KETR

The Tragedy Of 'St. Joe's'

Dec 24, 2020
Originally published on December 24, 2020 4:22 pm

The people in the yellow hazmat suits arrived at St. Joseph's Senior Home in Woodbridge, N.J., on a crisp morning in late March, emerging from blue and white ambulance buses all suited up, like astronauts descending from a lunar rover.

For the 78 residents whom they had come to evacuate on March 25, however, this all felt more like an alien abduction. As the hazmats approached, some residents shouted and furiously clawed at the air; others begged not to be taken away, clutching the nuns' sleeves, dissolving into tears.

The sisters who ran St. Joseph's told the residents' families later they'd never seen anything like it. "People were loaded up like cattle," said one person who saw the events unfold. "It was horrible. ... When I close my eyes, even today, I still see it."

That day St. Joseph's — most people call it "St. Joe's" — became the only long-term care facility in New Jersey to be entirely evacuated during the pandemic, and no other long-term facilities in the state have been cleared out in the same way since.

A months-long NPR investigation involving three dozen interviews with former and current New Jersey Department of Health officials, family members, experts on the elderly, and people who witnessed the events as they unfolded found that the state's decision to evacuate St. Joe's was both rushed and flawed.

Annette Kociolek, pictured last year, was a fireball who loved brooches, beads, barrettes and living at St. Joe's. "The nuns spoke Polish to her," one of her daughters said.
Dorothy Cassaro

The reporting makes clear the state failed to take into account the fragility of the evacuees sufficiently, possible alternatives to the move, and how complicated it would be to transfer 78 older adults to a facility 45 minutes away. The consequences of the decision are stark: Nearly half the people loaded on the ambulance buses that morning died a short time later, some within days. Experts on aging say the stress of the evacuation was undoubtedly a contributing factor.

According to people close to St. Joe's and families who were monitoring the facility at the time, when the evacuation order came, the nuns who ran St. Joe's were not presiding over an uncontrollable outbreak.

NPR saw contemporaneous emails that indicated that fewer than a dozen of the residents had been confirmed positive for the virus shortly before the state decided to evacuate. The New Jersey Department of Health, through a spokesperson, claimed that by the time of the evacuation there were twice that many.

In a written statement, the department said residents in the facility were initially showing signs of illness, but they stopped short of saying they had tested positive for the virus. Nonetheless, "the impact of COVID-19 on St. Joseph's was severe," a spokesperson wrote.

It appears that the real problem at St. Joe's was not so much a coronavirus outbreak among residents as it was an acute shortage of staff — something at least half the states in the U.S. are struggling with now in this latest winter surge.

Nurses, certified nursing assistants and caregivers at St. Joe's who had contact with residents who had tested positive for the coronavirus had to be quarantined to make sure they wouldn't contribute to the spread. Some of the facility's outside staff — concerned they would catch the mysterious virus that few understood at the time — stopped showing up for work. So St. Joe's needed help.

Before the coronavirus, a typical shift at St. Joe's included some 50 people with direct access to the patients. In the days just before the evacuation, that number had fallen to about 20.

That's why the nuns at St. Joe's started calling around for reinforcements. A Department of Health spokesperson said the agency spent two days looking for temporary staff for St. Joe's. They sent over some people from New Jersey's largest nursing home chain, CareOne. A handful of their nurses and managers covered three shifts.

"When I try to imagine what that would have felt like, seeing people in hazmat suits, me being wheeled out of the place that I know is my home ... ," said Angie Kociolek, Annette's youngest daughter, "it had to be traumatic."
Janie Osborne for NPR

Annette Kociolek, 93, a bubbly, devout Catholic who was known in her family for her love of brooches, beads and barrettes, had been sitting up in bed, watching TV and talking on the phone with her daughters just days before the evacuation.

So she was surprised to find herself strapped to a gurney and loaded onto an ambulance bus the morning of March 25. Her daughters said she was one of St. Joe's reluctant evacuees, fighting off the hazmat suits when they came for her, asking the nuns to tell them she wanted to stay.

"When I try to imagine what that would have felt like, seeing people in hazmat suits, me being wheeled out of the place that I know is my home, away from the caretakers, having no family around to comfort or explain what was going on," her daughter Angie Kociolek told me, "it had to be traumatic."

Christopher Neuwirth was part of the New Jersey Department of Health's Emergency Preparedness and Response at the time. As an assistant commissioner, he had helped with floods and fires, and yet when it came to the evacuation of St. Joe's, he'd never seen the state weigh in like this.

