel like the residents’ safety is in jeopardy.”

The devastating experience left Sandy, who lives in New York but has been self-isolating in Massachusetts, worried about how well Bronxwood was protecting its vulnerable residents. How many at the 320-bed facility had been sickened, she wanted to know. Other than her mother, how many had been killed by the coronavirus?

It should have been a simple question, but it wasn’t.

Although New York’s Department of Health requires the state’s 543 assisted living facilities to submit a variety of data about its residents every day, it withholds most of it from the public— including, crucially, the number of coronavirus infections recorded at each institution.

The Department of Health also does not report whether any employees of a given facility have contracted the disease. And as for COVID-19–related deaths, the state only attributes them to a particular assisted living facility if the resident died on the premises. That means that if a resident becomes ill but is transferred to a hospital or hospice, their death is not on the public record for that facility.

As a result, it’s extremely difficult, if not impossible, to track how many of the 384,000 coronavirus infections and 24,579 deaths to date in New York state may have originated in assisted living facilities, or if any of those facilities suffered from particularly large or deadly outbreaks. If some have poor isolation or hygiene standards, insufficient testing, or a shortage of personal protective equipment, they may be able to continue operating without outside scrutiny.

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BuzzFeed News contacted a total of 15 assisted living facilities in New York City, including the largest dozen, seeking numbers of COVID-19 infection and fatalities. Not one consented to share them. Some administrators hung up or refused to even hear the questions at all.

Bronxwood, the city’s third-largest assisted living facility, declined multiple requests to provide a complete accounting of the number of coronavirus-related infections and deaths. It also refused to respond to a detailed list of questions or provide a statement. In April, it said it was complying with all state health department protocols.

When Sandy began asking around about Bronxwood, a staff member told her that 30 residents had died by the end of March, she said. A resident later put the figure at 42, she said. An administrator agreed they had been hit hard by the virus but declined to give her any specific number. When Sandy tried to confirm the figures, a medication supervisor dismissed the high tally as rumors and said it was actually in the 20s. Finally, she called an administrator again at the end of May, but this time, she was told nothing. She soon realized there was simply no way to know if any of those numbers were accurate.

Geoff Lieberman, who runs the nonprofit Coalition of Institutionalized, Aged, and Disabled, has been trying to track the number of deaths at assisted living facilities in New York in order to better understand how the coronavirus has affected such a vulnerable population.

He said residents reported to his coalition that 42 people at Bronxwood had died, but then walked back the number to 24 deaths. Even those numbers, he said, are about a month old and may not be accurate; with no way to get numbers from the facility, his organization depends on residents to provide counts.

“We have deep concerns about the numbers of fatalities that Bronxwood and every other adult facility in New York City have been reporting to the health department. They don't reflect what we believe are the actual fatalities,” Lieberman said. “It’s absolutely frustrating.”

In response to questions about the death rate at Bronxwood, Jill Montag, a spokesperson for the state’s Department of Health, said, “all of the available information is on the COVID-19 tracker” on its website, adding that the data provided the “clearest possible understanding of the impact of COVID-19.“ Montag added that the state has avoided attaching out-of-facility deaths to individual facilities to avoid the potential for double counting.

According to the department’s website, the total number of coronavirus deaths from COVID-19 at Bronxwood still stands at zero.

Ever since the Life Care Center in Kirkland, Washington, became the nation’s first known coronavirus cluster in late February, nursing homes have been recognized as breeding grounds for the dangerous pathogen.

But the threat presented by the virus has been far less rigorously documented at the nation’s assisted living facilities, of which there are more than 28,000, housing more than 800,000 people who tend to be older, sicker, and at far higher risk than the public as a whole.

While nursing homes are required to have a registered nurse on hand every day, in many states, including New York, assisted living facilities are not licensed to provide medical care. Yet more than 4 in 10 people in assisted living have Alzheimer’s, more than half have high blood pressure, and almost two-thirds need help bathing, according to the National Center for Assisted Living, a trade group. And because assisted living facility residents are more mobile than those at nursing homes, often able to take walks or even go grocery shopping, they can be at greater risk when it comes to spreading infection.

On Monday, the CDC said people with underlying health conditions were 12 times as likely to die from the coronavirus as otherwise healthy people, according to data from 1.7 million cases and 103,700 deaths.

The CDC put out guidance for assisted living facilities in March. But because such institutions are not subject to federal regulation, the guidelines noted that “the structure and care provided” by assisted living facilities “can be distinctly different from that of nursing homes. As such, implementing that guidance might present some unique challenges.”

“As bad as nursing homes have been, they’re probably the most equipped senior care facilities to deal with this crisis,” said Brian Lee, executive director of Families for Better Care, a nonprofit that advocates for better conditions in senior long-term care settings. “The numbers in assisted living facilities are going to be even more apocalyptic as we continue through this crisis.”

A number of states, among them California and Florida, publish infection and death data for residents of assisted living facilities, regardless of where they may have died. Other states, including Pennsylvania and New Jersey, do the same but appear not to include fatalities that occur outside a facility’s four walls.

New York’s Department of Health data shows that at the end of last year, there were 38,320 people living in 543 assisted living facilities (which it calls “Adult Care Facilities”) in the state, compared to around 100,000 residents of nursing homes in the state. As of June 12, New York has recorded 173 deaths from COVID-19 at a total of 58 assisted living facilities. That compares to 6,208 deaths in the state’s nursing homes, which are generally more equipped for end-of-life care and thus less likely to transfer sick patients elsewhere.

California, meanwhile, has suffered slightly more than a fifth as many total coronavirus deaths as New York, yet it has tallied more than twice as many deaths in assisted living, a total of 377 that “includes residents and staff … that passed away at the facility or at another location, such as a local hospital.”

