Back in March, a coronavirus outbreak at St. Joseph's Senior Home in Woodbridge, N.J., led state officials to evacuate all 78 of its residents. Within weeks, nearly half of them were dead.



Last March, as the coronavirus pandemic was just starting to make its way through the United States, officials in New Jersey learned of a COVID-19 outbreak in a long-term care facility, and they did something unusual. They decided to evacuate 78 of its residents and move them someplace new. Three weeks later, nearly half of the people they transferred were dead. An NPR investigation by Dina Temple-Raston looks at how that happened.

DINA TEMPLE-RASTON, BYLINE: The evacuation of St. Joseph's began early on March 25.


UNIDENTIFIED REPORTER #1: Medical personnel in protective gear were busy Wednesday morning willing out nearly 80 residents who live at St. Joseph's Senior Nursing Home in Woodbridge.

TEMPLE-RASTON: Eva Kucaba watched it all from a parking lot across the street.

EVA KUCABA: There were, you know, the large ambulance buses, helicopters overhead. There were yellow hazmat suits with, you know, the face shields.

TEMPLE-RASTON: She saw these figures in yellow hazmat suits slowly moving dozens of elderly residents into waiting ambulance buses. Kucaba was there watching for her mother, Ann Gentile, and she didn't actually see her until later on the evening news.


UNIDENTIFIED REPORTER #2: ...Residents who are in their late 80s and early 90s...

KUCABA: Her hand was on her forehead, like, her fingers spread. And, you know, you can interpret it as, oh, my God, what's happening? Where are we going? What's this all about? I mean, that picture tells a thousand words.


UNIDENTIFIED REPORTER #2: And now this place is blocked off by law enforcement, waiting to be sanitized and disinfected.

TEMPLE-RASTON: This was a complete departure from the St. Joseph's, the St. Joe's, that everyone knew.


UNIDENTIFIED PERSON #1: The Saint Joseph's Senior Home Assisted Living and Nursing Center has been operated by the Little Servant Sisters of the Immaculate Conception since 1981.

TEMPLE-RASTON: That day, Saint Joseph's became known for something else. It became the only long-term care facility in New Jersey to be evacuated in its entirety during the COVID crisis. And this story is important because it pulls back the curtain on the panic that drove decisions during the earliest days of the pandemic.

Ninety-three-year-old Annette Kociolek was eating Polish doughnuts with her eldest daughter, Bernadette.

BERNADETTE SOHLER: Her little raspberry jellies, which she loved.

TEMPLE-RASTON: Annette's friends called her Toni, and they say she'd love lots of things - brooches, beads, barrettes. And she loved St. Joe's - the daily masses, the gardens, the fact that the nuns spoke Polish to her.

SOHLER: And we just thought it was a really good fit.

TEMPLE-RASTON: Bernadette Sohler said her mother may have been 93, but she was still the Toni everyone knew.

SOHLER: You know, whenever I'd walk through the door, she'd always say, Bernie (ph), and make a big deal - and this is my daughter - to all of the workers there. So, you know, little did we know, two weeks later, everything would change.

TEMPLE-RASTON: What changed was COVID-19.

SOHLER: On the 17th was the first day that we were notified by St. Joe's that one patient had contracted the virus.

TEMPLE-RASTON: The 17th of March, in the earliest weeks of the pandemic.

SOHLER: It just happened so, so very fast - you know, from when there were sniffles to when one person had it, six people had it...

TEMPLE-RASTON: And then her mother had it, though she didn't seem to be showing many symptoms.

SOHLER: Once again, in my mind, my mom is resilient, strong as a bull. And, you know, even though she was in a wheelchair, she was a fighter.

TEMPLE-RASTON: The staff at St. Joe's did what they were supposed to do. They quarantined, they called in reinforcements, and they asked the state if it would help, too. Just four days later, the state's response was harsh. It ordered an evacuation. The state wanted the entire facility to be completely emptied, which is a bigger deal than it might sound.

