A quarter of the residents at Bria of Geneva died from COVID-19. Families want answers
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Standing outside a window at the Bria of Geneva nursing home one morning last week, 2-year-old Rosa Morrow tried to get her grandmother's attention. She held her palm to the screen. She blew kisses. She counted slowly, "1 ... 2 ... 3 ..."
On the other side, 71-year-old Claudette Stasik, who has tested positive for COVID-19, sat in her reclining wheelchair, her eyes closed and her arms crossed against her chest, her gray hair braided to one side. A nurse, wearing gloves, gently rubbed her hand.
"Can you say hi? Wake up, honey. You have visitors."
Separated by the glass -- and by a devastating outbreak of the coronavirus at this facility in the western suburbs of Chicago -- Stasik's son Scott and his family can only attempt to communicate with her through a FaceTime call.
"Hi, Mom. We're over here. Can you look over this way?" her son said. Stasik opened her eyes, but only for a moment.
It's been a brutal few weeks at Bria of Geneva, which has experienced one of the largest and deadliest outbreaks of the coronavirus in the state, according to a ProPublica Illinois analysis of Illinois Department of Public Health data.
Since mid-April, 75 of the nursing home's 91 residents and 37 of its 120 workers have tested positive for the virus. Twenty-four residents have died from COVID-19, the most recent on Monday, according to Bria of Geneva and the coroner's office in Kane County, where the facility is located.
While other Illinois nursing homes may have seen larger overall numbers of cases and deaths, almost none have experienced an outbreak on the scale of the one here, with more than two-thirds of the residents infected with the virus and one-fourth killed by it. The situation at Bria of Geneva illustrates the price of insufficient and delayed testing and how a lag in public reporting of cases and deaths in nursing homes obscured the breadth of a crisis that has disproportionately hit the state's vulnerable elderly population.
The first resident at Bria of Geneva tested positive April 17. At the time, Illinois public health officials had instructed nursing homes that they did not need to test everyone when there were positive cases. That guidance changed soon after, when state officials acknowledged that more testing was needed in nursing homes to identify asymptomatic residents and staff members and prevent large outbreaks. Still, it took another week for Bria to obtain enough supplies to do widespread testing.
State public health officials first released coronavirus case data on nursing homes April 19. It showed no cases at Bria of Geneva, even though the outbreak was underway. In some of the Public Health Department's weekly updates since, the number of deaths has been undercounted or becomes outdated almost as soon as it's released, according to a comparison of state data with a tally from the Kane County coroner's office.
Some family members have blamed Bria officials for being unprepared for the virus and for failing to communicate with them about their family members. The county coroner, who has been performing posthumous COVID-19 tests, also has expressed frustration with the handling of the outbreak.
"I don't feel that it should be my responsibility at this point running around testing (dead) people that should have already been tested," Coroner Rob Russell said.
Philip Branshaw, the medical director at Bria of Geneva, said the last few weeks have been "trying" and "heartbreaking" for the medical staff, family members and residents, but he is confident patients are well cared for. As of this week, 43 residents and staff members have recovered from the virus or are asymptomatic, according to the nursing home.
"I likened it to following all the rules, and when you get ready to cross the street and look at the lights and you step out and get run over by a truck," Branshaw said.
At least 1,500 residents of Illinois nursing homes or other long-term care facilities have died from the virus -- roughly half of all COVID-19 deaths in the state, although residents of such facilities make up less than 1% of Illinois' population. The crisis is most apparent outside Cook County. In these areas, long-term care centers account for two-thirds of all deaths, according to a ProPublica Illinois analysis of data from the state Department of Public Health.
Across the state, more than 400 out of about 1,700 facilities have reported at least one positive case among residents and staff, and about 20 facilities have had 100 or more positive cases.
The 75 cases among residents at Bria of Geneva include Claudette Stasik, who has Parkinson's disease and dementia, her family said. Although she hasn't displayed a high fever, cough or other symptoms of the virus, her health has declined in recent weeks as she has been confined to her room.
Patricia Yanni, 78, had lived at Bria of Geneva for eight years. "The doctor called me and said, 'I'm not sure she will make it out of this,'" said her daughter, Kristin Davison. Yanni died several days later, on May 1.
Susan Borowiak knew her mother, Lucille James, had been tested for the virus, but nobody from the nursing home told her the results, she said. James died May 1, hours before Yanni. The death certificate listed the cause of death as COVID-19 and noted she was last seen alive in the late hours of April 30. "The hardest part is knowing there was nobody there with her," Borowiak said.
"Somehow the virus got in there and went like wildfire," Borowiak said. "You scratch your head over the whole thing."
A Dire Situation
When Branshaw discusses the timeline of the outbreak at Bria of Geneva, he starts with the morning of April 17. That's when the first resident, sent to Northwestern Medicine Delnor Hospital in Geneva a day earlier, tested positive for the virus.
"We did not have any testing available to us, which unfortunately is pretty common," Branshaw said. "Once we got our first patient, it was a landslide."