"It was obvious from the get-go that everything that happened with St. Joe's was odd," he told NPR. "The state doesn't get involved with local evacuations. Even at the time everyone in my office was saying, wait, why are we in the middle of this?"

Neuwirth no longer works for the state. He said he was fired earlier this year because he filed an ethics complaint against a high-ranking official. He has since filed a whistleblower complaint, and the suit is pending. The state has denied his allegations.

Little Servant Sisters

St. Joseph's Senior Home is a four-star, 101-bed facility run by the Little Servant Sisters of the Immaculate Conception, a Polish order established in the 1850s with the mission to "nurture the mind, body, and soul ... by serving the residents with the same love as if serving Christ Himself." The nuns have been operating schools, health care facilities and senior homes in New Jersey since 1926.

For Annette Kociolek — her friends called her "Toni" — the family atmosphere and the religiosity of the place appealed.

"My mom was Polish Catholic and St. Joe's was run by Polish sisters," explained the eldest of her three daughters, Bernadette Sohler. "They had Masses daily and the nuns spoke Polish to her," which Annette Kociolek loved.

St. Joseph's Senior Home is a four-star, 101-bed facility run by Little Servant Sisters of the Immaculate Conception, a Polish order established in the 1850s with the mission to "nurture the mind, body, and soul ... by serving the residents with the same love as if serving Christ Himself."
Erica Seryhm Lee for NPR

It is important to remember that in early March, the mere idea of a pandemic seemed a distant threat, like a light on a far-off field. The first big coronavirus outbreak on the East Coast, in New Rochelle, N.Y., had yet to make the headlines, and family members were still allowed to visit nursing homes and bring in food.

On Feb. 29, Kociolek was at St. Joe's eating Polish doughnuts with her daughter, Bernadette Sohler. Sohler said visits to her mother were riotous affairs. "She'd always say, 'Bernie!' And make a big deal, and 'This is my daughter' to all the workers there," her daughter recalled. "Little did we know, you know, about two weeks later, everything would change."

The first inkling that something was wrong came on March 16, when the nuns called Sohler to report that a couple of the residents "had the sniffles." Just to be safe, the nuns told her, they had confined everyone to their rooms.

St. Joe's phoned Sohler again the next day to say that the facility appeared to have its first positive coronavirus case. A day afterward, Sohler found out the St. Joe resident who had tested positive was her mother's roommate.

"I remember calling my sister saying, you know, hopefully we have nothing to worry about," Sohler said. "My mother is very, very resilient. She had been hospitalized three times last year; she bounces back all the time. I talked to her that day and I asked her how she was doing, and she goes, 'I got these little sniffles.' She was more concerned about what they were giving her for lunch than about any virus."

After that, however, everything seemed to pick up speed.

The staff at St. Joe's began quarantining; caregivers weren't showing up to work. The COVID-19 numbers inside the facility began ticking up. By March 21, seven residents had tested positive for the virus, and Kociolek was among them.

"It happened so, so very fast from when there were sniffles to when you know, one person had it, then seven people had it," Sohler said. "They had suspended social activity for the residents, and Sister Monika told me they had contacted the state for additional nursing support."

Sohler found out four days later that the state had ordered all the residents be transferred to another facility. The decision came so fast, Sohler said later, the nuns didn't have time to inform all the families.

A bus ride with the virus

Viral outbreaks have rocked New Jersey long-term care facilities before. In 2018, in what had become an infamous case, a strain of adenovirus raged through a pediatric ward of medically frail children in northern New Jersey.

The virus, common in communal living facilities, rarely results in serious illness, but it can be fatal to those with compromised immune systems, which is exactly what these children had. Dozens fell ill; 11 died.

In response, New Jersey Gov. Phil Murphy signed a law requiring that nearly all of the state's more than 840 long-term care facilities draw up outbreak response plans. Among other things, facilities needed to work out how they would isolate and separate the sick from at-risk residents who are healthy.

Police cruisers are parked near the entrance of the Wanaque Center for Nursing And Rehabilitation in Haskell, N.J., where the New Jersey Department of Health confirmed cases of adenovirus in October 2018. Dozens fell ill from the outbreak, and 11 died.
Julio Cortez / AP

The homes had 180 days to come up with a list of protocols and many had to submit their plans to the state by Feb. 11, 2020 — just weeks before the coronavirus arrived in earnest in New Jersey. St. Joe's does not appear to have created a plan, but it wasn't alone.

As COVID-19 raged, the uneven, panicked responses made plain that many had not, according to Laurie Facciarossa Brewer, an ombudsman for New Jersey's long-term care system. "It's pretty clear that most long-term care facilities did not have those plans in place when they were required to be done by the second week of February," she said.

