STATEN ISLAND, N.Y. -- The coronavirus (COVID-19) pandemic has wreaked havoc on nursing homes and adult care facilities throughout New York, with more than 3,500 deaths within the state as of Tuesday 125 of which were on Staten Island.

The stress of housing the boroughs most vulnerable population and the overflow of a strained health care system has caused concerns in multiple nursing homes across the Island, according to interviews with approximately a dozen health care workers and family members of residents.

In March, Dr. Ginny Mantello, the boroughs director of health and wellness, told the Advance/SILive.com that nursing homes were a critical piece in the puzzle to lessen the burden on hospital systems.

The least we can do is say the ones that are not critically ill and not in an ICU setting and not on a ventilator should be sent to the next step down level, Mantello said, which is not a triage tent, its not a building we stood up to take patients, its not a dormitory or a hotel its a nursing home."

That approach, according to Mantello, was executed and allowed hospitals to care for the most severe coronavirus patients throughout the height of the outbreak in the borough.

After weeks of extremely limited testing, Staten Islands 10 skilled nursing facilities, the Advance/SILive.com exclusively reported, will have all of its staff and residents tested in conjunction with a borough-wide partnership.

Mantello credits nursing home facilities across the Island for recognizing that keeping the coronavirus out of individual homes was an impossibility, and taking the the approach that it was the homes moral duty ... their obligation to the community, to the hospitals, to everybody, to be able to help decant these patients out of the hospitals in an effort to reduce hospital overload.

The extent of the role nursing homes played in reducing hospital capacity is becoming increasingly clear, with dozens of senior residents being discharged from hospitals to the care of the nursing home facilities in the borough.

Since the onset of the virus, Staten Island University Hospitals two campuses have discharged 105 COVID-19 positive patients to skilled nursing facilities across the Island. This total includes patients who were initially at the nursing homes.

The total number of coronavirus patients discharged from Richmond University Medical Center to nursing homes was not available.

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Life on lockdown: Coronavirus in NYC

STATE MANDATES

On March 25, the New York State Department of Health issued a directive that No resident shall be denied re-admission or admission to the NH (nursing home) solely based on a confirmed or suspected diagnosis of COVID-19.

During this global health emergency, all NHs must comply with the expedited receipt of residents returning from hospitals to NHs, said the directive.

The state Health Department did not provide the number of patients who were discharged from hospitals into nursing homes throughout New York by the time of publication.

On Thursday, Gov. Andrew Cuomo firmly referenced the states directive and said nursing homes are required to have enough personal protective equipment (PPE) for staff, isolate coronavirus positive residents, only re-admit positive coronavirus residents who can be cared for properly, and notify all residents and their family members if any resident tests positive or dies as a result of the virus.

Cuomo also announced that the states Health Department will be partnering with Attorney General Letitia James to investigate violations of the mandates, saying that facilities could be fined $10,000 per violation or even lose their operating licenses.

Beginning Thursday, nursing homes must immediately report all actions they have taken to comply with state Health Department and Centers for Disease Control and Prevention (CDC) directives. The New York State Department of Health will investigate those who have not complied with those guidelines.

Photo shows the entrance to the Carmel Richmond Healthcare and Rehabilitation Center in Dongan Hills on Friday, April 17, 2020. (Staten Island Advance/ Paul Liotta)

NURSING HOMES PERFORMED VALIANT EFFORT

In addition to re-admitted patients deemed stable by hospitals, some of the boroughs largest nursing homes, including Carmel Richmond Health Care and Rehabilitation Center, in Dongan Hills, and Eger Health Care and Rehabilitation Center, in Egbertville, have taken coronavirus patients who were not previously residents.

Carmel Richmond has admitted a total of 19 COVID-19-positive patients from the hospital as of April 22, as required by the state, according to Jon Goldberg, a spokesman for the Archdiocese, which runs the facility. As of last Friday, Eger Health Care and Rehabilitation Center had admitted the same amount, with more expected.

As ArchCare noted in its statement last Friday, the number of deaths by facility released by the state on Friday dont distinguish between infections that may have originated in a particular nursing home and those that were introduced to the nursing home by already-infected patients coming from the hospital, Goldberg said.

The statement came after a New York state survey determined at least 44 people died as a result of the coronavirus at the Dongan Hills nursing home. It was the only Staten Island nursing home on the list, which included any nursing home with more than five reported deaths.

However, Borough President James Oddo, who has called for more action to protect nursing homes, said in an interview with the Advance that hes worried that the list could paint an inaccurate portrait of how the virus is affecting the states most vulnerable.

I dont think that number, in a vacuum, and having Carmel Richmond alone on that list, is fair to those heroes that work in that facility and run that facility and are doing their very best under circumstances that they did not create, said Oddo, who added that he had only positive experiences when his loved ones were in that nursing home.

That sentiment is furthered, as some nursing homes including New Broadview Manor in South Beach have received no patients from hospitals during the pandemic, the facility said.

