The sisters were used to getting information. But the Isabella Geriatric Center was secretive about the virus outbreak from the beginning.
A little after 1 in the afternoon, Aida Pabey got the call from the nursing home: Her mother was not going to make it. It was April 6, nearly four weeks after the state had barred all visitors to nursing homes, and Aida and her sister, Haydee, had been struggling to get even the most basic information about their mother. Was she eating? Had the coronavirus reached her part of the home?
Now this dire call. Just the day before, the sisters had been assured by an aide that their mother was "fine."
They were both detectives in the New York Police Department, 20-year veterans. They were used to getting information, even from people determined to withhold it. But the nursing home had been a black box.
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They raced to the home. Haydee got there first and managed to get upstairs. Aida, arriving second, identified herself as a crime scene investigator and brought safety gear. "I had my face shield, my bootees, my mask, my gloves," she said. The security guard refused to let her in. "No. It was, 'No way.'"
Their mother, Elba, died that night. But it took the sisters nearly a month before they learned how bad things were at the Isabella Geriatric Center in Manhattan, where more than 100 residents have died, possibly the most pandemic deaths of any nursing home in the state.
The sisters still do not know how she deteriorated in those last days, and what was done to protect her, because the home has not released her medical records.
The Pabey sisters' story — two experienced police officers unable to crack the silences of their mother's nursing home — is a parable of corporate fog in the time of Covid-19. As nursing homes have been overrun by the virus, accounting for half of all deaths in some states, families say they have been kept in the dark, barred by law from visiting and given incomplete or contradictory information by the homes' administrators.
The detectives' forensic tools were useless to the sisters — there was no evidence they could examine, no witnesses they could interrogate.
The home declined a request to discuss how the virus got in and how it overran measures to contain it. Audrey Waters, a spokeswoman for Isabella, said the home had followed all state guidelines in battling the virus and informing families, adding: "We have worked tirelessly to prevent this deadly and ferocious virus from spreading in our nursing home, and we are committed to doing everything in our power to continue to limit its spread and protect our residents and heroic staff."
For Aida Pabey, the frustration of those last weeks has only escalated. "I feel betrayed," she said. "My mom is gone, but I want to do whatever it takes so that this doesn't ever happen ever again."
Isabella Geriatric Center is a 705-bed nonprofit home in Upper Manhattan, with an overall "average" rating from Medicare, though it received below-average scores for staffing and health citations. The Pabey sisters chose it reluctantly, after it became clear that their mother could no longer live with her eldest daughter.
Aida Pabey had bounced around — military service in Germany, twins, divorce, a stint living in a domestic-violence shelter — and her mother had moved with her for support. Aida joined the police force in 2000, trailing her sister by six months, and later moved her family an hour and a half north, to Walden, New York. Elba eventually became part of this home.
Six years ago, things got difficult. Elba would wander from the house, or get confused and call 911 to say someone was hurting her. One time she went out carrying a knife. She was just 65 or 66, but she needed more care than Aida could give her.
"That's where Isabella came in," Aida said.
Families of residents from that time, including the Pabey sisters, describe the home as a relatively nurturing environment, filled with dedicated staff.
Some of that changed after 2017, when the home became part of the Brooklyn-based nonprofit MJHS, formerly Metropolitan Jewish Health System, several families and employees said.
"Nursing is compassion," said a nurse who has been at Isabella for more than a decade, speaking on condition of anonymity for fear of being fired — a fear that runs throughout the industry. The new administration, she said, put more emphasis on containing costs.
Before the state banned visitors to New York nursing homes on March 12, the sisters would stop in to spend time with their mother several times a week, singing with her or bringing food. Nurses on the staff knew Elba as the singer, with no gray hair.
Family visits are a crucial part of any nursing home. They provide essential emotional care and relieve the staff of time-consuming tasks. Without visitors, Isabella's already-stretched staff had more work to do, and the virus multiplied their duties — more washing, more arranging video calls with family, more labor-intensive meal service, as homes ended group meals.
