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When COVID-19 hits home

Photo: Debbie Boniface and her father Larry Canovali on his 90th birthday in January.

Cloistered like dormmates, the five elderly men who died of COVID-19 over a 10-day span in April lived in the memory care wing at HarborChase, the assisted living facility that was the first in the county to see cases.

And in the way college dorms draw different people together, the five came from diverse backgrounds. With histories pieced together from the raw data of medical examiner reports and the poignant details of obituaries, the group that COVID-19 felled at HarborChase turns out to have been an extraordinary bunch.

A man who worked on a mission to the moon. An engineer in the pulp industry. A top Wall Street executive. A public school system administrator.

One man was born in Gifford. Another was born in the Bronx to immigrants and didn’t learn English until he started first grade. One man excelled at painting; another was always dancing. Still another sang in a barbershop quartet.

One had a marriage that lasted three-quarters of a century. Another was a widower who had found a new girlfriend.

Scattered around this county and in counties far away are families, friends, co-workers, church-goers, civic leaders, club members, all who remember the men for reasons having nothing to do with a virus. But their loss will always be framed by COVID-19, the global grief of the pandemic and the mysteries it spawned.

HarborChase is considered among the nicer elder care facilities in Vero. It is not alone in its anguish over COVID-19.

As of Monday, two nursing homes and three assisted living facilities in Indian River County were all dealing with infections. So far, none apart from HarborChase has lost any lives to the disease. Though the elder care homes share in an industry-wide anxiety, none experienced anything like the serial tragedy at HarborChase. Five deaths in ten days.

“This pandemic affects our clients more than anybody else,” said David Dodson, vice-president of sales and marketing for HarborChase’s parent company, HRA. The company, headquartered in downtown Vero, also owns the independent living facility Regency Park, located on the same campus as HarborChase. The Vero project opened in 2007.

HRA was founded in 2002 by Tim Smick and Dan Simmons, who worked together in Orlando before moving to Vero. HRA operates more than 35 facilities in eight states, and according to its website it is actively expanding. The company manages revenues of $150 million and $1 billion in assets. 

For HRA, the toll of COVID-19 could well be financial. With 2,500 employees – some certainly on the front lines of the disease – the consequences could be as frightening for the company as it is for the residents it serves.

“This is an insidious virus and despite all our best precautions in these communities – being very conscientious and doing the right thing – sometimes it just can’t be avoided,” said Dodson. “It’s getting in despite extremely proactive preventions.”

In Broward County, HarborChase of Tamarac informed families of residents by robocall of its first COVID-19 case April 2, according to the local ABC-TV affiliate. The memory-care facility there houses 106 patients. As of last weekend, HarborChase of Tamarac was reporting six deaths and a total of 20 cases.

HarborChase’s first positive case in Vero showed up in state records April 7.

Its residents and families learned by robocall or voice call the next day that the positive was a staff person.  Within two days, though, there were three cases – and two were residents. By April 23, five residents had died.

As the shock set in, the numbers seemed to stabilize. Health Department tracing appeared to have successfully contained the outbreak to the memory care wing, though one more caregiver would test positive.

Then late last week, HarborChase of Vero, with 75 residents, appeared to be losing its grip on COVID-19 again, with its tally jumping from seven to nine.

That was in contrast to a spokesman’s insistence the week before that “between HarborChase and Regency Park” only one resident was still testing positive for COVID-19. That resident had tested positive April 10, the spokesman, Dan Ellis, added. The resident was “on droplet precautions in their community and will be tested again May 18.”

The most recent report was showing two residents in the building testing positive, not one. It showed six having transferred out of the building, a number that would include the five deaths plus any hospitalizations. And it showed the positive staffer.

HarborChase did not respond when asked if any cases were outside of the memory care unit.

Ellis, HRA’s communications director who came on the job in April, said an associate that had tested positive at Regency Park had made a full recovery.

“Statistically, it is evident that our protocols which we have implemented are working,” he said.

During those painful days in April, when coronavirus was spreading through the Vero Beach memory care unit, the same robocall notification method used at the Tamarac facility was employed here to spread the word. 

