How Covid-19 Became the Last War for Elderly Veterans

(Bloomberg) -- Arnold Haber beat colon cancer and survived a massive heart attack. He later lost the use of both legs after a severe infection. But even when confined to a wheelchair, the 230-pound U.S. Army veteran managed to stay active, his children said. They called him the “Bionic Man,” because nothing could stop him.

In 2017, Haber moved into the New Jersey Veterans Home at Paramus, part of a national network of elder-care facilities for veterans and their families. When the novel coronavirus arrived this year, it ripped the place apart. Of the 281 residents there in early April, at least 189 have tested positive and 65 have died—the most of any nursing home in the hard-hit state.

Among the 670 licensed long-term care facilities in New Jersey, at least 508 have witnessed outbreaks, with 3,733 deaths, close to half of all Covid-19 deaths in the state. Nationally, about one-fifth of all Americans who have died from the virus had been in nursing homes. Elected officials have vowed to get to the bottom of what went wrong, to shed light on how months of delays and mistakes allowed the contagion to cut short the lives of America’s most vulnerable.

At veterans’ nursing facilities, there is an additional layer of sorrow. These homes are the last post for American servicemen and women who are no longer able to care for themselves. Willing to die for their country, many of these former soldiers, sailors and marines are meeting their end bereft not only of the comfort of loved ones, but the dignity and timely military funeral rites that are their due. Haber, an Army corporal who served in Germany during the Korean War, was one of them. He died last month at the age of 91, a victim of the coronavirus.

“My father was very proud to be an American and fight for his country,” said Mitchell Haber, 60, a day after his father was buried in a small, short service, with no bugler to play taps or the flag ceremony his family had planned years ago. “This is not the way my father deserved to go.”

The U.S. Veterans Health Administration calls itself the “largest integrated health-care system” in the nation. It provides nursing-home care in three settings: VA-owned homes known as community living centers, often part of VA medical centers; facilities owned and operated by the states but regulated by the VA; and through contracts with more than 1,700 public and private locations, known as community nursing homes.

State-run veterans’ homes date to the end of the Civil War, when America was overwhelmed by hundreds of thousands of men who had been injured or maimed in the bloody defeat of the slave states. Today, every state has at least one, for a total of 157, while the VA runs 134, with a subsidy program for veterans in general-population nursing homes.

Veterans who move into these facilities often do so because they lack the financial resources to afford privately run homes. If veterans need nursing home care because of a military service-connected disability, the VA pays the full cost; otherwise, it pays only part of the expense. About two-thirds of state-run homes participate in Medicare or Medicaid.

The VA system, which includes hospitals, reported 6,672 Covid-19 cases and 413 deaths as of April 25. It doesn’t report data for specific homes; neither does the National Association of State Veterans Homes, an advocacy group. Only some states publicly disclose such information, and they differ in whether they report only fatalities at the facility or those that occur at hospitals.

Even before the pandemic, the system was under stress. The Government Accountability Office, which had been asked by Congress to examine the program amid concern about quality of care, reported last year that between 2012 and 2017, there were 576 deficiencies at 126 VA-run homes, including infection control, and 192 deficiencies at 148 state-run homes, with problems spanning safety, health assessments and quality of care.

The near-apocalyptic scale of death wrought by the virus on these homes may illustrate the GAO’s call for increased oversight. “In the week where we will acknowledge the 75th anniversary of the end of World War II, to lose some of these veterans to this thing, after all that they did for our country, is just particularly wrenching,” New Jersey Governor Phil Murphy said on May 2.

Across America, the coronavirus has been detected among residents or staff in veterans’ homes run by at least 17 states. Alabama officials said they are assessing procedures at a veterans’ home in Alexander City after 64 residents and 23 employees tested positive and eight residents died. In New York, where 59 residents at the Long Island State Veterans’ Home died, Governor Andrew Cuomo ordered an investigation of all nursing homes in the state. In Pennsylvania, Maine and Louisiana, the story has been the same.