One way to minimize outbreaks in communal living situations is something called cohorting — essentially it involves isolating those who have the disease or virus from those who don't. St. Joe's began doing that when its residents first began to "have the sniffles." That may be why the nuns seemed to be able to keep the total number of positive cases among the residents so low.

The evacuation team, when it first arrived the morning of March 25, attempted to keep all of St. Joe's coronavirus-positive patients together, relegating them to their own buses.

But by the end of a long day, with nearly everyone loaded and ready, the team started to put the remaining residents wherever they could find room, according to medical officials who received the patients and family members who heard about the evacuation later.

A Department of Health official said later that they just assumed everyone at St. Joe's had been exposed to the virus.

"Well, that's kind of crazy," said Melissa O'Connor, an expert in nursing care for older adults at Villanova University's M. Louise Fitzpatrick College of Nursing in Pennsylvania. "Buses don't have filtration systems like airplanes; they were all breathing the same air" and probably contracting the virus in the process.

O'Connor and others said that given what we now know about the community spread of the coronavirus, those residents who didn't have COVID-19 when they left St. Joe's on March 25, may well have caught it during their transfer. Even if they were masked, the danger was there as they waited in the buses for the other residents to load and then drove, all together, the 45 minutes to the new facility.

It took much of the day to load the residents of St. Joe's onto the caravan of ambulance buses. The lines of buses left all at once, with a police escort, and drove the group to CareOne at Hanover in Whippany, N.J., 45 minutes away.
Seth Wenig / AP

Dr. Pamela Cacchione, who studies older adult care at the University of Pennsylvania School of Nursing, said she doesn't understand why the state didn't just designate St. Joe's a COVID-19 facility and leave all the residents there — isolating the sick — instead of transferring them somewhere else.

That would have been easier on everyone involved, particularly given that CareOne at Hanover didn't actually have vacant beds waiting for the residents of St. Joe's. To accommodate them, CareOne had to move dozens of their own residents to three other CareOne homes in the area.

CareOne declined to comment for this story.

Neuwirth, the former Department of Health assistant commissioner for emergency preparedness, told NPR that, among other things, New Jersey officials seemed to have fixed on the wrong protocol when they decided to empty out St. Joe's.

"This wasn't a flood or a fire, but they responded like this was a natural disaster, and they needed to rush to higher ground," he said. "That doesn't work when you're dealing with a pandemic disease. It follows you, wherever you go."

Behind the scenes

Around the same time the nuns were having their staffing problems at St. Joe's, there was a much worse coronavirus outbreak at the New Jersey Veterans Home at Paramus, a state-run facility for former military veterans about 40 minutes from St. Joe's in Woodbridge.

By late March, almost every resident at the Paramus facility — 98% — had contracted the coronavirus. Some 60% of the staff was out sick in what quickly evolved into one of the biggest coronavirus outbreaks in the country.

U.S. Rep. Josh Gottheimer, who has Paramus in his district, weighed in and arranged for nurses and the National Guard to help.

No one seems to have an answer as to why the same wasn't done for St. Joe's, though officials who were there at the time, and spoke on the condition of anonymity out of concern they would lose their jobs, said it seemed once Department of Health officials decided to evacuate, momentum to finish the job continued to build.

Donna Leusner, director of communications for the New Jersey Department of Health, denied this in response to questions from NPR.

She said the state tried to help the sisters find staff and, she said, the Department of Health spent two days looking for reinforcements.

At some point, a nun named Sister Patricia Codey began talking to state officials about the staffing issues at St. Joe's. "Sister Pat," as she's called, is president of the Catholic HealthCare Partnership of New Jersey, and few people in the state's health care circles are as connected as her. Her brother, Richard, used to be governor.

Codey declined to be interviewed for this story. But three officials familiar with the discussions, whom NPR agreed not to name because they fear retaliation for revealing internal deliberations, said she brought the problems at St. Joe's to the attention of health department officials, and to one in particular, deputy commissioner of health systems, Marcela Maziarz, who oversees nursing homes in the state.

A focus on evacuation

"Maziarz was quite open about asking people in meetings to help her find a place to put people from St. Joe's," said one Department of Health official, who was part of the discussions in mid-March and still works there. "She wanted them to be first in line for a move."

According to three officials who attended meetings with Maziarz in March and April, the deputy commissioner told colleagues in meetings that she thought the best thing to do would be move them to CareOne at Hanover. As the largest nursing home chain in the state, CareOne had the beds, the ability to isolate COVID-19 patients and a willingness to help.

Maziarz had been working with people at CareOne on various licensing agreements for months so the transfer was relatively simple to arrange.