Not all the families got the calls, or listened to them. HarborChase uses robocalls – they call them by the system’s brand name, Call-’em-all – routinely to inform families about events and activities.

One resident’s daughter, Debbie Boniface, did pick up the robocall on April 8, never expecting to hear news of COVID-19.

The carefully worded message recorded by HarborChase manager Gloria Tausch lasted two full minutes, all of it concerning COVID-19 preparations except for a few brief sentences, a quarter of the way in. A staff person had tested positive and was hospitalized.

It’s not known how many family members got the robocall, or how many bothered to listen to it if they did.

Boniface, whose father was in memory care and later died, said the upbeat tone of the call made her feel the outbreak was being downplayed.

HarborChase denied that. Dodson also said there were families who were called individually by the facility manager.

“We’re working very hard as an industry to help people,” he said.  “This is more than just a business for us. People in our industry come to it from a place of having been called to it – something in our background, or something in our hearts. We care for these people, we love these people and want to lift them up.”

Over weeks of inquiries by Vero Beach 32963, beginning on Easter Sunday when Dodson dodged a reporter’s questions by saying he was running into a church service, Dodson never explained how COVID-19 first began at HarborChase.

Over the nine days following Easter, as daily state reports showed cases climbing in an unnamed senior care facility in Indian River County, multiple HRA and HarborChase executives did not respond to phone or email messages.

Dodson finally got in touch on the day a Vero Beach 32963 story was going to press about a family member of someone in the assisted living wing who said she had only learned of COVID-19 cases at HarborChase through an outside caregiver, not from management.

He said HarborChase manager Tausch had personally called families in memory care about the first case, but Boniface never got one. Tausch then followed up as more cases arose, and a  robocall was sent to families of residents in assisted living. Both are wings in the same building.

Dodson made no mention of whether notification calls went out facility-wide when there were deaths by COVID-19. By then, three men had died of the virus; a fourth would die that night, the fifth three days later.

Though the first case of the virus at HarborChase was said on the robocall to involve an “associate” – the term the company uses to mean employees, Dodson and Ellis did not respond to the question of whether that staff person was the same as the one who tested positive at Regency Park.

That three-story structure of independent living apartments is also home to older, vulnerable people. But unlike assisted living and nursing home facilities, independent living communities are not required to publicly report their COVID-19 cases.

Yet, there is a way that COVID-19 infections there could show up on a state report. If Regency Park and HarborChase share common staff, vendors or even visitors, were they to become infected, they could show up on the HarborChase report. That would be determined through the work of the Health Department’s epidemiologists.

Why Dodson and the others would want to keep the origin of the outbreak secret has never been explained.

Five days after the initial robocall went out, on April 13, the man who would become the county’s first long-term care facility resident to die of COVID-19 was taken from HarborChase to Cleveland Clinic Indian River’s emergency room.

According to the medical examiner’s report, the man was experiencing “worsening shortness of breath.” He also had a fever and a chest X-ray was abnormal. With signs of acute hypoxic respiratory failure, over the course of the Easter weekend, his condition worsened. He died two days after leaving HarborChase.

On Easter Sunday, another HarborChase memory care resident had been taken to Cleveland Clinic. That second man was Larry Canovali; his daughter, Debbie Boniface, had been frantically trying to get him tested for the bad cough he had since before the robocall about the positive case.

From the first, Boniface wondered if it was COVID-19. But nobody at HarborChase seemed to agree. Though they said they were checking his temperature three times a day, they said he didn’t have fever. When Canovali finally went to the hospital, he had a temperature of 104 degrees and double pneumonia. He died six days later.

Another man from HarborChase memory care died the same day, April 18, at Lawnwood Regional Medical Center. The fourth man died April 20. The fifth died April 23.

For all five, despite their various illnesses and complications, the medical examiner determined the cause of death to be COVID-19.

Until the facility went on lockdown March 15, the men ate their meals together at HarborChase, typically with three or four sitting at the same table. The same staff took care of them, moving from room to room during the lockdown. After lockdown, HarborChase says the staff all wore PPE, including masks and gloves.

“We stopped congregate dining and started in-room meals, brought therapeutic services to residents’ suites, and discontinued the use of communal amenities,” HarborChase said in a statement, adding, “We continue to pioneer life enrichment initiatives that are unparalleled in their service.”