While veterans’ homes appear equally susceptible to Covid-19 as other elder-care facilities, it was in Massachusetts, at the Soldiers’ Home in Holyoke, where the nation first learned of the horrendous toll the pathogen has taken on them. At least 80 residents died, while 160 residents and staff have been infected. Federal and state officials announced investigations of the facility, including for potential civil rights violations.

“There wasn’t enough personal-protection equipment,” said Cory Bombredi, internal organizer for SEIU Local 888, a union that represents 270 nurses and staff at the Holyoke home. He said they were told: “You don’t need a mask. This is like the flu. If you leave, you might as well leave your ID at the door.”

Massachusetts officials have boosted staffing and assembled a clinical team, according to Brooke Karanovich, a spokesperson for the state’s Executive Office of Health and Human Services. Val Liptak, the new acting administrator of the Holyoke Soldiers’ Home, declined to comment on the status of the facility or its staff, though her predecessor has pushed back against criticism by state officials.

In New Jersey, there are three veterans’ homes with a combined 900 beds. In normal times, they run at full capacity and have waiting lists, according to Kryn Westhoven, spokesman for the state’s Division of Military and Veteran Affairs. The Paramus home where Arnold Haber lived is in Bergen County, a densely populated suburb of New York City—itself ground zero for the pandemic in America.

With close to 16,185 cases and 1,210 deaths of it own, the county has the most cases in New Jersey. A second state veterans’ home located in Edison, also near New York City, has had 163 cases and 61 deaths. The third facility, on the southern end of the state in rural Cumberland County, has reported only six infections.

Arnold Haber and his wife Rena raised their family in Paramus. In the years after World War II, he worked in New York City’s lingerie industry, starting out as a shipping clerk. After the Korean War, he would eventually buy his own store, Lea’s Corset Shop on Broadway. His children would follow in his footsteps a few decades later, opening their own lingerie stores in New Jersey.

When three years ago Haber began to fall and his wife could no longer care for him, he moved into the Paramus veterans’ home. Rena Haber, 87, visited him every day, and his kids dropped by several times a week, chatting with other families in the day room. “They had never been apart a day in their life,” Loren Haber said of her parents.

That changed on March 12. The home, like so many others, sealed itself off to prevent the spread of the virus. The family said Arnold Haber shared a room with a resident who had tested positive for Covid-19, and that staff waited several days before testing their father, even though he was coughing and lethargic. The family’s only contact with him was through a caring aide.

On April 18, the aide called from Arnold Haber’s bedside. Their father was unconscious and on his deathbed. “He’s on the way out,” Rena Haber said that night. Early the next morning, Arnold was gone.

Westhoven, the New Jersey state spokesman, said Paramus veterans’ home chief executive Matt Schottlander wasn’t available for comment. Westhoven said the facility was following U.S. Centers for Medicare & Medicaid Services guidance issued April 2, which stated that confirmed Covid-19 patients aren’t to be placed with patients who haven’t tested positive.

Steve Mastropietro’s father, 91-year-old Thomas Mastropietro, arrived at the Paramus home in February. He also died of the coronavirus last month.

Steve said a nurse told him his father was recovering from the virus, only to call back and say he had in fact died hours earlier. Mastropietro said he received another call later that day: Not only had his father died, but there had been a mixup of identification bracelets, and his body was sent to the wrong funeral home.

Like Haber, the elder Mastropietro served in the Army during the Korean War. Steve Mastropietro said the last time he saw his father was shortly before the March 12 decision by Paramus to bar visitors. At the time, a ward had been sealed off because some residents were having respiratory issues. Over the next few weeks, Steve Mastropietro said he was told there were only a few Covid-19 cases among the residents.

Each time he asked about his father, he was told his symptoms were mild. Then, a few days before his father’s death, he saw on the news that more than 40 people at Paramus had the virus, and that several had died.

“If I knew how bad it was, I could have taken him home,” said Mastropietro, 60, of Hasbrouck Heights. “It’s so unfortunate that I put him in there.”

During the first two weeks of April, the New Jersey Army National Guard sent 40 combat medics to the Paramus home. On April 14, Governor Murphy said he had spoken to VA Secretary Robert Wilkie, who agreed to send 90 nurses to assist at all three state veterans’ homes.