Three more Bria of Geneva residents were admitted to Delnor that day. Others have been admitted since. Some of the first residents to test positive were transferred to a facility in Palos Hills that Bria of Geneva's parent company, BRIA Health Services, operates. At the time, staff members thought they could contain the virus by transferring them to a coronavirus-designated wing at the Palos home.
"We were still trying to figure out the scope of the issue," Branshaw said.
He was hamstrung, he said, because he couldn't get testing supplies. At the direction of the Kane County Health Department, Bria of Geneva eventually obtained 10 tests from a state lab, the amount supplied to facilities at the time, county health officials said. Branshaw secured an additional 60 tests after asking, in a group chat with medical professionals, if anyone could help; top health officials from Northwestern's Central DuPage and Delnor hospitals supplied them.
On April 23 and 24, Branshaw and a nurse practitioner went from room to room at the nursing home. "We swabbed everyone we could," he said.
Russell, the coroner, said he was frustrated by the difficulty nursing homes had in obtaining tests. "The biggest disappointment to me is why aren't long-term facilities testing folks? There are things they could do to mitigate the spread," he said last month, as the outbreak was just beginning. He tested some nursing home residents after they died, to provide answers to family members and to build a more accurate public accounting of the disease.
Only four nursing homes in Illinois had more deaths than Bria of Geneva when the state updated its count last Friday. All of them are larger facilities, with more beds and a higher average number of residents. Meadowbrook Manor of Bolingbrook has had at least 26 deaths, the most in the state, but it has three times the capacity of Bria of Geneva. Symphony of Joliet, with twice the capacity of Bria of Geneva, has had 24 deaths.
Pat Comstock, the COVID-19 response director for the Health Care Council of Illinois, an industry group that represents about 300 nursing homes, criticized state public health officials for not providing nursing homes with personal protective equipment early enough. Hospitals obtained gear directly from the state, but nursing homes initially had to go through county health departments or secure it on their own, she said.
"Not prioritizing nursing homes early enough created some challenges across the board," she said. "At the beginning, even if facilities went out and tried to find their own test kits, the supply just wasn't available. Help was needed from the state."
Gov. J.B. Pritzker has said the state provided protective gear to all county health departments and made clear that the long-term care facilities are "priority recipients" for distribution. Kane County health officials provided masks, gloves, gowns and other gear to Bria of Geneva, a spokeswoman said.
On April 20, state officials said they would send teams to nursing homes to test residents and staff -- including at facilities with no confirmed cases to try to isolate cases and avoid major outbreaks. It's unclear how many sites they've visited, and the Illinois Department of Public Health did not respond to a request for that number.
"We are working to test all residents and all staff at those homes," Pritzker said in April, adding the state would prioritize homes serving minority populations. State officials also said staff members should be tested more regularly instead of relying on "wellness checks" that don't detect asymptomatic carriers.
In response to questions from ProPublica Illinois, an Illinois Department of Public Health spokeswoman said the agency has sent 30,396 test kits to 129 long-term care facilities and Quest Diagnostics, a private company, has sent at least an additional 2,653 test kits to eight facilities.
"This effort continues daily," IDPH spokeswoman Melaney Arnold said. "Early in the pandemic when testing capacity and PPE were limited, and asymptomatic transmission was thought not to occur, isolating residents and restricting staff could be done with symptoms alone."
Arnold said the state releases data on nursing home cases and deaths only once a week because public health officials are currently "stretched" and their focus is on responding to outbreaks to limit the spread and protect residents and workers.
"Without widespread testing and without frequent release of the data, there are undoubtedly buildings across the state that have outbreaks that we don't even know about or don't know as much about as others," Comstock said.
At the front door of Bria of Geneva, it's as if time stopped before the coronavirus arrived. A sign at the front door still reads: "Visiting hours are only a suggestion. Visitors are welcome any time."
But no visitors have been allowed inside since mid-March. Messages in the windows signal the fight that's going on inside: "#WeGotThis." "#BriaStrong." "#AllforOne." "GenevaProud."
BRIA Health Services operates nine facilities in Illinois, all in the Chicago area and near St. Louis. Five of them have had deaths from COVID-19.
The Centers for Medicare and Medicaid Services, which inspects and regulates nursing homes, gives Bria of Geneva an overall rating of four stars, which is above average, and its top rating, five stars, for the care of long-term residents. But in its most recent health inspection report, in July 2019, the federal agency cited the facility for having insufficient staff to meet residents' needs and for some workers not using proper hygiene, among other concerns, and gave it just two stars in that report.
The report described residents waiting so long for workers to respond to them that they soiled their clothes or were essentially confined to their rooms. "We just don't have enough staff," one resident told inspectors last year, according to the report. "I have waited up to 2 hours to get my call light answered."
Inspectors also watched a nursing assistant change a resident's soiled underwear without changing her gloves. The same worker, 45 minutes later, changed another resident's soiled underwear and then, still wearing the same pair of contaminated gloves, transferred him back to his wheelchair, wiped his face with a wet washcloth and combed his hair.
"Staff should wash their hands and change their gloves after caring for residents to prevent the spread of infection," the report states. Inspectors concluded residents did not face immediate harm but there was potential for it. Bria of Geneva was not fined.
Some family members whose relatives died from the virus told ProPublica Illinois they were left in the dark as COVID-19 spread through the home.