Three Department of Health officials close to the discussions said it started as a verbal agreement — CareOne would take St. Joe's residents — and the precise terms, everyone agreed, would be worked out later.

The Department of Health's Leusner told NPR that "emergent discussions came before executing" the agreement because it was "very time sensitive."

NPR filed an Open Public Records Act request to look at any contracts and agreements between CareOne and the Department of Health, and the request was denied.

The Department of Health declined to make Maziarz available for comment. Care One declined to comment as well.

Residents from St. Joseph's Senior Home, including Annette Kociolek, were moved to CareOne at Hanover (seen here) in Whippany on March 25. Five days later, Kociolek was dead.
Erica Seryhm Lee for NPR

"I'm not surprised that a company like CareOne would be a place where you would look to try to do something quickly," said Brewer, the long-term care ombudsman. "A lot of other long-term care facilities were really struggling at that point and would not have been able to do it."

Brewer said she couldn't say why state officials didn't just supplement St. Joe's staff instead. "I think the model is to move people out when there's a crisis," she said. "Historically that has been the way to solve a problem in a facility; usually it is a physical plant problem" such as a flood, not a virus.

Two Department of Health officials confirmed that someone in the deputy commissioner's office — it is unclear if it was Maziarz — asked CareOne to send people over to St. Joe's to assess the situation. They were nurses and managers from various CareOne facilities, and, according to the Department of Health, they reported what they saw at St. Joe's to state officials the same day.

"Because CareOne had sent staff into the facility to assist, they were able to provide the Department with information to determine the best way to provide care" for the residents of St. Joe's, Leusner said in a written statement.

Their recommendation was to move them all to CareOne. There was never an independent assessment before the evacuation. The University of Pennsylvania's Cacchione, the elder care specialist, said having CareOne do that assessment was "very concerning" because of the obvious conflict of interest. "It's like the fox guarding the henhouse," she said.

NPR filed numerous Open Public Records Act requests to the Department of Health asking for a copy of that assessment of St. Joe's. Several Department of Health divisions said they had no documents that would be responsive to the request. One division said it would keep looking.

The report CareOne sent to the state, according to two officials familiar with it, characterized the situation inside St. Joe's as chaotic. CareOne officials claimed there were only a handful of nuns taking care of the residents there.

Officials close to St. Joe's said that when the CareOne officials showed up on March 22 — three days before everyone at St. Joe's was evacuated — there were nearly two dozen caregivers, nurses, nurses' assistants and visiting nuns in the facility caring for the residents. Little Servant Sisters' other locations in New Jersey had pitched in to help.

Shortly after CareOne provided its report to the State, New Jersey Department of Health Commissioner Judy Persichilli told reporters, at a March 24 press conference, that the department was working with St. Joe's on an evacuation.

"This may result, unfortunately and ultimately, in the closure of that facility," she said, "a facility that has cared for the most vulnerable population in Woodbridge and the surrounding area for decades."

Twelve hours later, the ambulance buses arrived.

Care transition

For the 78 residents of St. Joe's, the arrival of emergency workers in hazmat suits felt like an alien abduction. It took all day to load the older adults onto a caravan of buses and take them to another facility.
Seth Wenig / AP

Standard operating procedure when moving older patients is to look for available beds close by, where people can live temporarily and their families can still have some sort of access. Typically, there are a couple of beds here, and a few others there. In March, as the pandemic was starting to rage, the state's long-term care ombudsman Brewer said, those spare beds were hard to find.

"To me, the part of the St. Joe's evacuation that was really unusual was that they all went from one place to another place," she said. "But then, everything was unprecedented at that time. The rules that we had all abided by all these years seem to be falling by the wayside."

One of those rules is that moving older adults is a last resort.

When the University of Pennsylvania's Cacchione was doing her research on long-term care, she had worked with older adults during a natural disaster. A mini-tornado had knocked out the power to a long-term care facility that she was studying. Everyone had to be evacuated for five days. She said the move traumatized those who were evacuated.

"Over 50% of the participants in the study became delirious or developed acute confusion, which is potentially fatal in itself," she said. "To think that [St. Joe's] had to transition 78 older adults from one facility to another is hard to fathom. The literature shows that these acute evacuations are very dangerous for older adults."

Even if older evacuees weather the physical transfer, Cacchione said, under the best of circumstances they have to endure mix-ups at the receiving facility. Just think how complicated it is to check someone into the hospital, she said, now multiply that by 78 all arriving at once.

"Just the medication errors that would occur from a transition like that are just tremendous," she said. "Getting the appropriate diet, preparing them for appropriate roommate situations, when they often had their own rooms prior to this. That's a real significant challenge to an older adult."