CHRISTOPHER NEUWIRTH: When you evacuate a facility, you're moving residents who are medically fragile. And any time you transfer them into unfamiliar environments, places a lot of, you know, stress on the individuals and can jeopardize their health and safety.

TEMPLE-RASTON: That's Christopher Neuwirth, and he's a former New Jersey Health Department assistant commissioner in charge of emergency preparedness. And when he first heard about St. Joe's, he remembers thinking two things. First, why was the state involved? Evacuations are usually handled locally. And second, that the whole operation, which involved transferring the residents to a new facility, CareOne Hanover, it all seemed oddly rushed.

NEUWIRTH: You know, this wasn't a flood or a fire where they had to evacuate within a matter of minutes or hours.

TEMPLE-RASTON: Neuwirth no longer works for the state because, he says, he filed an ethics complaint against a high-ranking official and was fired. He has since filed a whistleblower complaint, and the suit is pending. But he isn't alone in thinking that the evacuation of St. Joe's was problematic. It wasn't just the push to move everybody out quickly. It was the stress that such a move would put on the residents of St. Joe's. Just ask Pamela Cacchione. She studies older adult care at the University of Pennsylvania School of Nursing, and she says evacuations like this are rare for a reason.

PAMELA CACCHIONE: The literature shows that these acute evacuations are very dangerous for older adults.

TEMPLE-RASTON: But according to three current and former health department officials who were there when the evacuation was discussed, the trauma associated with this kind of a wholesale move didn't seem to figure into the state's calculus. They said leaders at the Department of Health seemed to be reacting to the outbreak as if it were a natural disaster, as if an evacuation was the only viable option. A health department spokesperson told NPR that just wasn't true. In a written response, she said that the state spent two days trying to find reinforcements for St. Joe's - two days. As far as the New Jersey Department of Health was concerned, that was long enough.

During a press conference, the state's health commissioner, Judy Persichilli, said the outbreak at St. Joe's couldn't wait.


JUDY PERSICHILLI: More residents and staff are symptomatic, so we made the assumption that residents and staff of St. Joseph's had all been exposed to COVID-19.

TEMPLE-RASTON: But the thing was, we don't know if they'd all been exposed. The health department claims they confirmed two-dozen residents had tested positive before the evacuation. But according to contemporaneous emails at the time, families understood the number was half that much, about a dozen, a dozen out of 78. So the real problem wasn't how many people had the virus. The problem St. Joe's was facing was more fundamental. The nuns needed some temporary help just to tide them over. The nuns asked for out-of-state nurses or for the deployment of the National Guard, but what they got instead was this evacuation. And in case there was any resistance to the idea of letting all their residents go, there was also what some saw as a thinly veiled threat from the New Jersey commissioner of health.


PERSICHILLI: This may result, unfortunately and ultimately, in the closure of that facility.

TEMPLE-RASTON: Persichilli said later, the sisters at St. Joe's asked for the residents to be moved. And while the sisters declined to talk to NPR about the evacuation, the families say the nuns told them at the time that the evacuation came as a complete surprise. They only had 12 hours' notice.

There's another reason why the state's decision to evacuate everyone at St. Joe's all at once was puzzling. Even in the best of circumstances, these kinds of large transfers are fraught. People get lost in the shuffle. Meds get missed. There's no continuity of care. And in this case, the residents of St. Joe's would arrive at CareOne all at once as strangers. Just consider Toni Kociolek. Her middle daughter, Dorothy Cassaro, worried people at CareOne would just see her mother how she was when she arrived after that bus ride from St. Joe's.

DOROTHY CASSARO: She was going to be presented on a stretcher. She's going to look weak and feeble. And I guess I felt that there would be judgments made.

TEMPLE-RASTON: As soon as her mother was admitted, a doctor at CareOne recommended that she be put into hospice, essentially compassionate care for people in those last stages of life.