The assisted living facility with the most reported deaths in New York state, the Ambassador of Scarsdale, located in Westchester County, has 138 beds. As of June 15, it had reported 10 deaths, but internal emails obtained by the Journal News from early April showed that a number of its residents had been moved to hospitals for acute care and that only those deemed “medically stable” were permitted to return. The number of residents of the Ambassador of Scarsdale who died off-site is unknown.

In a statement, Jean Dunphy, president of the Ambassador, attributed the death rate to the fact that the facility has hospice care on-site, which “allowed residents to return or remain at the Ambassador during their final days.” She said the Ambassador “currently has no COVID-19 cases.” A spokesperson did not respond to multiple queries about how many of its residents died from the virus after being transferred to other facilities.

Last month, Argentum, an industry group that represents 13,000 senior care communities, issued a statement calling for more complete reporting of COVID-19 statistics at the state level. “We want the states to be more transparent” about reporting such data, said James Balda, the group’s president and CEO.

Balda said that assisted living facilities haven’t gotten the same level of government support that nursing homes have during the pandemic. The CARES Act — which set aside billions of dollars to fund nursing homes and hospitals — omitted assisted living facilities, which also were not allocated personal protective equipment and other supplies from federal stockpiles.

In April, a coalition of advocates, including Geoff Lieberman, wrote letters to New York’s Department of Health addressing the manner in which the state’s adult care facilities were handling the coronavirus pandemic. The letters raised a long list of concerns, saying that a lack of social distancing, a shortage of personal protective equipment, and a failure to isolate residents suspected of having COVID-19 shows that the current regulations are “inadequate to protect the lives of vulnerable residents.”

New York City has recorded 22,145 probable or recorded deaths to date. But the city’s 12 largest assisted living facilities, with a total of 3,230 beds among them, have been tagged with only three coronavirus-related deaths, according to state data. None of those facilities agreed to provide data on their total number of infections or deaths, including residents who had been transferred elsewhere after testing positive for the virus.

A spokesperson for the Queens Adult Care Center and the Brooklyn Adult Care Center, which have a total of 562 beds and an official death count of zero, said, “We comply fully with all New York State Department of Health regulations and report fully and accurately to them."

It costs as little as $1,200 a month to live in a shared room at the Bronxwood Home for the Aged, where Darien lived. That places it on the lower end of the spectrum: Median monthly fees for assisted living homes in New York City, many of which are for-profit businesses, run almost $7,000 a month. Unlike nursing homes, the facilities do not receive funding through Medicare, the federal insurance program for people 65 and older. Instead, they often get by on a combination of Medicaid, long-term care and disability insurance, and direct payments from residents or their families.

Bronxwood, which is a nonprofit, opened in 1977. The five-floor facility promises “an enjoyable and affordable independent lifestyle in a supervised, supportive and well appointed environment.” Long before the pandemic hit, however, Bronxwood suffered from problems with its quality of care and lax rules, according to inspection records, complaints, and interviews with residents and current and former employees.

“The patients were people who were low income or on Medicaid and really didn't have a place to go,” said Candy Garcia, a former admissions director for the facility.

Last fall, the state cited Bronxwood for 17 different violations related to inadequate food services, improperly managed medications, poor sanitation, and failing to provide residents with a regular allowance that they’re entitled to under the Social Security program, among other things. Building complaints show issues with malfunctioning elevators and a lack of heat and hot water.

Marguerite Wilkins, 72, moved in back in 2010 after a cardiac emergency left her unable to fully care for herself. She had been a first responder after 9/11, helping shuttle city officials to ground zero, she said.

Wilkins recalled watching residents fall down drunk, assault other people, and use drugs openly in the courtyard. There were fights when medication was distributed. Some of her things were stolen from her room. At meal times, she stuck to hard-boiled eggs, she said, because the meat was often gray or green.

“It was horrible. I had to get out of there,” said Wilkins, who eventually moved to a facility in Washington state but keeps in touch with friends still living at Bronxwood. “They said they’re dropping like flies over there. They’re not being counted.”

Although it has a full-time administrative staff, Bronxwood has since 2000 paid an annual management fee to a Brooklyn company owned by a property developer named Willy Beer. In recent years, that fee has topped $800,000. Employees say Beer’s family runs Bronxwood. Sandra Beer is listed on the tax returns for the not-for-profit as the person who keeps the organization’s books and records; Willy has been listed as a managing member of the facility. Beer’s management company collected nearly $14 million in fees between 2000 and 2017.

Between 2015 and 2017, the most recent years for which its tax records are available, the facility reported a total of nearly $8 million in losses. To keep beds filled and revenue up, Bronxwood has aggressively recruited from area hospitals along with homeless shelters, former staffers said.

A report by the Forward in early 2016 found that Bronxwood had given away nearly $20 million in grants to ultraorthodox Jewish charities over the previous two decades, a highly unusual practice for an assisted living facility. Later that year, New York state regulators proposed excluding Bronxwood from Medicaid for three years after an audit found it had been overpaid by as much as $7 million thanks to incorrect or misstated claims.

Bronxwood responded by suing the state, denying responsibility. That suit is still pending.

In interviews, current residents of Bronxwood said that in the last couple of weeks, the facility has made changes to protect them from infection. They were mostly staying in their rooms now, and meals were delivered to them three times a day. They had access to personal protective equipment like face masks. Some residents still have roommates.

Sandy keeps in touch with some of the residents of Bronxwood, including one who moved into her mother’s empty room after she died.

Sandy said she plans to return to Bronxwood later this month to retrieve her mother’s possessions. When she called to arrange a pickup, a staffer told her they would bring the items to the curb for her since no visitors are allowed in the building. Despite repeated calls to administrators, Sandy still doesn’t know how many people were sickened inside the facility, or how many, like her mother, later died. ●

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