It wasn’t clear from the statement what those life enrichment initiatives might be.

When COVID-19 came into the building, the Health Department quarantined private duty nursing aides – who assist some residents – with their assigned residents. That included the aide for Canovali. When Canovali finally went to the hospital April 12 after more than a week of coughing, one of his private aides had already stopped coming to work. She blamed her weakness on exhaustion. It turned out she had COVID-19.

Boniface still gets calls from both aides. She grew to adore them and felt they truly loved her father. Boniface, who is married, lost her mom seven years ago. She was an only child, so there was never any debate over who would take care of her father should he ever age out of independence.

It took a long time. Well into his late 80s, Larry Canovali maintained a four-bedroom home, handled his finances, and drove himself around. He had even found a girlfriend, and they were dating on weekends. A retired electrical engineer, he was handsome, quick-witted, charming and full of fun.

But as he approached 90, his perceptions weren’t always corresponding with reality. His choices began to be unsafe. In March of last year, his daughter persuaded him to give up his car and move into an apartment in Regency Park. Boniface found someone to help with the cooking and a nurse’s aide helped with his medications. But within a couple of months, it became obvious that the help was not enough.

Last July, Canovali moved into the memory care wing at HarborChase.

Even there, Boniface felt her dad needed extra help. She found two full-time aides through Coastal Concierge Services, a home health referral service that runs what it calls a wellness center in Regency Park.

Coastal Concierge owner Eileen O’Donnell, who once worked with HRA, calls HarborChase “over the moon fabulous,” but agreed that Canovali still needed care beyond the staff HarborChase provided. She connected Boniface to two aides. One worked days, the other nights.

“They were wonderful,” Boniface said. “They knew everything that was going on with my dad and they told me everything.”

When Boniface dropped by HarborChase on a Saturday evening in mid-March – she wanted to come when she could talk with her night-shift aide –  the aide told her the lockdown was coming the next day.

“Oh my gosh, I can’t believe they didn’t call and tell me,” Boniface said.  In fact, she got the call from HarborChase the next day, March 15, after visitors were already banned.

That evening visit to her dad would become momentous.

“I brought him peaches,” she recalled. “That’s my last memory of him. He was so happy. He loved those peaches.”

A couple of weeks into the lockdown, Canovali developed a bad cough. “I could hear it over the phone,” said his daughter, who was prohibited from visiting him, even though his private aides were saying he was getting weaker and weaker.

“Do you think it could be COVID-19?” she asked one of the staff nurses. The nurse dismissed it, Boniface said, saying he didn’t have a fever.

“The cough was so bad. My father was sick, and sick, and sick. When my father was well, he walked everywhere. He went out with his caregiver, he went out with us. He was as active as could be. And now it took three people to get him to the bathroom. And they won’t test him because he doesn’t have a fever?”

At some point in her daily calls, HarborChase knew what Boniface did not. COVID-19 was suspected in a staff member who had already been tested; they were awaiting results.

Late in the evening of April 8, Boniface got the robocall from HarborChase. Thirty seconds in, manager Tausch got to the point: The staff person tested positive and was hospitalized. Yet Tausch’s voice stayed upbeat, explaining for another minute and a half the precautions being taken. “We continue to monitor all of our residents and associates vigilantly,” Tausch said on the recording.  They had been informed the associate was doing well.

“The associate is doing well?” repeated Boniface. “Like, in a happy voice, really? How would you feel if you got a robocall at 8:30 at night telling you an associate has tested positive and is in the hospital, and you’ve got a loved one in the facility?”

Boniface called Tausch’s number directly three times. Three times, she left messages. They were not returned, she said.

Finally she reached a nurse. She asked who the associate was and whether there had been contact with her father.

“I can’t tell you for legal reasons,” the nurse replied.

Tausch, in her recorded call, asked for understanding if future messages seemed repetitive. “It simply means things are stable and we have nothing new to report. Rest assured that if there is anything specific regarding your loved one, we will contact you individually to discuss it.”

Sadly, there would be a great deal of news to report in the ensuing weeks, with five residents dying of COVID-19 in quick succession.