CASSARO: She was admitted on Wednesday, and I believe it was Saturday she went into hospice.

TEMPLE-RASTON: Cassaro wanted the nurse to take her mother's vitals so she could figure out how much time her mother might have left.

CASSARO: And I guess the nurses station was kind of busy, so she makes a comment saying, oh, they're really busy here. And I said, OK, well, that's OK. Why don't you go in, we'll do this FaceTime call, and then you can catch me up on the vitals afterwards?

TEMPLE-RASTON: So the nurse went in with the phone.

CASSARO: She's very cheery, and she has my mother on FaceTime. I'm like, hey, ma, how are you doing? Oh, I said, you don't look any worse for wear today, or I say something to her.

TEMPLE-RASTON: But the FaceTime camera was only showing her from the nose up.

CASSARO: So I said, can you do me a favor and move the camera down? And she moves the camera down. And I was like, oh, because it was, to me, what I would refer to as the death gape.

TEMPLE-RASTON: CareOne denies this ever happened, but Cassaro has a time-stamped screenshot, and NPR has seen it. Moments after she took it, another nurse walked into the room off camera. Cassaro could only hear her voice.

CASSARO: And she goes, oh, yeah, no, your mother's near the end. She gone. And I said, she's gone right now? She goes, oh, yeah, yeah, she's gone.

TEMPLE-RASTON: The nurse turned the camera on herself and told Cassaro, I'm sorry for your loss. And then the line went dead. The mother who loved brooches, beads and barrettes died at CareOne Hanover on March 30, five days after the evacuation.

CASSARO: I know that the day before the evacuation, my mother was still vocal. My mother was still coherent.

TEMPLE-RASTON: And now she was gone.

There's something else a little odd about the whole St. Joe's affair and its administrative. All 36 of St. Joe's residents who died after the move are listed as having died at St. Joe's, not CareOne. The New Jersey Health Department told NPR in a statement that during outbreaks, deaths are counted based on the association with an outbreak facility, not the actual location of the individual's death. What that presupposes, though, is that no one got the virus at CareOne after the transfer. For Kociolek's youngest daughter Angie, all of this was more than she could take.

ANGIE KOCIOLEK: (Crying) And my mom was 93. It's realistic to think that she probably wouldn't have lived more than a few more years. I get that. But she wasn't able to die with dignity and comfort. That's the thing that hurts the most.

TEMPLE-RASTON: And remember Eva Kucaba, that woman who watched the evacuation from across the street? She lost her mother, too, and she believes the stress of the move, which she saw on her mother's face in that evening news footage, contributed to her death. Kucaba's mother tested positive for the coronavirus five days after her arrival at CareOne. She was dead two days after that. Whether Ann Gentile caught the virus at St. Joe's or at CareOne is unclear. For Kucaba, who's a nurse, the more fundamental problem was the state's decision to evacuate St. Joe's in the first place.

KUCABA: No other facility was ever evacuated after that, and I'm sure they realized what a mistake that was because if it wasn't a mistake, they would have done it with other facilities, and it wasn't done.

TEMPLE-RASTON: Last November, there was a surprise party for Ann Gentile at St. Joe's.

KUCABA: She was singing, dancing full of life.

TEMPLE-RASTON: In a video, Kucaba's mother was wearing a pretty sweater, and there were balloons and cupcakes.


TEMPLE-RASTON: Ma, sing your song.

UNIDENTIFIED PERSON #2: Come on. That was good.


TEMPLE-RASTON: And everybody was trying to get her to sing.

KUCABA: My mom used to sing on the radio. She would be on every - I think every Saturday.


ANN GENTILE: (Singing in non-English language).

Wait, I'm...


TEMPLE-RASTON: Gentille would have been 90 in November. Dina Temple-Raston, NPR News.

(SOUNDBITE OF RIOPY'S "LE REVE") Transcript provided by NPR, Copyright NPR.