In the final days of her mother’s life, Marilyn Roche listened regularly to Courtyard Nursing Care Center conference calls, which described COVID-19′s sweep through the Medford facility in increasingly stark terms.
One day, test results for 39 of 55 patients came back positive for the virus. During another call, Roche learned about the death of four patients in the same wing where her mother, Joan Bretta, 90, lived. On another call, the staff shared information about end-of-life care.
With each update, the situation seemed more desperate. Still, it didn’t prepare Roche, 69, for missing Bretta’s dying moments on April 17.
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“I never in my life thought I wouldn’t be holding my mother’s hand and talking in her ear when she died,” Roche said. “I’ll never get over it. It was a terrible, terrible death.”
On Wednesday, the Medford nursing home acknowledged that 56 patients had died from the coronavirus since April 5 in one of the region’s deadliest known outbreaks. The fast-moving contagion is believed to be linked to a patient who was admitted to the facility after a hospital stay.
On Tuesday, a spokeswoman for the Pennsylvania-based company that runs the home, Genesis HealthCare, said another 24 patients had died at a second nursing home it operates in Medford.
An additional 66 patients and 29 workers at Glen Ridge Nursing Care Center had tested positive for COVID-19. At Courtyard, a 224-bed facility, there were 117 patients and 42 workers with the virus as of Monday.
The deadly outbreaks spread for weeks within these nursing homes with little public notice and no announcement from Massachusetts regulators about the death tolls. New York and New Jersey, the states with the most COVID-19 fatalities, publicly report the long-term-care facilities with outbreaks and the number of infections and deaths at each site.
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Massachusetts discloses the names of long-term-care and assisted living facilities with COVID-19 outbreaks, but doesn’t provide the precise number of cases or fatalities at individual sites. COVID-19 cases are reported in ranges: under 10, 10 to 30, and 30 or more.
On April 20, the Centers for Medicare and Medicaid Services, the top regulator of US nursing homes, said that long-term-care facilities must now report COVID-19 cases to patients and their families, but the data isn’t expected to be made widely available for weeks.
In Massachusetts, 60 percent of the state’s 4,420 COVID-19 fatalities were patients in long-term-care facilities. On Tuesday, Governor Charlie Baker said the state is offering more funding to nursing homes that meet requirements, for infection control, personal protective equipment, and managing virus outbreaks. The state has been in contact with Courtyard Nursing Care Center during the outbreak, he said.
“We have been in touch with all the nursing homes in Massachusetts around this program and people have been in touch with that one in particular for quite a while now,” Baker said.
Roche said the administrator at Courtyard repeatedly assured her that Bretta wasn’t showing symptoms of COVID-19 and didn’t need to be tested, even as her condition deteriorated. Bretta had dementia, difficulty hearing, and couldn’t verbalize her feelings.
But when Roche visited her at the nursing home’s urging on April 16, Bretta was struggling to breathe, sealing her lips shut and filling her mouth with air until her cheeks puffed out.
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“It just wasn’t normal,” said Roche, a retired municipal employee who lives in Stoneham. “She just stared at me.”
The next day, Roche said, she was about to visit her mother again when the nursing home called and told her Bretta had died. The death certificate lists failure to thrive and dementia as causes, but does not mention COVID-19, Roche said.
A day or two later, Roche said, she called Courtyard’s administrator and asked whether her mother had COVID-19. The administrator said she had tested positive for the virus, according to Roche.
“ ‘You always said she didn’t have COVID because she didn’t have signs,’ ” Roche said she told the administrator. "I was just flabbergasted.”
Roche said it pains her to think about what her mother endured during her final weeks as the home closed to visitors, her roommate died, and the nurses she adored began wearing protective gear that obscured their faces and deprived patients of human touch.
“They’re all coming in looking like Martians,” Roche said. “She was frightened to death.”
Still, many caregivers wound up contracting the virus. Guirlene Joseph, a certified nursing assistant who has worked at Courtyard for five years, returned to her job on Sunday after recovering from the coronavirus.
She said that management and staff did everything they could to try to protect residents and workers, but that the virus spread quickly after the first resident tested positive, killing four people in one week.
Residents who were showing no symptoms began testing positive, but there was no widespread testing of workers, who went to their own doctors if they became ill.
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“I was feeling sick,” said Joseph, 45, of Everett, recounting how she told her doctor in early April that she felt weak and tired and wanted to be tested. He told her it wasn’t necessary since she didn’t have a fever or other symptoms linked to the virus, she said. Her doctor told her she could continue to work, so she did.
Joseph said she thought maybe she was tired from working so hard during the pandemic, which left the nursing home short staffed. But after eight days she still felt run down and called her doctor again, insisting on a test. It came back positive, and she remained under quarantine for several weeks. Joseph said she had a fever for several days, then quickly regained her strength.
“I’m very good and I’m happy to go back,” she said. “I like to take care of my residents. I was happy to go back to see them.”
Joseph said the company provides full protective gear, including a jumpsuit, N95 masks, and gloves. But Marlishia Aho, a spokeswoman for 1199SEIU United Healthcare Workers East, a union that represents 160 employees at Courtyard, said workers at all long-term-care facilities need to be tested for the virus.
“The hardest hit has been our nursing homes so priority testing is very important to stop the spread of the virus,” Aho said. “It doesn’t change the heartbreaking impact on those who have lost their lives, but hopefully with the governor’s actions it will stop the spread and save lives in the future.”
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Since the outbreak began, the Baker administration has established a mobile testing program to screen for COVID-19 at long-term-care facilities, boosted their reimbursement rates, and provided staffing help and personal protective equipment.
Genesis HealthCare notified the state on April 3 that COVID-19 cases had surfaced at its Courtyard and Glen Ridge facilities, said Tom Lyons, a spokesman for the state’s COVID-19 Response Command Center.
The National Guard conducted virus testing at Courtyard twice, testing 12 patients on April 12 and 119 patients five days later. The state said it also encouraged Courtyard to accept help from a National Guard clinical support team, but the offer was rebuffed.
The National Guard has conducted testing at Glen Ridge, a 164-bed facility, four times and tested 107 patients for COVID-19, the state said. Courtyard has received two deliveries of personal protective equipment from the state and Glen Ridge has received four shipments, the state said.
In response to questions from the Globe, Genesis HealthCare said it is currently working with the National Guard to test 200 employees. The company declined the state’s offer for support staff on April 29 because it had normal staffing levels at that time, according to Lori Mayer, a company spokeswoman. Two Courtyard employees have died since the pandemic began, but the deaths were not related to COVID-19, she said.
Concetta Meyer, 91, died April 11 at Glen Ridge Nursing Center after contracting COVID-19. Her daughter, Maureen Rivieccio, said she and her brother had talked to her on FaceTime the day before.
“What we saw was just heartbreaking,” Rivieccio said. “It was awful to see my mother like that.”
Laura Crimaldi can be reached at laura.crimaldi@globe.com. Follow her @lauracrimaldi. Shelley Murphy can be reached at shelley.murphy@globe.com. Follow her @shelleymurph.