In December 2019, Sharon Farrell flew from Florida to visit her brother Stephen at a New Jersey nursing home, where, she said, she found “disgusting” conditions. "I told the nurse, 'I am calling the state,'" she said. "I’m paying $9,000 a month, and I wouldn’t let my dog live like this."
Farrell said that four months later, as Covid-19 was spreading rapidly, she repeatedly called the facility to ask how her brother was doing. When she finally reached someone, she said, she was told he was fine. Within a few days, however, he was dead.
It has been 19 months since the discovery of 17 bodies in a tiny morgue at the Andover Subacute II nursing home in Sussex County, New Jersey, in April 2020. The federal government fined the owners $221,115 for not being in "substantial compliance," and the attorney general’s office began an investigation.
But the owners are still in business. They changed the names of Andover and its sister facility and installed new signs out front. As of Friday, there were 25 residents of Andover with Covid, according to state data.
And the owners are still being paid by Medicare and Medicaid, the taxpayer-funded programs that pay most costs for U.S. nursing home operators — even though one of the owners, Louis Schwartz, helped run a chain called Skyline Healthcare, which collapsed in 2019 amid accusations of neglect and financial mismanagement, which the chain denied.
"The individuals that ran Skyline should not ever be in charge of a nursing home again, and yet here we are," said David Grabowski, a professor of health care policy at Harvard Medical School. He said the pandemic exposed an industry already in crisis, with a lack of resources and regulation.
"Different names, same practices," Grabowski said. "We need to ensure that there aren’t these kind of back doors, that nursing homes aren’t able to simply put a new name on the building and continue to operate as is."
Some family members of those who died at Andover say they are frustrated, and some are suing over the facility's alleged lack of preparation to deal with Covid and for mingling the infected and the healthy.
Farrell joined a lawsuit with other families but said: "I couldn’t care less about the class action. I want these guys out of business."
At its peak, Skyline Healthcare had more than 100 facilities and oversaw the care of more than 7,000 elderly residents. But from 2017 to 2019, the chain began a slow-motion collapse, and more than a dozen Skyline-operated nursing homes shut their doors, throwing residents, vendors, employees and state regulators into chaos.
Many homes ran out of money. Others were shut down over neglect documented in government records. In one Arkansas nursing home regulators identified maggots in a resident’s catheter, according to an inspection. Fourteen homes were forced to close permanently, displacing more than 900 residents to new facilities, sometimes hours away.
Skyline’s main owner, Joseph Schwartz, and his son Louis did not return multiple messages and emails requesting comment in 2019. They have denied the allegations of neglect.
The Schwartz family has not left the nursing home business. While Skyline is defunct, Joseph Schwartz is still listed as the owner or a co-owner of four facilities, according to federal nursing home ownership data.
Louis Schwartz and Chaim Scheinbaum have ownership stakes in at least seven nursing homes between them, including the facility once known as Andover Subacute II.
In January 2020, New York health officials recommended against allowing Scheinbaum to take over a nursing home in upstate New York, citing an "ongoing investigation" and noting that they disapproved of his "character and competence," according to a Health Department document. Scheinbaum did not respond when asked to comment about the recommendation.
A year before the Covid outbreak, a female Andover resident with dementia walked out of the facility through two broken doors and was found at 4:30 a.m. sitting in the snow with severe frostbite, according to a federal inspection. Terri Thompson, her daughter, sued the facility, alleging violations of the minimum standard of care. The lawsuit is pending, and the owners have denied the claims.
Dante Maglioli said that in early 2020, his father, Joseph, complained about the quality of care at Andover. The family was talking about moving him to another facility.
As Covid began to spread, Maglioli said, he heard his sister and his father talking on the phone. His father was saying he was not sure Andover could cope if he came down with the deadly new disease. And then, Maglioli said, "my sister never talked to my dad again." Maglioli’s father died April 9, 2020.
Schwartz and Scheinbaum did not respond when asked to comment about the conditions at Andover before the pandemic.
When the pandemic arrived, nursing homes in New York and New Jersey, including Andover, took the early brunt. Eighty-three of the home’s 539 residents, or almost 1 out of every 6, died of Covid in the first four months of the pandemic. Farrell’s brother was among the casualties.
Preston Nicolai, then a 20-year-old maintenance worker at the facility, said it was "horrific."
"We were losing sometimes between 10 and 12 people a night," he said.
Before the bodies began to pile up at Andover, Nicolai said, he was told to move residents from room to room, even though the facility did not know who had Covid and who did not. "I do believe it helped spread the cases of Covid throughout the building," he said.
Nicolai said he was told to stack bodies on top of one another in a small room as the facility struggled to deal with the surge in deaths.
On Easter Sunday, April 12, Nicolai said, he went to work and found the body of a woman in an outdoor maintenance shed, next to shovels, rakes and a lawn mower. He said there was no more room for corpses inside the nursing home.
"I was so morally devastated," he said. "It felt so wrong to put someone’s loved one out in the shed."