A FaceTime goodbye

It appeared to be a challenge for Annette Kociolek.

"My gut reaction was that [my mom] was going to get lost in the mix," Kociolek's middle daughter, Dorothy Cassaro, told me, as she tracked her mother's progress from St. Joe's to CareOne. "Up until the time of the evacuation my mother was still sitting up, watching TV, and she was still verbal," but the new facility wouldn't know that, she said. She was sure her mother would seem weaker than she was.

Cassaro, Kociolek's middle daughter, said up until the time of the evacuation her mother was sitting up, watching TV and was still verbal. She was sure her mother would seem weaker than she was to the people admitting her at CareOne.
Erica Seryhm Lee for NPR

"She was going to be presented on a stretcher, she's going to look weak and feeble, and I guess I felt that would impact judgments," she said.

Cassaro's inclination proved to be prescient. When her mother arrived at CareOne, the doctor there immediately recommended she be put into hospice, a kind of compassionate care for people in the last stages of life.

"We were a little stubborn about signing the papers," Cassaro said, adding they were trying to slow walk the decision, hoping her mother would rally. "She was admitted on a Wednesday or Thursday, and I believe it was Saturday that she went into hospice."

Cassaro kept calling, asking for updates. The nurse offered to set up a FaceTime call as soon as her mother arrived on her floor. First 9:30 came and went without a call. Then 10:30 came and went. "You're in a weird situation, right, because you're a family member, but you don't want to be that family member" — the kind of family member whose calls nurses try to avoid.

Finally at noon Cassaro called back. The nurse told her to stay on the line while she went to her mother's floor. The call dropped in the elevator.

Cassaro called back, and she and the nurse began talking about end-of-life visits. "I was asking her if she can give me my mother's vital signs only because I felt like if I heard the vital signs, I would know how close she was," Cassaro said.

But doing something as simple as checking her vitals seemed like more than the nursing station could handle at the time. "They seemed really busy," Cassaro said, so she told the nurse that a FaceTime call with her mom would do and the nurse could "catch me up on the vitals afterwards."

Cassaro listened as the nurse walked into the hospice room and started talking to Cassaro's mother, telling her that her daughter was on the line. "I'm like, Hey, Ma, how are you doing?" Cassaro said. "I said you don't look any worse for wear today, or something to her."

Cassaro could only see her mother from the nose up. She asked the nurse to move the camera down and then she gasped. What Cassaro saw was what she called a "death gape."

"I was kind of taken aback," she said, "and I take a screenshot and another nurse walks in off camera and she goes, 'Oh, your mother has passed.' " Then, Cassaro said, the nurse turned the camera on herself and told her, "I'm sorry for your loss."

Then the line went dead.

CareOne told NPR that it "unequivocally denies the allegation. The family didn't FaceTime immediately in advance of their loved one's passing." Cassaro shared that last screenshot with NPR, which had a time stamp coinciding with Cassaro's version of events.

The list

Cassaro holds a photograph of her mother. "My mom died among strangers," she said.
Erica Seryhm Lee for NPR

Annette Kociolek, 93, who loved brooches, beads and barrettes, died March 30, five days after the buses came to take her away from St. Joe's. The cause, according to her death certificate: complications from COVID-19.

But there is an odd thing about that, too. The New Jersey Department of Health Long-Term Care Facility list of recorded COVID-19 deaths indicated that Kociolek and the 35 other St. Joe's evacuees who died days after the move didn't die at CareOne.

Instead the list suggests they died at St. Joe's. Kociolek's family found that galling. Their mother was moved against her will, and now it appeared the nuns at St. Joe's had presided over her death when they hadn't. "No one she knew was holding her hand," Cassaro said. "My mom died among strangers."

The keeper of the COVID-19 list, Dr. Tina Tan, who is the state's epidemiologist at the Department of Health, declined NPR's repeated requests for an interview.

But the Department of Health said in a statement that during outbreaks "deaths are counted based on the association with an outbreak facility, not the actual location of the individual's death."

The Department of Health said there were 36 confirmed COVID-19 deaths among the residents of St. Joe's, and three or four additional deaths that were thought to be related to COVID-19 but weren't confirmed — the patients hadn't been tested.

But that's odd, too. St. Joe's claims it only had about a dozen confirmed COVID-19 cases among the residents before the evacuation. The state maintains it was twice that many, but again, it has not produced any documents corroborating that figure.

Yet all 36 of the evacuees who died at CareOne in the ensuing weeks showed up as part of the tally of dead associated with St. Joe's.

