The facilities knew that frail and aging residents were especially vulnerable to the outbreak, but they were unable to stop it.
At Crown Heights Center for Nursing and Rehabilitation in Brooklyn, workers said they had to convert a room into a makeshift morgue after more than 15 residents died of the coronavirus, and funeral homes could not handle all the bodies.
At Elizabeth Nursing and Rehabilitation Center in New Jersey, 19 deaths have been linked to the virus; of the 54 residents who remain, 44 are sick.
After 13 people died in an outbreak at the New Jersey Veterans Home in Paramus, the governor called in 40 combat medics from the National Guard.
In Manhattan, two women who met during visits to the Upper East Side Rehabilitation and Nursing Center felt helpless while their mothers died of the virus within minutes of each other. Both had been unable to see their mothers for weeks.
“The last day I went there, I told a supervisor, ‘I’m thinking of taking my mother out before something terrible happens,’” one of the women, Lynda Walsh-Clifford, said. “He said, ‘Don’t worry, everything will be fine.’”
In New York, the U.S. epicenter of the outbreak, the virus has snatched lives in every part of society, the daily death toll near 800 for a third straight day on Friday in what officials hoped would be a peak.
Overall, 8,627 deaths in New York had been attributed to Covid-19 by Saturday, and the total for New York, New Jersey and Connecticut was over 10,000.
The virus has perhaps been cruelest at nursing homes and other facilities for older people, where a combination of factors — an aging or frail population, chronic understaffing, shortages of protective gear and constant physical contact between workers and residents — has hastened its spread.
In all, nearly 2,000 residents of nursing homes have died in the outbreak in the region, and thousands of other residents are sick.
As of Friday, more than half of New York’s 613 licensed nursing homes had reported coronavirus infections, with 4,630 total positive cases and 1,439 deaths, officials said.
In New Jersey, nursing homes had been linked to 252 virus-related deaths, more than 90 of them in the past two days. The outbreak has now affected at least 70 percent of the state’s long-term care centers.
The actual infection rate in nursing homes is almost certainly higher than the data indicate because few homes have the capacity to test residents. The assumption among many in the industry is that every nursing home in the region has people with Covid-19.
In New York, nursing home administrators said they had been overwhelmed by an outbreak that quickly spun beyond their control. They were unable, they said, to have residents tested to isolate the virus or to get protective equipment to keep workers from getting sick or transmitting the virus to residents.
“The story is not about whether there’s Covid-19 in the nursing homes,” said Scott LaRue, the chief executive of ArchCare, which operates five nursing homes in New York. “The story is, why aren’t they being treated with the same respect and the same resources that everyone else out there is? It’s ridiculous.”
Advocates for nursing home residents in the New York region lashed out at the homes’ owners, saying they were negligent and had hastened the crisis by cutting staff to a minimum.
“The residents are sitting ducks,” said Richard Mollot, the executive director of the Long Term Care Community Coalition.
Andrew M. Cuomo, New York’s governor, said last month that the pandemic was difficult to stop. “Coronavirus in a nursing home can be like fire through dry grass,” he said.
New York State health officials defended their oversight of nursing homes, saying they had adopted a raft of regulations in recent weeks to protect residents.
The regulations barred visitors from homes and ceased all group meals and activities — difficult choices because loneliness is its own plague in nursing homes — and required that every worker be tested for fever or respiratory symptoms at every shift.
Gary Holmes, a state Health Department spokesman, said, “We’ve said from the start that protecting our most vulnerable populations including people in nursing homes is our top priority, and that’s why the state acted quickly and aggressively to issue guidance specifically for these facilities on testing, infection control, environmental cleaning, staffing, visitation, admission, readmission, and outreach to residents and families.”
New Jersey’s health commissioner said the state had moved quickly to house sick people in separate hallways or wings, and to address outbreaks by enforcing strict protocols. Late last month, an entire nursing home was evacuated and 94 residents were relocated to a facility a half-hour away after dozens of residents and staff members tested positive for the virus.
New Jersey officials are planning to move more residents out of some facilities and into new ones to create a firewall between those who are infected, and those who are not. “Situations like this show pretty clearly the vulnerability of our systems of care,” Dawn Thomas, a spokeswoman for the Health Department, said on Friday.
When the coronavirus broke out in a nursing home in Kirkland, Wash., in late February, killing at least 35 people, nursing homes and state health officials in New York and New Jersey recalled that they knew it would soon arrive.
Yet they were not prepared for the scale of the crisis.
“It seems like an eternity ago,” said Jeffrey Farber, the chief executive of the New Jewish Home, which has homes in Manhattan and Westchester County. “We were following the news, hearing about China. It was, ‘We’ve dealt with epidemics before, we know how to care for people who have respiratory diseases.’”
