MILAN — The last time Renato Lambranzi saw his mother was in late February, the day her nursing home closed its doors to visitors in response to a growing number of coronavirus cases in the area.
Not allowed to visit, he called Palazzo Don Gnocchi, a well-known nursing home in Milan, every evening to ask about his mother’s health. When he thinks back on those conversations now, he says it sounded like staff were reading from a script. “Your mother is fine, she’s eating, don’t worry,” the person on the other side of the line would reassure him night after night.
It wasn’t long before he got the call he feared: His mother, Isabella Valentini, had had a respiratory crisis during the night; they gave her oxygen but she didn’t make it. She was 90 years old. “I immediately asked what she had died of,” Lambranzi said. “They answered they didn’t know yet, but that was a lie.”
He found out the real cause of her death at the funeral home. On the phone to the nursing home, the undertaker asked whether it was a case of COVID-19. “Of course,” they replied.
Since the start of the outbreak, thousands of senior citizens in Italy and across Europe have succumbed to the virus in nursing homes, which have become hotbeds of the epidemic.
Nursing homes are “perfect places for the proliferation of the virus,” Filippo Anelli, president of the National Medical Association, said.
A report by academics based at the London School of Economics found that in Italy, France, Ireland, Spain and Belgium between 42 percent and 57 percent of deaths from the virus have taken place in nursing homes. In the U.K., care homes have warned that the virus is likely already running rampant in more than half of the country’s facilities and that government figures likely vastly underestimate the number of fatalities. Half of all European COVID-19-related deaths have occurred among residents in nursing homes, according the WHO’s regional director for Europe, Hans Kluge.
In Italy, people are calling it “the silent massacre.” As the losses multiply, no one is keeping tabs on the number of cases, not even among staff. In Milan, at least 20 families have made allegations against Don Gnocchi, claiming the nursing home mishandled the epidemic, lawyer Romolo Reboa told POLITICO. Another well-known nursing home, Pio Albergo Trivulzio, is also facing similar allegations, following an investigation by Italian newspaper La Repubblica, which found that at least 190 of its residents have died since the beginning on March.
Of the three other other elderly women in the room with Lambranzi’s mother, two are dead and one has tested positive for the virus. He has no idea how she is doing, he said.
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Nursing homes are “perfect places for the proliferation of the virus,” Filippo Anelli, president of the National Medical Association, said in an interview over the phone. “No test swabs were done, dozens of workers who were not given proper protection fell ill, becoming carriers of the disease, and confirmed cases were not isolated soon enough.”
Exact figures on the number of people who have died of COVID-19 in Italy’s nursing homes are extremely hard to come by, partly because there is no centralized system to record them, unlike in hospitals. A recent national survey carried out by Italian authorities suggested that 8.4 percent of nursing home residents have died since the beginning of the outbreak.
At Don Gnocchi, more than 140 of the nursing home’s 600 residents have died since the start of the outbreak, said Andrea Mastragostino, a health worker at the nursing home.
Mastragostino has been home since he fell ill with COVID-19 in mid-March. Along with 17 other colleagues — 15 of whom also tested positive — he complained to management about its handling of the crisis and filed a lawsuit against them. He and two other colleagues were subsequently fired; several other colleagues received disciplinary warnings after speaking to the media. “The risk is that most of the other workers [who are suing the nursing home] are also likely to be laid off,” Reboa, who represents the 18 health care workers behind the suit, told POLITICO.
There were already cases of COVID-19 at the nursing home in late February, both among residents and staff, according to Mastragostino. And although several of his colleagues were hospitalized in the first and second weeks of March, the home’s health director did not inform the rest of staff, residents or their families of the immediate risk until March 14, “when the situation was already out of control,” said Mastragostino.
Two days later, on March 16, the nursing home opened a dedicated COVID-19 ward, with 36 beds for confirmed but non-life threatening cases. The move came in response to a call from the Lombardy region, which includes Milan, asking nursing homes to host COVID-19 patients on a voluntary basis, in order to ease pressure on hospitals.
The nursing home was paid “[up to] €150 each a day” per bed, according to Mastragostino.
The idea of asking a nursing home, which is full of people who are particularly at risk of dying of the virus, to take in infected people is “atrocious,” said Marco. “But that was not the problem,” he added. “The virus had been going around there for weeks, and the COVID-19 ward was actually the only that followed the safety rules.”
The nursing home’s staff were not given proper protective equipment and were told not to wear masks to avoid frightening patients, a common directive in many other nursing homes in Italy during the crisis.
On his floor, 26 of the 77 residents have died since March. “They died abandoned in their beds, many suffered,” said Mastragostino. “More assistance should have been given, but these facilities are not prepared, they are not hospitals. And the truth should have been told.”
The number of deaths at the facility is far higher the national average, indicating “that it is probable that it is related to a flaw in the prevention system,” Reboa said.
The Don Gnocchi clinic, for its part, has rejected the accusations. In a statement to POLITICO, the nursing home said it followed guidelines issued Italy’s health authorities and the WHO to protect its staff and residents, including guidelines on rationing the use of face masks. It added that there was “no absence of information” regarding the first COVID-19 case at the home, and that the complaint made by former staff members was a result of a “serious misunderstanding.”
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The problem is widespread in Italy. Out of more than 600 facilities controlled since February, at least 100 did not comply with the law and dozens have been shuttered as a result, according to a report by the NAS, a special unit of the national carabinieri. Some 60 members of staff have been reported and more than 150 have been sanctioned for a total of more than €72,000.
The report paints a bleak picture of overcrowded facilities with too few professional staff to take care of the sick or enforce proper quarantine measures to slow the spread of the virus.
“I hear a lot of stories from all over Italy like that of my mother” — Anna Rita Ulturale, a 43-year-old woman from Milan
The governor of the Lombardy region, Attilio Fontana, said earlier this month he welcomed the investigations of the nursing homes in Lombardy, though he added that he blamed the national health protection agency’s decision to divert COVID-19 patients to nursing homes for worsening the situation.
“I hear a lot of stories from all over Italy like that of my mother,” Anna Rita Ulturale, a 43-year-old woman from Milan, said over the phone.
Her mother, Gilda, died in the hospital at age 86 after spending more than 10 days with an untreated high fever at her nursing home in Milan, Residenza Borromea. Thirty-four families have joined forces and filed a lawsuit against the nursing home for attempted murder and mishandling the epidemic, after 150 residents were hospitalized and 66 died.
“In the days before, they told us that they gave her oxygen, but then a person who worked inside the facility sent my sister a video of our mom in bed. In the video she didn’t have oxygen, she was without blankets, and her arms were blue,” said Ulturale.
She feels grief, she said, but also an overwhelming anger. She had trusted the institution to take care of her mother. Imagining her mother alone in her final hours destroys her.
When contacted for comment by POLITICO, the lawyer representing Residenza Borromea, Giuseppe Iannaccone, said the nursing home rejects the allegations brought against it and is confident the results of the investigation will confirm its version of events.
“This speaks volumes about how society views the elderly,” said Lambranzi, who didn’t hold back his tears as he spoke.
“I was an only child, my mom was 90 years old, but she was a part of me. All that I have done in life I owe to her. We paid €2,000 a month to ensure her care and respect, but that didn’t happen.”