If there were further calls about COVID-19, Boniface never got them. After the one about the associate testing positive, the only calls she got were festive. One she calls “the hoppy bunny call,” informing family that on Easter Sunday someone dressed as an Easter Bunny would be hopping around the facility passing out candy.

Then came a call on the Friday before Easter, this time, from her father’s caregiver. “Did you know that the Health Department came in and tested your father?” she said.

She did not know.

“Nobody called me,” said Boniface later. “I’m his power of attorney. I’m everything. And nobody called me.”

The Health Department had come through the memory care wing. The caregiver told her they had quarantined her in the same room with Canovali; three other residents were also quarantined.

Boniface called the nurse again and demanded to know what was going on with her father. According to Boniface, she seemed to downplay it. “They just tested him because he has flu-like symptoms.”

Canovali missed the hopping bunny. On the morning of Easter Sunday, he was finally taken to the hospital. An alert nurse had made the call. “I took one look and thought, this is not the Larry I know,” she told Boniface by phone.

Frantically, Boniface called Cleveland Clinic Indian River. She reached the physician overseeing her dad’s care. He told her he was treating him as if he were a COVID-19 patient.

“Did you know that he’s been tested already?” Boniface asked.

“No,” the doctor replied. “But that’s good to know.”

Somehow, that information hadn’t made it to the hospital with her father. Boniface couldn’t believe it.

Moments later, Tausch was calling Boniface.

“Why didn’t you return my calls?” Boniface  asked. “How come my dad was tested and nobody told me?”

“Well, that’s what I’m calling about,” Tausch said. “Your father tested positive for COVID-19.”

The next call from Tausch was a robocall, this time announcing it was costume week. All the staff would be dressing up to a different theme each day.

Boniface was incredulous.

“I thought, are you really out of your mind sending this to people?” she said. “There’s a pandemic. People are going to the hospital with COVID-19, and you’re sending this ridiculous robocall?

“I really felt they were trying to act like this wasn’t happening,” said Boniface. “HarborChase was supposed to be the best. They did not want COVID-19 to get in. This is how I felt when all this was going down: They’re trying to keep this quiet.”

Her father spent six days in the hospital. He died on the Saturday after Easter, more than two weeks after the onset of his cough. Boniface wonders if treatment might have worked had they caught COVID-19 earlier, when she first suspected it.

Following Canovali’s death, HarborChase sent Boniface a plant, she said. Coastal Care, the private nursing aide service, sent a message of sympathy that struck Boniface as “really heartfelt.”

And the aides that Coastal Care had recommended for her father were particularly kind. “They really loved my father,” said Boniface.

His daytime aide was tested by the St. Lucie County Health Department and was told to isolate at home. According to Boniface, the other aide was never tested – she had no symptoms, the health department told her. She too isolated at home.  

Boniface, who believes both aides had families in the house where they were isolating, begged her to make up symptoms in order to get a COVID-19 test. But the aide, a woman from Haiti who was deeply religious, told Boniface she could never lie.  She did not get sick, nor did her family members. The other aide has recovered, Boniface says.

The five deaths at HarborChase of Vero and  the six deaths at HarborChase of Tamarac, a memory care center in Broward County, place the two facilities near the top of Florida’s 600 facilities that the state is keeping an eye on.

As of May 15, there have been an estimated 875 deaths in Florida’s nursing homes and assisted living facilities from COVID-19. That's 43 percent of the state’s 1,997 deaths.

In Vero, four other facilities are reporting cases but no deaths as of Monday. Renaissance, an assisted living facility and memory care center, has one staff member testing positive. Palm Garden of Vero, a nursing home, had at one point four cases but they were reduced to only two cases, and both had transferred out of the facility. Another nursing home appeared with one case Saturday but that case disappeared the next day.

Sonata, an assisted living facility that has proactively tested its residents and staff, said late Monday that all its positive cases – four staff and one resident, are now testing negative. All five were asymptomatic when they were first tested.

According to Sonata spokeswoman Beth Dutton, on a call to elder care facility operators late Monday, Florida’s Agency for Health Care Administration announced it is now requiring all assisted living facilities to test all residents and staff for COVID-19.