With state officials lifting restrictions, old friends could sit together again at tables in dining rooms or gather for St. Patrick’s Day celebrations last week. There were joyful reunions, plenty of hugs, and cellphone photo displays of grandchildren. At the Elizabeth Seton Residence nursing home in Wellesley, resident Dorothy Lynch, 91, and her daughter Jeannie Breen, 55, sang a duet of “You Are My Sunshine.”
“You can see the spirits soaring,” said Steven Tyer, the administrator at Copley at Stoughton. “Our residents are social beings. Anything social they’ve been craving.”
But even as the deadly virus recedes, the scars of the past year aren’t far from the surface. More than 8,800 long-term care residents have died of COVID-19 in Massachusetts in the last 12 month — a staggering 1 in 5 of all the people living in senior care sites before the pandemic — and 125,000 have died nationally.
And the virus, with new variants evolving, has yet to be vanquished. Whether life can resume as it was before it arrived is far from certain.
“There’s some short-term optimism but, long term, there’s a need for real reform,” said David Grabowski, a health policy researcher at Harvard Medical School. “This pandemic has shown us just how broken the long-term care system is.”
Problems that dogged the sector before the virus invaded — underfunding, staff shortages, infection control lapses — contributed to the outbreak’s severity. Stagnant state Medicaid payments have kept wages so low that nursing homes must compete with warehouses and fast-food restaurants for workers. In an article in the Health Affairs journal this month, Grabowski and a pair of colleagues showed annual turnover rates for nurses topping 90 percent before the pandemic.
A flurry of state and federal legislation has emerged to bolster long-term care, including more than a dozen bills in Massachusetts. Among them are proposals for higher Medicaid payments, more hours of care for residents, staff dedicated to preventing infections, and steps toward single-room layouts in nursing facilities where two or more residents have long roomed together.
“We owe it to the memory of those we lost to make nursing homes places where older adults who are frail and ill can have a safe quality of life,” said state Representative Ruth Balser of Newton, a member of the House speaker’s leadership team, who has filed four of the bills. Some of the measures are backed by the nurses’ Service Employees International Union and the senior advocacy group AARP.
Two national organizations representing nursing homes, the American Health Care Association and LeadingAge, proposed federal legislation last week calling for $15 billion in funding for clinical improvements, such as 24-hour nursing, and to support state Medicaid reimbursements for long-term care.
Nursing homes were a secondary priority for Massachusetts officials in the early weeks of the pandemic, when their main focus was to prepare hospitals for a rush of patients, the Globe Spotlight Team reported last September. The report faulted the Baker administration for failing to quickly provide senior homes with protective gear and to authorize testing, and for creating a plan — ultimately abandoned — to claim nursing home beds as reserve space for recovering coronavirus patients.
Governor Charlie Baker, in an interview last week, attributed the tragedy at nursing homes to an insufficient inventory of personal protective equipment — and a lack of understanding, at first, that residents and staff could transmit the coronavirus without having symptoms. “When I think back to last year, not only did nobody have any PPE,” he said, “no one had ever heard of asymptomatic [spread].”
State officials later mandated testing at senior care sites, required them to meet stringent conditions before admitting new patients, and stockpiled masks, gowns, and gloves, the governor said. Going forward, he said, “The first thing is to have more PPE on hand than we can ever imagine what to possibly do with. We plan to be in that position.”
Baker said he would have to study specific nursing home reform bills before deciding whether to support them. But he added, “I think everybody in the long-term care space learned a lot over the past year, and so did we. … We’re going to do whatever we need to do to keep people safe here.”
Looking back, it’s astonishing how rapidly COVID-19 infiltrated the state’s senior care facilities. The first known casualty, 91-year-old retiree Jose Rivera, who lived in Rogerson House in Jamaica Plain, died March 20 last year. In the weeks that followed, the virus ripped through scores of senior sites.
The toll has been especially high in Massachusetts, where long-term care fatalities have accounted for more than 53 percent of all deaths from COVID-19, compared with 34 percent nationally. As of last week, only eight other states had a higher share of coronavirus deaths in senior facilities.
Almost everyone who lived through the outbreaks in nursing homes, rest homes, or assisted living centers saw illness and death up close while suffering through stress, trauma, and isolation. Many lost loved ones and long-time pals.
The departed have been memorialized in photo montages and at outdoor gatherings and prayer services at many of the homes. Some have dedicated walkways or installed flames in their lobbies to remember those lost to the virus.
“Now that we’re able to open up our facilities, we’ll see more dedications and more intimate remembrances of the people who sadly died,” said Tara Gregorio, president of the Massachusetts Senior Care Association in Waltham.
At the nursing homes, there is relief and exhaustion, along with a determination to make sure it never happens again.
“It was very heartbreaking what we’ve seen in the past year, how many people got sick, how many died,” said Dr. Asif Merchant, medical director at four nursing homes in the Metro West area. “People are feeling better now, but there’s some fatigue setting in. Some things are going to change. There won’t be any three- or four-bedrooms going forward.”
But there’s also a recognition that it will be difficult to make all the needed changes quickly. Because many nursing homes in Massachusetts are older, transitioning to single-person rooms would mean having fewer residents or making huge investments in new buildings or renovations, options that aren’t financially viable for many long-term care sites.
“Right now you can’t operate a nursing facility by going from 120 beds to 60 beds,” Gregorio said. “If you flipped a switch and went from double-occupancy to single-occupancy rooms, you would displace thousands of residents.”
Vaccinations have been a bright spot at senior sites. While they were slow to protect residents and staff last spring, state officials made them a priority in the vaccine rollout. They were the second group to get injections, after hospital workers, and with homes launching aggressive campaigns to educate skeptics about vaccine safety and effectiveness, injection rates are higher in Massachusetts than most other states.
As of last week, about 32,000 long-term care residents had received first doses, 97 percent of all residents, and 26,000, about 84 percent, had gotten both doses of the two-shot Pfizer-BioNTech vaccine regimens. At the same time, about 37,600 employees had their first doses, 79 percent of the staff, while 32,000, or 70 percent, were fully vaccinated.
The surge of vaccinations, administered at clinics run by CVS and Walgreens, was followed by a plunge in COVID-19 cases. Infections declined 94 percent, from 214 on Dec. 28, the day the clinics began, to a dozen on March 16. Deaths fell from 25 to eight, a 68 percent drop, in the same period.
“We’re clawing our way back,” said Tom Lavallee, chief operating officer of Alliance Health & Human Services, which manages eight nursing homes in the state. “The vaccine has been a literal shot in the arm. It will allow our residents to engage in meaningful group activities, for their loved ones to visit and feel safe. It will let us feel like home again.”
Dr. Larissa Lucas of the North Shore Physicians Group, who serves as medical director for nursing homes in Peabody, Lynn, and Marblehead, say many employees are “burned out,” but also hopeful as the homes open up to visitors.
“There’s a lightness in the air,” Lucas said. “We don’t have a constant spread of COVID in our buildings. I think we’re going to have a wonderful summer with a lot of activities and visitations. But we have a lot of work to do.”
No one toasted the COVID-19 vaccine at last week’s reunions, but the gatherings couldn’t have happened without it.
Joe Kaczynski, 86, and his wife Mary, 81, married 60 years, had been forced to live in different rooms in Alliance Health at Abbott, a nursing home in Lynn, after each was admitted separately last month. Both are now vaccinated, and they were reunited in a room together last week.
“We can hold hands if we want to,” Joe Kaczynski said. “We’re going to have a party tonight.”
Jessica Rinaldi of the Globe staff contributed to this story.