Members of Dr. Farber’s staff consulted suppliers of protective equipment, like masks and gowns, to make sure they could deliver the usual quantities by the time the virus arrived. They assured him they could.
Dr. Farber declined to say how many residents had died of the virus, but both New Jewish Home facilities added refrigerator trucks to act as morgues because funeral homes were overburdened.
The response from nursing homes and government agencies has been a patchwork, with some homes barring visitors before states acted. In New York, relatives were prohibited from visiting homes beginning March 13. Similar restrictions took effect in New Jersey on March 14. As a result, families were unable to get information about how residents were faring.
“No one knows anything,” said Paul Bunten, who had two close friends die in nursing homes in Manhattan and the Bronx. “They don’t tell us anything. My head is sort of spinning.”
Nursing homes were already understaffed. Now workers were calling in sick or were themselves quarantined — all as the workload was increasing, with more sick patients, more need for sanitizing, more individual delivery of meals and medications.
“We’re all infected already,” Margaret Boyce, a certified nursing assistant at JFK Hartwyck at Edison Estates in New Jersey, remembered a supervisor telling her.
In New York City, the virus was confirmed at a nursing home as early as March 8, when a worker at King David Nursing Home in Brooklyn tested positive. The home isolated the worker and tested the eight residents he had come in contact with. All tests were negative.
But the virus spread, and King David now has confirmed cases, said a spokesman for Allure Group, which owns King David and Crown Heights.
Crown Heights is the Brooklyn nursing home that had to create a makeshift morgue because of the rising number of deaths. “They had to convert another area to temporarily hold bodies of the deceased in a humane and safe way,” the home’s management said in a statement.
As the virus spread, some nursing homes went into denial, not wanting to alarm residents or their families. Some instructed workers not to wear protective gowns or masks for the same reasons.
Staff members at Alaris Health at Hamilton Park, a 260-bed home in Jersey City, said they were instructed to tell family members that while a patient there had tested positive for Covid-19, there was no cause for alarm.
“Everything is fine,” the script read, according to a handout obtained by The New York Times. “We are closely monitoring all residents and staff of any signs of illness….”
But inside the home, it was chaos.
Workers said they moved from patient to patient without adequate protective equipment. Some workers were hospitalized, said LaDawn Chapman, a certified nursing assistant.
“It’s so many deaths,” Ms. Chapman said. “We’re losing people left and right.”
Staff members said that so many workers had fallen ill supervisors were imploring them to come to work even if they were sick, according to copies of text messages reviewed by The Times.
“You had it for weeks already, what does it matter if you work 2 more days,” one supervisor texted a sick worker, according to messages reviewed by The Times.
More residents developed fevers and hacking coughs, and the home did not isolate everyone with symptoms, workers said. One complained that healthy residents were being infected by coughing roommates, and “you have two people dying instead of one.”
Robert Chinery Jr. said he was horrified when he was FaceTiming with his 80-year-old father, Robert Chinery Sr., last week and saw that the caregiver holding the phone was only protected by a paper mask.
“You’re bringing it from one patient to the next,” Mr. Chinery said. “They basically exposed him.”
Mr. Chinery said his father developed a fever and was taken to the hospital. But a doctor discharged him, saying he would be safer in the nursing home.
There he began to have trouble breathing and then deteriorated rapidly.
On April 7, Mr. Chinery got a call telling him his father had died. Fifteen minutes later, a staff member called back, asking what to do with the body.
“He should not be dead,” Mr. Chinery said. “It was preventable.”
The same day, the Jersey City health department took the rare step of issuing an administrative order telling Alaris to sequester coronavirus patients on one floor, and to provide staff members with proper protective gear, according to a copy of the health order.
For many, it was too late. At least 11 residents and two staff members have died, according to city health officials and interviews with workers. As of Thursday, 17 residents had tested positive for the virus, five of whom were hospitalized, according to the home.
Matt Stanton, an Alaris Health spokesman, said the facility had taken proper precautions to protect residents and staff members from “a monster of a problem.”
“We’ve been ahead of all state and federal guidelines throughout this entire process,” Mr. Stanton said. He said the home was hamstrung by a lack of available testing and had enough protective gear for workers. He also said it was “completely false” that sick workers were being asked to show up to work.
As families and homes scrambled to keep up, often the only choices were bad ones.
Lisa Crowley, whose mother and stepfather are at the Veterans Home in Paramus, has watched helplessly as infections in the home multiplied. Finally, the home dedicated one wing to people with the coronavirus, with only two residents with no signs of infection. Those two are Ms. Crowley’s parents.
“They have been told to stay in the room,” Ms. Crowley said. But she was worried because they shared a bathroom with other residents, and the same workers brought them meals. “They have no idea of the magnitude of what’s happening outside their door,” she said.
Jesse McKinley contributed reporting.