Without additional context, the number of Covid-related deaths in a given nursing home is a misleading statistic,'' the ArchCare statement said last week. "On their own, these figures do not accurately reflect the overall quality of care a facility provides or its diligence in trying to control the infection.

New York City announced on Thursday that it would surge supplies and staff to nursing homes across the city, including multiple borough homes.

Mantello, despite the lack of testing and PPE available, said the efforts performed by nursing homes throughout Staten Island was very valiant, to say the least."

Our nursing home partners stepping up was very brave on their part, she said, adding that the facilities were forced to stretch themselves to the limit in order to help overall hospital capacity in light of earlier projections, which forecasted long-term overflow at hospitals across the city.

Mayor Bill de Blasio delivered supplies to Richmond University Medical Center today along side him were Borough President James Oddo, Councilwoman Debi Rose and Assemblymember Charles Fall. April 20,2020. (Staten Island Advance/Jan Somma-Hammel)

OUR RESPONSIBILITY

Regardless of the new patients admitted into nursing home facilities from hospitals, borough senior living centers reported positive coronavirus cases even before the state mandate as a variety of factors, including staff with limited PPE, could cause the virus to transmit easily.

It doesnt matter if a nursing home has 20 patients or 30 from a hospital that are COVID positive -- remember, they have staff going in and out daily, said Mantello.

(COVID-19) is in every nursing home, an ArchCare spokesman said previously. Theres absolutely no way to contain it, no matter how hard they try."

Concerns about the availability of testing within nursing homes and adequate PPE have been strongly aired by facilities, officials and health care workers alike.

In an interview with the New York Times, Scott LaRue, the president of ArchCare, said: I cant test, I dont have PPE .. What am I supposed to do?

Testing for the coronavirus at individual nursing homes has been an impossibility so far, effectively handcuffing the facilities, and with larger hospital systems such as Northwell Health fighting for PPE, smaller institutions like skilled nursing facilities were left in a somewhat untenable position, Oddo said.

In the face of criticism against nursing homes and how individual facilities handled the outbreak, Oddo said: If youre going to be angry at someone, be angry at us. Be angry at us in government.

In a crisis to this degree, individual hospitals, individual hospital systems, individual skilled nursing facilities they have a responsibility, but ultimately the only entity out there that could provide the answer to the problem was government, and we didnt, because there are nurses and aides walking through skilled nursing facilities without the proper PPE, Oddo said.

A sign on Manor Road gives strength to Staten Islanders. Wednesday, April 8, 2020. (Staten Island Advance/ Jan Somma-Hammel)

PERSPECTIVE FROM THE FRONT LINE

A nurse in a Staten Island nursing home, who answered emailed questions from the Advance/SILive.com from her hospital bed in Staten Island University Hospital in Ocean Breeze, said the coronavirus continues to take a heavy toll on the health care workers in the boroughs senior facilities.

After attending to 47 patients during a single shift on April 2, the woman said she began to feel body aches, chills and headaches. The next day, the woman said she called her sister-in-law to take her 10-month-old baby in fear she could infect her child.

After heading to a City MD, a chest X-ray confirmed pneumonia, though the facility did not have enough capacity to test for the coronavirus at the time. After receiving antibiotics, her chest pain progressed and her fever rose before she was taken to RUMC.

Within days, she returned home, but ended up calling the state Health Department to have a coronavirus test conducted and was swabbed the next day at 11 a.m.

Her condition continued to stagger, with her oxygen dropping to dangerous levels. Family and friends were checking on me, urging me to go back to the hospital, she said.

After days of pain and struggling to breathe, I rushed to SIUH ER Friday April 10 around 4:30 a.m. and was admitted for hypoxia -- low oxygen, the woman said.

Days later, the woman was discharged; however, she said she felt a lack of proper PPE contributed to my illness.

We were being told to use one surgical mask during our shift,'' she said. "I was one nurse for 40-50 almost every night at work.

This photo provided by U.S. Centers for Disease Control and Prevention shows CDCs laboratory test kit for the new coronavirus. (CDC via AP) APAP

A CORONAVIRUS TRAGEDY

The reality within nursing homes for some families despite what some officials say has been concerted efforts to handle the pandemic proactively has been bleak.

For one woman, whose 89-year-old mother was a long-term resident of Carmel Richmond, the coronavirus situation in the facility accelerated rapidly.

Early in March, the woman said she noticed visiting protocols being changed at the nursing home. A week later, visitors were not allowed in the nursing home.

The following week, she was told patients had tested positive for the coronavirus but that her mother was not symptomatic. Then I was called and told that she had a fever, but she didnt have the virus, she said.

Just days later, she was told her mother had the coronavirus and was dehydrated. That was on Sunday, and then Monday night they called me and told me she died," she said.

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How Staten Island nursing homes stepped up to face hospital coronavirus overflow - SILive.com