He moved the body back inside the facility, but he cannot shake the images. "I have had really bad dreams, and I don’t have the money to pay a therapist," he said.
‘They do not even know what they do not know’
Documents newly obtained through an open records request by NBC News show how the facility struggled to cope with the outbreak in April 2020.
Emails from Andover staff members to Sussex County officials document repeated requests for personal protective equipment, or PPE, like masks and gloves, some of which was delivered to the facility.
A summary of an inspection from the early morning hours of April 12 written by Kyle Wilson, a registered nurse, and addressed to the Andover Township chief of police describes in detail conditions inside the facility days before the first story broke about bodies stuffed into the tiny morgue. Wilson is employed part-time at the police department, according to a dispatch operator. He did not return a call seeking comment.
Wilson wrote that protective equipment delivered to the facility by the Sussex County Sheriff’s Office was unaccounted for. He said an Andover employee said the facility was "aware of a batch of PPE 'donated by the Sheriff’s office' but could not account for its whereabouts or the inventory of the facility’s existing PPE, if such an inventory exists."
Wilson wrote, "Staff were observed to be touching their PPE (face shield, gown, mask) and their face with bare hands." He wrote that he "confronted [the nurse on duty] about this observed behavior. She assured me that it was okay because she was 'not in a room.'"
Wilson wrote that there was no Covid testing at the facility and that the staff had not segregated the patients suspected of having Covid. He wrote: "It is my opinion that the acquisition of PPE alone will not resolve the rate of spread at this facility. … [S]taff are undoubtedly contaminated throughout their shift. While the staff are tangibly scared, a culture of safety is not present in this facility. They have not been educated. They do not even know what they do not know."
Two days later, a federal Department of Health and Human Services administrator working in Sussex County, Carol Novrit, emailed county officials to say Andover staff members had told her that residents were "not being fed," that residents had "open wounds" and that the deaths of both residents and staff members were not being reported to public health officials. She wrote that the staff told her "there is no infection control now."
Schwartz and Scheinbaum did not respond when asked to comment about the documents obtained by NBC News.
Federal inspection reports conducted in mid-April 2020 showed similar observations, noting that residents who had symptoms were intermingled with those who were asymptomatic.
'Impossible to know'
Representatives for the owners said that at that time it was "often impossible to know who had Covid and who did not because of a lack of testing capability."
In a statement, the owners of Andover, now known as Woodland Behavioral, said that "the safety and health of our residents has always been the top priority for Woodland Behavioral," adding: "The COVID-19 pandemic brought unprecedented challenges, and our heroic staff faced those challenges as best as they could. We continue to thank them for everything they did (and continue to do) to protect our residents."
Representatives for Scheinbaum and Schwartz said they asked for help from multiple government agencies, including two verbal requests to the National Guard on April 11 and April 15, but were told by military officials that they could not provide any assistance.
A spokesperson for the New Jersey National Guard disputed their assertion. "The National Guard does not have any information indicating that the Andover Subacute facility made a request for assistance, much less one that was turned down." The spokesperson said that at the outset of Covid, the Guard "supported every single mission request we received."
The National Guard did respond to a request for emergency aid that Sussex County officials sent to the governor on May 6. Two days later, 22 members of the Guard went to Andover and performed nonmedical tasks, like cleaning the facility.
The owners say problems identified in the federal inspections from spring 2020 have been resolved with state and federal regulators.
A spokesperson for an industry trade group, the American Health Care Association, said, "Even the best nursing homes with the most rigorous standards could not stop this highly contagious and invisible virus. Many lives were lost because long-term care was not made a priority by public health officials, especially in the initial months of the pandemic. Critical resources were directed toward hospitals, leaving long-term care facilities at a severe disadvantage."
The investigation continues
Preston Nicolai said he was fired four months after the overstuffed morgue was discovered, accused of improperly disposing of medical waste.
He said he believes the owners were looking for an excuse to get rid of him after what he saw. He said he has not been contacted by the attorney general’s office. Sharon Farrell, however, was contacted this April.
Asked when the attorney general’s office would complete its investigation, a spokesperson said, "As is our standard practice, we will not provide updates on the investigation or release any additional information unless and until we bring an enforcement action or close the matter."
The spokesperson said the Andover inquiry is part of a larger investigation of "facilities with high numbers of Covid-related deaths and below-average track records for health inspections, staffing, and quality of care."
The class-action lawsuit filed by some relatives of the deceased, including Maglioli and Farrell, recently won a legal ruling allowing the lawsuit to stay in state instead of federal court, said the families’ attorney, Daniel Marchese. Marchese said that is good for the plaintiffs, who can plead their case before a local jury instead of being referred to a federal compensation program set up through the PREP Act, which shields businesses from some forms of liability after natural disasters like Covid.
Maglioli said: "I think that these gentlemen, their corporation, whatever it is, needs to pay the price. And I don’t mean in a financial way."