Kristin Davison's mother returned to Bria of Geneva after being treated at a hospital for COVID-19 symptoms around April 25. Davison said she spent hours repeatedly calling the nursing home to get updates, but nobody answered the phone. She FaceTimed with her mother on Wednesday, April 29. The next day, she couldn't reach anyone at the facility.
"They either didn't pick it up, I was hung up on, I was transferred. It took forever for someone to call me and most people would not return your calls," Davison said. "I had to hound them. It was ridiculous. You shouldn't have to do that."
On Friday evening, May 1, she got a phone call that her mother had died. "The director said, 'We did our rounds and when we came around she was gone,'" Davison said. She called the nursing station to ask what had happened and why she wasn't contacted. She said a nurse replied: "We are very busy here. I didn't know she was going to pass, so I didn't know to contact you."
"What hurts me the most is my mother was alone," Davison said. "I would have loved to have been able to FaceTime her one more time to say goodbye, and I didn't have that option."
Susan Borowiak said she's also concerned about the care her mother, Lucille James, received in the weeks before she died. When Borowiak last saw her mother through a window, she "looked really rough," she said. Her hair was long and unkempt. Food was stuck on her shirt.
"The nurses we did know there, we liked. They were very caring. Once the staff all got sick, it was a rolling boil there," she said. "I don't think they were as prepared as they should have been and didn't have the proper protective equipment."
She also expressed frustration at not getting updates about her mother's declining health after learning through a mass email from Bria of Geneva on April 24 that residents and staff had tested positive. The next evening, she emailed the nursing home with a plea for an update on her mother's health, saying she had been trying to reach someone there for two days. "I understand it's insane there. I'll even take a text or email," she wrote. "Thank you for being there and taking care of my mom."
Administrators allowed Borowiak's sister, Donna James, to visit her mother the night before she died, and she held her hand for the last time. As she walked into the home, James said, a resident was wheeled out on a stretcher and into an ambulance. The nursing home workers did not have face shields or medical-grade masks as they went from room to room, James said.
Lucille James died on her husband's birthday. They had been married for 59 years. Borowiak, who had said goodbye to her mother on FaceTime, went to Bria of Geneva one last time and watched as the funeral home arrived to pick up her mother's body, draped in purple velvet, her favorite color.
When Stasik's family visited last week, the nurse by her bedside wore a face shield, gown, mask and gloves. But during visits before that and since, the family said, workers didn't wear gloves and one nurse assistant wore his mask below his mouth.
"He was touching her and everything," said Stasik's daughter-in-law, Maria. "No wonder it is spreading so fast."
Branshaw said Bria of Geneva has been "more than adequately staffed" by nurses working longer shifts or through pulling in employees from other BRIA homes. He said the nursing staff has been "heroic" and that it has had sufficient protective gear.
Bria of Geneva resident Debbie Jacobs, who tested positive for the virus but is asymptomatic, has lost many of her friends in the past few weeks. She learns the disease has taken another life when the nursing home plays the hymn "How Great Thou Art" over the intercom to mark each death.
She said the outbreak was "like a bomb went off." Two days after residents met with the Bria of Geneva administrator to discuss preemptive lockdown procedures, the first resident tested positive, Jacobs said. "Nobody expected it," she said. She said workers have been supportive during the crisis and have kept residents informed through flyers and one-on-one meetings.
"I have never met a (nursing home) administrator that cares so much for her building," Jacobs said.
Other families, including whose loved ones died, have sent letters, emails and food to thank the nurses and other workers for their courage to keep coming to work. Community members provided lunch from Panera Bread Co. and the Geneva library staff sent a letter of thanks.
During the 90 minutes Stasik's family visited her last week, at least two other residents had windowside visits from their families.
Mary Niceley dropped off homemade fudge and pumpkin-date bread for her 95-year-old mother, who has also tested positive for the virus but is doing well, she said.
"I love you mom," Nicely said, during a brief windowside visit. She cried as she walked away, waving her hands in front of her eyes to try to stop the tears.
Noel Corral saw his 89-year-old father, Alfredo, who had tested positive for COVID-19 a week earlier and was moved to a room on the first floor so his family could visit. Corral tapped on the window and told his father he wasn't alone. He told him not to worry anymore.
"Every day he is getting weaker and weaker," Corral said, choking up. His father died the day after that visit. Nursing home workers escorted Alfredo's body outside when the funeral home came to pick him up. "The staff did everything possible to make us feel like we were there with our dad," he said.
During last week's visit, Stasik's son shared small talk and asked questions he knew his mother, who can no longer speak or feed herself, would not answer. "I haven't seen you in a few days? Anything new and exciting?"
"You have to eat a little more, OK?" Morrow said. "It will make you feel better."
Stasik occasionally opened her eyes. Once, she wiggled her fingers, as if she were waving. "Grandma's 'wake!" shouted her 2-year-old granddaughter.
The end of the visits are always the hardest. "We all love you," Morrow said through the window.
As he drove off in his minivan, he had the same thought he has every time. "Will she be OK the next time I see her?"
Ash Ngu contributed reporting.