These visits also provide checks against abuse or neglect. All that ended on March 12. No longer could the sisters get information for themselves.
Meanwhile, the nurses and aides at Isabella were getting sick. Fill-ins from outside agencies often worked at multiple homes, increasing the chances of bringing the virus in.
Personal protective equipment was scarce, according to two nurses, and employees handled both Covid and non-Covid residents, creating avenues for the virus to spread. To keep the staff from misusing protective gear or taking it home, the administration rationed gowns, face shields and hand sanitiser, the nurses said. They each got one N95 mask per week, for which they had to sign, one of the nurses said. It was dangerous work: "I got my son sick," the nurse said.
Waters, the spokeswoman at Isabella, said that the home always had enough protective gear, and that it followed Health Department guidelines for conserving PPE.
Nonetheless, Covid had come to Isabella. Waters said the first resident to get sick was sent to the hospital for testing on March 21. The first confirmed death among residents was on March 25. That day, the home posted on its website that some residents had tested positive.
But earlier, in late February or early March, according to a nurse, a cluster of residents in one unit had developed fevers and coughs. Soon after, the unit's licensed practical nurse, Ian Wilson, was hospitalised with respiratory failure and had to be put on a ventilator; he died of the coronavirus on April 1.
The families of Isabella residents knew none of this. "I did not get one call to say the virus was in the home," said Melody Jenkins, who said she had no contact with her mother between March 15 and March 26, when she was alarmed to see that the aide on the video call with her mother was not wearing a mask. Her mother, Adrienne Blackett, died two weeks later.
The Pabey sisters were also unaware that residents and staff were getting sick, but video calls arranged by the staff gave them pause. They could see their mother's roommate wandering around the room, sometimes touching their mother or her things, also without a mask.
On March 24, a Twitter account using the name NYCStrong posted that there was an outbreak at Isabella.
MJHS's Twitter account promptly replied that there was no outbreak.
At this time, Isabella does not have an outbreak of COVID-19.
— MJHS Health System (@MJHS01) March 24, 2020
We care about our patients, residents & staff. We also continue to adhere to state & federal guidelines, which include suspending visitations, screening staff daily & wearing masks.
Then on March 27, the Pabeys said, their video calls stopped.
When the sisters asked about their mother, it was hard to get more than bland assurances. "They'd just say, 'She's good,'" Haydee said. Often they could not reach anyone at all.
Waters said that throughout the pandemic, "staff was often in residents' rooms providing care, making it difficult for them to take calls."
By then, the virus was spreading within the home, according to the two nurses. "They kept it private for various reasons," one said. Because the home had very limited access to testing, administrators could not tell which residents or staff members had the virus and were spreading it.
"We knew that residents were passing away," the nurse said. "We knew that staff were getting sick. All I could tell you is that we were just hoping it'd come out on the news so someone could give us the help that we are receiving right now."
The home encouraged nurses who were not too sick to come to work, the two nurses said. "If you didn't present symptoms, even if you tested positive, you were supposed to work," one said. "It happened to a lot of us. We worked."
Waters said the home followed guidelines from the Health Department regarding when employees could work.
The home's website posted no updates on infections. When the sisters got through to the staff, Haydee said, "They said, 'She's fine.'"
Then on April 5, when Aida called for an update, the aide answered distractedly, even getting her mother's gender wrong. "She said, 'He's fine, his respiration is good,'" Aida recalled.
This was too much. She demanded the aide's name. The aide snapped, "'Why are you asking my name, we're all stressed here,'" and hung up the phone, Aida said.
Then the following day, Isabella called to say that Elba was not going to make it. The home posed a question to the sisters: Should they call an ambulance to take their mother to the hospital, or should they try to simply make her comfortable? Call an ambulance, they said. Then they changed their minds.