Angie Kociolek has been trying to get the state of New Jersey to change the way it records COVID-19 deaths at long-term care facilities. Right now, even though her mother died at CareOne, the state's list suggests she died at St. Joe's.
Janie Osborne for NPR

Kociolek's youngest daughter, Angie Kociolek, has been trying to get that changed for months. She needs that, she said, for closure. "Even though my mother had already died, I felt like the least we could do is honor the deaths that occurred by reporting the deaths accurately," she said.

Since July, the New Jersey Department of Health has changed the way it compiles the list, reporting only active outbreaks in long-term care facilities, telling NPR it made the change "to more accurately represent the current situation in facilities. Cases or deaths from an outbreak that ended are not included in the list."

An outbreak is considered over in a facility if there hasn't been a new case in 28 days.

Of the 320,000 deaths attributed to the coronavirus in the United States, some 116,000 of them are linked to long-term care facilities — almost 40% of the nation's COVID-19 deaths.

At St. Joe's, the numbers are equally stark — 78 people evacuated, 36 of whom died.

There's little question that New Jersey officials would handle St. Joe's differently if the outbreak happened today, if only because no outbreak has been handled like it since. St. Joe's is still the only long-term care facility in the state to have been emptied out in that way.

The residents of St. Joe's were moved back to the Little Servant Sisters in Woodbridge three weeks after the evacuation. According to the state's tally of coronavirus outbreaks in long-term care facilities as of Dec. 21, St. Joe's is doing well: One resident and four staffers have tested positive for the virus.
Erica Seryhm Lee for NPR

Shortly after it took in the residents of St. Joe's, CareOne was given a license agreement to provide more than 700 beds at five of its facilities to care for COVID-19 patients being discharged from hospitals, according to the Department of Health.

According to an investigation by ProPublica published in August, in the early days of the pandemic, CareOne would go on to have the highest rate of deaths related to COVID-19 among large long-term care companies in New Jersey.

As for St. Joe's? Three weeks after the evacuation, the state of New Jersey moved 38 surviving evacuees back. As of Dec. 21, records show that St. Joe's had one resident and four staff testing positive for the coronavirus.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

ARI SHAPIRO, HOST:

Last March, as the coronavirus pandemic was just starting to make its way through the United States, officials in New Jersey learned of a COVID-19 outbreak in a long-term care facility, and they did something unusual. They decided to evacuate 78 of its residents and move them someplace new. Three weeks later, nearly half of the people they transferred were dead. An NPR investigation by Dina Temple-Raston looks at how that happened.

DINA TEMPLE-RASTON, BYLINE: The evacuation of St. Joseph's began early on March 25.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #1: Medical personnel in protective gear were busy Wednesday morning willing out nearly 80 residents who live at St. Joseph's Senior Nursing Home in Woodbridge.

TEMPLE-RASTON: Eva Kucaba watched it all from a parking lot across the street.

EVA KUCABA: There were, you know, the large ambulance buses, helicopters overhead. There were yellow hazmat suits with, you know, the face shields.

TEMPLE-RASTON: She saw these figures in yellow hazmat suits slowly moving dozens of elderly residents into waiting ambulance buses. Kucaba was there watching for her mother, Ann Gentile, and she didn't actually see her until later on the evening news.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #2: ...Residents who are in their late 80s and early 90s...

KUCABA: Her hand was on her forehead, like, her fingers spread. And, you know, you can interpret it as, oh, my God, what's happening? Where are we going? What's this all about? I mean, that picture tells a thousand words.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #2: And now this place is blocked off by law enforcement, waiting to be sanitized and disinfected.

TEMPLE-RASTON: This was a complete departure from the St. Joseph's, the St. Joe's, that everyone knew.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: The Saint Joseph's Senior Home Assisted Living and Nursing Center has been operated by the Little Servant Sisters of the Immaculate Conception since 1981.

TEMPLE-RASTON: That day, Saint Joseph's became known for something else. It became the only long-term care facility in New Jersey to be evacuated in its entirety during the COVID crisis. And this story is important because it pulls back the curtain on the panic that drove decisions during the earliest days of the pandemic.

Ninety-three-year-old Annette Kociolek was eating Polish doughnuts with her eldest daughter, Bernadette.

BERNADETTE SOHLER: Her little raspberry jellies, which she loved.

TEMPLE-RASTON: Annette's friends called her Toni, and they say she'd love lots of things - brooches, beads, barrettes. And she loved St. Joe's - the daily masses, the gardens, the fact that the nuns spoke Polish to her.

SOHLER: And we just thought it was a really good fit.