Mitchell Haber and Steve Mastropietro said that, before the outbreak, the Paramus veterans’ home was clean, the nurses were cordial and their parents seemed happy. In a statement last month, Representative Josh Gottheimer (whose district includes Paramus) said he was “deeply concerned about the recent performance of the facility and a departure from its regular health and safety standards.’’

Mark Piterski, 54, a state deputy commissioner who oversaw the three state veterans’ homes before he quit last week, said that after he made a plea to Gottheimer for more nurses, the Democratic congressman instead called for a federal probe of the Paramus home.

“I asked him for nurses; I got an investigation,” said Piterski, a retired brigadier general who spent 30 years with the New Jersey Army National Guard. Piterski said he quit his post to run as an independent against Gottheimer in the November election. Gottheimer denied that Piterski requested more nurses for Paramus. The lawmaker said he has been working with state and federal officials to help the facility since he learned about the conditions there in early April.

Governor Murphy’s office defended Gottheimer, saying he has been “very helpful” while noting any requests for federal help should be directed first to the state. Piterski said the New Jersey Department of Health was “in up to the eyeballs trying to find the nurses,” and added that Murphy and state Health Commissioner Judith Persichilli were “rock stars.”

Nationwide, people age 75 or older make up 58% of all Covid-19 deaths, according to Centers for Disease Control and Prevention data as of April 24. Those in nursing homes or other long-term care facilities make up 18% of all deaths—with almost half having occurred in New York and New Jersey—the two worst-hit states.

The Paramus facility, located on 23 acres across the street from the Bergen New Bridge Medical Center, says its mission is “to honor and serve the military veteran, their spouses and Gold Star Parents by consistently providing the highest quality of resident-directed long term care.”

The Trump administration announced last month that it’s requiring nursing homes to report to patients and their families if there are Covid-19 cases in their facility. As states begin to reopen, federal surveillance around the virus is to begin in nursing homes. Westhoven, the state spokesman, said New Jersey will be doing its own review, and evaluating “how we can be better prepared in the event of another public health crisis.”   

Claire Hovsepian, 96, who currently lives at the Paramus home, was “one of the lucky ones,” said her daughter, Kim Deas. Hovsepian moved into the home less than a year ago and has recovered from Covid-19—her husband, a World War II Army veteran who received two purple hearts, lived there until his death in 2015.

Deas, 54, said her mother wasn’t eating or drinking very much while she was sick, and was very tired and confused. Deas believes her relentless calling and pushing led to her mother being tested for the virus. “She’s on the right track at this point,” Deas said.

According to Gottheimer, one of the biggest problems at the Paramus facility was its failure to properly communicate with families. In an April 3 letter from Schottlander, the home’s CEO, family members were advised that daily communication with relatives wasn’t practical. “If there is an immediate concern or development with your loved one, rest assured, you will be contacted,” Schottlander wrote.

“Every day, we were waiting and hoping someone was going to call,” Loren Haber, 56, said. “Nobody had the time there.” The Paramus facility’s lockdown, she said, left her father “and so many others to die alone.”

“Did we have a lack of communication? Yes we did,” Piterski said. “Because I had the CEO making beds. I had all hands on deck.’’

Over the past week, the Paramus veterans’ home has regained its footing and arrested the spread of the disease, according to New Jersey officials. But Joe Bosotina, a veteran who lives in Morris County, said the quality of veterans’ homes has been declining for some time.

Bosotina, 47, comes from a family of World War II and Vietnam War veterans. He retired from the Army after 25 years, and now works as a sales director for a health services company in New York. He’s also an advocate for veterans’ services and a member of the Disabled American Veterans. Bosotina said services at the Paramus veterans’ home, where his grandfather used to seek medical attention, had slipped over the years.

“The county, the state, the federal government—they’ve all fallen short in providing services to our nation’s heroes during their time of need,” he said. “On the surface, America says how much we love our veterans. Then we put them in the corner and leave them alone.”

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