On Monday morning, at a private nursing home in Queens, a registered nurse arrived for what she thought would be a job interview. She found more than a dozen prospective applicants, all of them responding to the same urgent, unsolicited text message from the Fairview Rehab & Nursing Home. They were whisked through a brief training session and hired on the spot.

The nurse leading the orientation, who’d started at the facility only three days earlier, explained that much of Fairview’s regular staff and management are out sick with COVID-19. There are more than forty residents for every nurse, she said, before asking who in the group could begin a double shift immediately.

The situation inside disturbed even battle-hardened medical professionals. According to multiple healthcare workers who spoke to Gothamist this week, a majority of the 200 residents at Fairview are suffering from acute pressure ulcers — gaping sores on their shoulders or elbows or pelvic bones, indicating they haven’t been turned over in days.

One nurse was so horrified by what she saw she began taking detailed notes of her shifts, which she shared with Gothamist. Her accounts, relayed here, were confirmed by multiple staff members at Fairview. (We’ve agreed to withhold the names of some of the healthcare workers, because they were not authorized to speak to the press.)

“They’re slumped over in bed, just laying there rotting,” said one nurse. Another staff member, reached by phone mid-shift, said she wasn’t sure who was in charge at Fairview anymore. “It’s crazy in here right now,” she said. “Everything you’re hearing is true.”

Left unsupervised, some of the new personnel roamed the five-story building, finding shortages of gloves, hand sanitizer, stethoscopes and, most concerningly, medication. When they can’t locate a certain pill, they’re told to note that a resident refused it, rather than record it as out of stock, according to two of the employees.

Tests for COVID-19 are hard to come by at nursing homes across New York, and while nurses say they were told of at least one positive patient at Fairview, it’s not clear who else may be infected. Many of Fairview’s residents are in need of medical care typically offered at hospitals, employees said.

Some nursing assistants, newly out of school and certified through an emergency federal waiver, are given high-level tasks. One of them is observed inserting a nasal oxygen cannula upside down. The potentially deadly error is caught in time, but not before sending the elderly resident into a gasping fit of hypoxia.

By the end of their first shift, multiple newly-hired workers had quit, citing fear of being named in an inevitable malpractice suit.

“I don't think anyone is going in there and getting better,” said one nurse. “They’re in there getting worse.”

Repeated inquires to Fairview were not returned.

“Like Fire Through Dry Grass”

The arrival of COVID-19 in a nursing facility, Governor Andrew Cuomo observed late last month, “can be like fire through dry grass.” In the days since, the number of confirmed cases in nursing homes has skyrocketed to more than 4,000. At least 1,231 residents have died from COVID-19, up from 86 recorded deaths from the virus just two weeks ago, according to state data. Nursing homes now account for more than 17 percent of all fatalities statewide.

Given the speed with which the virus can kill the elderly and immunocompromised, some of that growth may have been inevitable. But according to healthcare workers and watchdog groups, the combination of critical staffing shortages and bureaucratic neglect have greatly exacerbated the anguish and death inside New York’s nursing homes.

Even before the pandemic, chronic staffing shortages in New York’s 620 nursing homes were widely seen as a point of concern. The state-licensed facilities are almost entirely funded by Medicaid, meaning they typically pay nurses significantly less than hospitals.

A proposal unveiled by Cuomo last year to slash Medicaid spending by $2.5 billion forced many nursing homes to cut back on already depleted resources; despite the staggering economic toll of the pandemic, the governor says he still plans to go through with the cuts.

As nursing home operators have struggled to provide existing staff with necessary personal protective equipment, the workforce has withered in recent weeks, according to Stephen Hanse, president and CEO of the New York State Health Facilities Association and the New York State Center for Assisted Living.

A survey conducted by his organization found more than 100 downstate nursing homes in New York are having an “extremely difficult” or “impossible” time filling shifts with registered nurses and licensed practical nurses.

At the urging of Governor Cuomo and Mayor Bill de Blasio, tens of thousands of medical workers have volunteered to help ease the strain that COVID-19 has put on hospitals. The vast majority have not yet been put to work; it’s unclear whether any have been sent to nursing homes.

The dire staffing shortages come as many nursing homes are busier than ever. A directive from the state health department, issued over fierce objections from nursing home operators, now requires the facilities to accept patients discharged from hospitals, regardless of whether they have a suspected or confirmed COVID-19 diagnosis.