Haydee got there first and was told she could not enter, but she fell in with the paramedic team that was already heading to her mother's room.
Aida arrived soon after with full protective gear but was stopped at the security desk. The state's ban on visitors instructed homes to make an exception for residents at the end of life. But the guard would not let her pass.
Aida felt betrayed. She and her sister were risking exposure to the virus every day; they had lost friends and colleagues. Her twins, now 29, were also on the police force, risking their lives. "We're Puerto Rican blue blood," she said. Now Aida was denied a final visit with her mother.
Meanwhile, the scene in her mother's room upstairs was a mess. Two nurses were unable to insert an IV in her mother's arm, so they left the needles sitting on her bed. Haydee was astonished to see her mother's roommate still in the room, exposed.
Elba's eyes were closed, and she was having difficulty breathing. Haydee called her sister using FaceTime, and from the lobby Aida was able to sing to her mother one last time. Elba Pabey died that night, at age 72, just one day after the staff had said she was "fine." The death certificate, Haydee said, cited "natural causes" and did not mention Covid-19.
"I don't believe that," she said. "Especially after speaking to the doctor, who said he was shocked at how quickly Mom died from this virus. And he agreed that she was in generally good health. I know she did not die of natural causes."
Isabella may have a shocking number of deaths, but it was hammered by a virus that it was unable to control. Waters said the death toll was not exceptional given the home's size and its significant hospice population, which was particularly vulnerable. As at other homes with high death numbers, its residents are predominantly African American or Latino; the surrounding neighbourhood, Washington Heights, has the highest infection rate in Manhattan.
For the Pabey sisters, the weeks after their mother's death felt like a rolling insult. On April 17 the state Health Department released death counts at individual nursing homes, citing 13 at Isabella. But this number was misleadingly low. It included only confirmed Covid-19 deaths at the home, omitting residents who died without being tested and those who died in a hospital. The actual death toll was much higher.
Then, a day later, the home for the first time informed families of Covid deaths, reporting on its website that 70 residents had died, either confirmed or presumed to have been as a result of the virus. Then, two days after that, it revised its figure again, omitting suspected deaths; the total was now 32 dead. But the next two bulletins removed the death counts entirely, until finally on May 1, after a report on the cable news channel NY1, it released a staggering count: 98 deaths among Isabella residents.
Since then, at least eight more residents have died.
After a complaint from Adriano Espaillat, a congressman from Washington Heights, the state attorney general is looking into whether there were violations at the home. Inspectors from the state Health Department spent three days in the home, citing it for deficient infection control, including inappropriate use of protective equipment and not following state guidance on cohorting, or grouping infected residents together — both essential measures during a pandemic.
Chris Burch, whose father died of the virus on April 10, said he watched the changing accounts and was "devastated," because he had always found the home to be forthcoming with information.
"I never asked about coronavirus, because they had always been straight up with me," he said. "But going from 13 to 98 — somebody's hiding stuff. There's people suffering like me."
Even now, the true death toll at Isabella is not available to the public. The state Health Department would confirm only the 68 who died at the home, omitting residents who died at hospitals. Waters declined to give a total.
Haydee Pabey also filed a complaint with the attorney general. She still does not have her mother's medical records, she said, because the home told her she had to request them from the court system.
On that final visit, Haydee removed a bracelet from her mother's wrist to give to her sister. It was a small consolation, she knew. "I didn't visit as law enforcement," Haydee said of those last moments. "I visited as a little girl. We couldn't fight this for my mother."
Aida felt defeated. "I feel I failed her," she said.
"All we wanted to know is, What happened?" Aida said. "Why did it happen? These are questions that forensic investigators ask. But something as simple as asking, 'What happened to our mom? What did not happen? What did you do? What did you not do?' That was just left out. We still don't know. And our mom is gone. That's the problem."
Written by: John Leland
Photographs by: Kholood Eid and Gregg Vigliotti
© 2020 THE NEW YORK TIMES