TEMPLE-RASTON: Bernadette Sohler said her mother may have been 93, but she was still the Toni everyone knew.

SOHLER: You know, whenever I'd walk through the door, she'd always say, Bernie (ph), and make a big deal - and this is my daughter - to all of the workers there. So, you know, little did we know, two weeks later, everything would change.

TEMPLE-RASTON: What changed was COVID-19.

SOHLER: On the 17th was the first day that we were notified by St. Joe's that one patient had contracted the virus.

TEMPLE-RASTON: The 17th of March, in the earliest weeks of the pandemic.

SOHLER: It just happened so, so very fast - you know, from when there were sniffles to when one person had it, six people had it...

TEMPLE-RASTON: And then her mother had it, though she didn't seem to be showing many symptoms.

SOHLER: Once again, in my mind, my mom is resilient, strong as a bull. And, you know, even though she was in a wheelchair, she was a fighter.

TEMPLE-RASTON: The staff at St. Joe's did what they were supposed to do. They quarantined, they called in reinforcements, and they asked the state if it would help, too. Just four days later, the state's response was harsh. It ordered an evacuation. The state wanted the entire facility to be completely emptied, which is a bigger deal than it might sound.

CHRISTOPHER NEUWIRTH: When you evacuate a facility, you're moving residents who are medically fragile. And any time you transfer them into unfamiliar environments, places a lot of, you know, stress on the individuals and can jeopardize their health and safety.

TEMPLE-RASTON: That's Christopher Neuwirth, and he's a former New Jersey Health Department assistant commissioner in charge of emergency preparedness. And when he first heard about St. Joe's, he remembers thinking two things. First, why was the state involved? Evacuations are usually handled locally. And second, that the whole operation, which involved transferring the residents to a new facility, CareOne Hanover, it all seemed oddly rushed.

NEUWIRTH: You know, this wasn't a flood or a fire where they had to evacuate within a matter of minutes or hours.

TEMPLE-RASTON: Neuwirth no longer works for the state because, he says, he filed an ethics complaint against a high-ranking official and was fired. He has since filed a whistleblower complaint, and the suit is pending. But he isn't alone in thinking that the evacuation of St. Joe's was problematic. It wasn't just the push to move everybody out quickly. It was the stress that such a move would put on the residents of St. Joe's. Just ask Pamela Cacchione. She studies older adult care at the University of Pennsylvania School of Nursing, and she says evacuations like this are rare for a reason.

PAMELA CACCHIONE: The literature shows that these acute evacuations are very dangerous for older adults.

TEMPLE-RASTON: But according to three current and former health department officials who were there when the evacuation was discussed, the trauma associated with this kind of a wholesale move didn't seem to figure into the state's calculus. They said leaders at the Department of Health seemed to be reacting to the outbreak as if it were a natural disaster, as if an evacuation was the only viable option. A health department spokesperson told NPR that just wasn't true. In a written response, she said that the state spent two days trying to find reinforcements for St. Joe's - two days. As far as the New Jersey Department of Health was concerned, that was long enough.

During a press conference, the state's health commissioner, Judy Persichilli, said the outbreak at St. Joe's couldn't wait.

(SOUNDBITE OF ARCHIVED RECORDING)

JUDY PERSICHILLI: More residents and staff are symptomatic, so we made the assumption that residents and staff of St. Joseph's had all been exposed to COVID-19.

TEMPLE-RASTON: But the thing was, we don't know if they'd all been exposed. The health department claims they confirmed two-dozen residents had tested positive before the evacuation. But according to contemporaneous emails at the time, families understood the number was half that much, about a dozen, a dozen out of 78. So the real problem wasn't how many people had the virus. The problem St. Joe's was facing was more fundamental. The nuns needed some temporary help just to tide them over. The nuns asked for out-of-state nurses or for the deployment of the National Guard, but what they got instead was this evacuation. And in case there was any resistance to the idea of letting all their residents go, there was also what some saw as a thinly veiled threat from the New Jersey commissioner of health.

(SOUNDBITE OF ARCHIVED RECORDING)

PERSICHILLI: This may result, unfortunately and ultimately, in the closure of that facility.

TEMPLE-RASTON: Persichilli said later, the sisters at St. Joe's asked for the residents to be moved. And while the sisters declined to talk to NPR about the evacuation, the families say the nuns told them at the time that the evacuation came as a complete surprise. They only had 12 hours' notice.