Mixing infected patients with those hyper-susceptible to the disease, while not ensuring the facilities are equipped with the necessary staff or protective equipment, is akin to a mass death sentence, according to advocates.

“As a result of not being prepared, we’re experiencing a whirlwind,” said Susan Dooha, the executive director at the Center for Independence of the Disabled in New York. “We’re going to have so many more people die than needed to.”

In an effort to increase bed capacity, the city has reopened a public hospital at the Roosevelt Island Medical Center, which shares a building with an acute nursing facility known as Coler. Though residents were initially told the new hospital would not include coronavirus patients, that assurance was later rescinded. A spokesperson for NYC Health + Hospitals, Chris Miller, said the patients are kept in separate areas with “no overlap.”

A resident at Coler, meanwhile, told Gothamist he believed cross contamination was responsible for the recent spread of cases inside the nursing home. He noted that his own nurses share an elevator and other parts of the facility with personnel treating COVID-19 patients. Members of the staff published a video last week pleading for N95 masks and other equipment.

“I feel like I’m trapped here,” said the patient, a parapalegic with breathing issues, who asked for anonymity because he feared retribution for speaking out. “This is a nursing home with real, vulnerable people where they’re spreading an outbreak.”

“You Should Take Them Out Right Now”

Major outbreaks have been reported inside nursing homes in Washington, California, Louisiana, Connecticut, and elsewhere. But unlike some of those other states, New York is not releasing the names or locations of the nursing homes where coronavirus cases and fatalities have been identified. Cuomo has cited privacy concerns, a justification that fellow lawmakers dispute.

“Each facility is a black box,” said Dooha. “We cannot get our arms around this right now if there’s no transparency and people can’t make appropriate decisions.”

The New York Department of Health is supposed to conduct unannounced inspections at nursing homes every 9 to 15 months. But those visits appear to have slowed or stopped entirely during the pandemic, according to Dooha.

An agency spokesperson told Gothamist that the health department is still investigating complaints, but would not say whether inspections were proceeding on schedule.

Absent official information about where the worst nursing home outbreaks are located, information has trickled out haphazardly. On Friday, City Councilmember Justin Brannan expressed shock at a report suggesting eight bodies were left unattended for days at a Crown Heights nursing home.

At one large Westchester nursing home, 25 patients have died in the span of a week, compared to an average or one or two before the pandemic, according to a nursing supervisor at the facility.

“They never stood a chance,” the healthcare worker told Gothamist. “If you have loved ones in a nursing home and have the capability to take care of them, you should take them out right now.”

That option is not available for many of New York’s more than 100,000 nursing home patients. With little time to make high-stakes decisions, even those who may be able to evacuate a loved one from an infected facility say they’ve been stymied by bureaucratic indifference and a series of maddening dead ends.

On Thursday morning, Jiayang Fan received a text message from a healthcare worker informing her that multiple cases of COVID-19 were detected at the Henry J. Carter Specialty Hospital and Nursing Facility, a long-term care ward run by the city’s public hospital system, where her 68-year-old mother has lived for six years.

Fan was already exploring options for removing her mother, who has ALS and diabetes, from the facility. When she called patient services on Thursday, Fan was told it would take weeks to arrange the necessary sign-offs and equipment, and that her mother was better off in the nursing home anyway.

“The hospital basically sabotaged my attempt to get my mother out,” she said. “They were very dismissive of my concerns.” Fan, a staff writer for The New Yorker, who has written previously about her mother’s nursing home, emphasized that blame rested with the administrators and city officials, not healthcare workers.

How do you quantify pain in ur mute mother's eyes? "Dont leave me alone at Henry Carter," she begged. "Don't let me die like this,Jiayang" Meanwhile Patient Relations telling me it'll take a month to get her out of facility bc bureaucracy. She cant survive even a day there alone. https://t.co/KTHNVB3lFB — Jiayang Fan (@JiayangFan) April 9, 2020

Adding to her anxiety, she soon learned that her mother’s live-in aide, who plays a critical role in her care, would have to evacuate the facility, due to a new policy banning private health aides. The worker was escorted from the facility by security guards on Thursday evening, as Fan’s mother sobbed uncontrollably into a video conference with her daughter.

A spokesperson for New York City’s public hospital system did not respond to a request for comment by press time.

“I don’t know if my mom will be alive tomorrow or if she’s choking on her own saliva,” Fan told Gothamist on Thursday evening. “It feels helpless.”