There's another reason why the state's decision to evacuate everyone at St. Joe's all at once was puzzling. Even in the best of circumstances, these kinds of large transfers are fraught. People get lost in the shuffle. Meds get missed. There's no continuity of care. And in this case, the residents of St. Joe's would arrive at CareOne all at once as strangers. Just consider Toni Kociolek. Her middle daughter, Dorothy Cassaro, worried people at CareOne would just see her mother how she was when she arrived after that bus ride from St. Joe's.

DOROTHY CASSARO: She was going to be presented on a stretcher. She's going to look weak and feeble. And I guess I felt that there would be judgments made.

TEMPLE-RASTON: As soon as her mother was admitted, a doctor at CareOne recommended that she be put into hospice, essentially compassionate care for people in those last stages of life.

CASSARO: She was admitted on Wednesday, and I believe it was Saturday she went into hospice.

TEMPLE-RASTON: Cassaro wanted the nurse to take her mother's vitals so she could figure out how much time her mother might have left.

CASSARO: And I guess the nurses station was kind of busy, so she makes a comment saying, oh, they're really busy here. And I said, OK, well, that's OK. Why don't you go in, we'll do this FaceTime call, and then you can catch me up on the vitals afterwards?

TEMPLE-RASTON: So the nurse went in with the phone.

CASSARO: She's very cheery, and she has my mother on FaceTime. I'm like, hey, ma, how are you doing? Oh, I said, you don't look any worse for wear today, or I say something to her.

TEMPLE-RASTON: But the FaceTime camera was only showing her from the nose up.

CASSARO: So I said, can you do me a favor and move the camera down? And she moves the camera down. And I was like, oh, because it was, to me, what I would refer to as the death gape.

TEMPLE-RASTON: CareOne denies this ever happened, but Cassaro has a time-stamped screenshot, and NPR has seen it. Moments after she took it, another nurse walked into the room off camera. Cassaro could only hear her voice.

CASSARO: And she goes, oh, yeah, no, your mother's near the end. She gone. And I said, she's gone right now? She goes, oh, yeah, yeah, she's gone.

TEMPLE-RASTON: The nurse turned the camera on herself and told Cassaro, I'm sorry for your loss. And then the line went dead. The mother who loved brooches, beads and barrettes died at CareOne Hanover on March 30, five days after the evacuation.

CASSARO: I know that the day before the evacuation, my mother was still vocal. My mother was still coherent.

TEMPLE-RASTON: And now she was gone.

There's something else a little odd about the whole St. Joe's affair and its administrative. All 36 of St. Joe's residents who died after the move are listed as having died at St. Joe's, not CareOne. The New Jersey Health Department told NPR in a statement that during outbreaks, deaths are counted based on the association with an outbreak facility, not the actual location of the individual's death. What that presupposes, though, is that no one got the virus at CareOne after the transfer. For Kociolek's youngest daughter Angie, all of this was more than she could take.

ANGIE KOCIOLEK: (Crying) And my mom was 93. It's realistic to think that she probably wouldn't have lived more than a few more years. I get that. But she wasn't able to die with dignity and comfort. That's the thing that hurts the most.

TEMPLE-RASTON: And remember Eva Kucaba, that woman who watched the evacuation from across the street? She lost her mother, too, and she believes the stress of the move, which she saw on her mother's face in that evening news footage, contributed to her death. Kucaba's mother tested positive for the coronavirus five days after her arrival at CareOne. She was dead two days after that. Whether Ann Gentile caught the virus at St. Joe's or at CareOne is unclear. For Kucaba, who's a nurse, the more fundamental problem was the state's decision to evacuate St. Joe's in the first place.

KUCABA: No other facility was ever evacuated after that, and I'm sure they realized what a mistake that was because if it wasn't a mistake, they would have done it with other facilities, and it wasn't done.

TEMPLE-RASTON: Last November, there was a surprise party for Ann Gentile at St. Joe's.

KUCABA: She was singing, dancing full of life.

TEMPLE-RASTON: In a video, Kucaba's mother was wearing a pretty sweater, and there were balloons and cupcakes.

(SOUNDBITE OF ARCHIVED RECORDING)

KUCABA: Ma, sing your song.

UNIDENTIFIED PERSON #2: Come on. That was good.

(CHEERING)

TEMPLE-RASTON: And everybody was trying to get her to sing.

KUCABA: My mom used to sing on the radio. She would be on every - I think every Saturday.

(SOUNDBITE OF ARCHIVED RECORDING)

ANN GENTILE: (Singing in non-English language).

Wait, I'm...

(APPLAUSE)

TEMPLE-RASTON: Gentille would have been 90 in November. Dina Temple-Raston, NPR News.

(SOUNDBITE OF RIOPY'S "LE REVE") Transcript provided by NPR, Copyright NPR.