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Health & Science

What Went Wrong At Arbor Terrace

DON GONYEA, HOST:

Our next story begins last February at an assisted living facility just outside of Atlanta. Ernestine Mann stood in front of her new neighbors to give a short speech.

(SOUNDBITE OF ARCHIVED RECORDING)

ERNESTINE MANN: Well, good evening, everyone.

UNIDENTIFIED GROUP #1: Good evening.

GONYEA: She was dressed to impress in delicate earrings and a flowy blouse with a little hint of shimmer.

(SOUNDBITE OF ARCHIVED RECORDING)

E MANN: I'm so glad to see all of you here. And this is my first year living here, and I'm having a great time.

GONYEA: She was up there to read aloud a proclamation celebrating Black History Month.

(SOUNDBITE OF ARCHIVED RECORDING)

E MANN: To celebrate the remarkable accomplishments and lasting impact of the country's great African American leaders and citizens.

GONYEA: The people in the room were themselves great African American citizens - doctors, musicians, veterans. Ernestine had been a teacher in Atlanta for 30 years. In a little more than two months, at least 17 residents, including Ernestine, would be dead from COVID-19. Their families wanted to know, why did so many people die at the one home that served a Black community but not at the nearly dozen other locations in the state run by the same company? Meg Anderson of NPR's investigations team has some answers.

MEG ANDERSON, BYLINE: The facility is called Arbor Terrace at Cascade, and it's managed by The Arbor Company. By now, many of its other Georgia locations have had COVID cases and deaths, but nothing like what happened at Cascade. There, 54 residents and 36 staff members caught the virus. That's not the only difference, though, between this facility and the rest. Arbor Terrace at Cascade is also the company's only facility in Georgia in a Black neighborhood, which to some of the families just doesn't seem like a coincidence.

TRICIA JOHNSON: Their brand has definitely been tarnished, but it doesn't appear it's going to be tarnished in the white areas.

CEDRIC HENDRIX: It makes you really wonder that. I mean, I would drive by there just to look and see what was going on.

JUDITH HATCH: I'm still trying to put it together. How did that happen?

ANDERSON: That was Tricia Johnson, Cedric Hendrix and Judith Hatch. They're all children of residents who died or contracted the virus. The outbreak at Arbor Terrace at Cascade is part of a grim pattern we've seen playing out all over the country. Black people are getting and dying from COVID-19 at higher rates than white people. And to understand how it happened here, it helps to understand a bit about this area of Southwest Atlanta, which is called Cascade.

UNIDENTIFIED GROUP #2: (Singing, unintelligible).

ANDERSON: That's Hoosier Memorial United Methodist Church on a Sunday a few months before the pandemic. Ernestine Mann was there most Sundays.

GARY DEAN: She was always smiling. She was just an open person. She loved people. And everybody here was Ms. Ernestine's best friend.

ANDERSON: Pastor Gary Dean says the congregation there mirrors the community, which is older and almost entirely Black. Over the years, the late Congressman John Lewis lived in Cascade. So did several former Atlanta mayors. But until about the mid-1960s, much of the area was white.

DEAN: It was one of those white flight things where the Blacks were moving into the area more and more. And the - of course, the whites - they left, and the community became basically all Black.

ANDERSON: Living in Cascade became a badge of honor in the Black community. And when Arbor Terrace opened there in 1999, it became a kind of status symbol, too. Ernestine Mann moved there in August of 2019.

KARLA MCKINNEY: It was looked upon as one of the creme de la creme assisted living facilities.

ANDERSON: Her daughter Karla McKinney says she fit right in.

MCKINNEY: She wasn't the resident that just kind of showed up for the dining hall and then just stayed in her room. She was not just over there wasting away.

ANDERSON: March 25 was the last day that McKinney and her brother Bill Mann were able to see Ernestine alive. The facility had restricted all visitors a few weeks earlier, so the family had come for a window visit.

MCKINNEY: We could see her coming across the lobby as she was toddling like a baby just beginning to walk.

ANDERSON: They knew then that something was off.

BILL MANN: She was able to talk, but see, if you know her, my mom spoke - she spoke strong. This particular time, she sounded extremely weak. It was almost to a whisper.

ANDERSON: Their mom seemed dazed. Her eyes were darting around. She had trouble recognizing her granddaughter.

MCKINNEY: We ended up not staying as long as we thought we might have because she clearly was tired, and something wasn't right. And when we did get ready to go, she stood up, and she stumbled.

ANDERSON: McKinney called afterward to have someone check on her mom. The staff agreed that something was wrong. They called an ambulance.

B MANN: And then once she got to the hospital, you know, we're blowing up at the hospital trying to find out what is going on.

ANDERSON: Ernestine's coronavirus test came back positive on March 27. She was placed on oxygen. By March 29, she had taken a turn for the worse. That day, Bill Mann and McKinney talked to their mom on the phone.

MCKINNEY: I still try very hard to get the sound of her voice out of my mind, even to this day. My mom was crying out for help. She says, come help me. Help me. Help me, you all. Please come help me.

ANDERSON: The family couldn't come visit because of coronavirus restrictions.

MCKINNEY: I hear her crying out for help. To know that I couldn't get there, just that desperation that she seemed to be having at that moment - it's hard. It's hard.

ANDERSON: Ernestine died that afternoon. She was 84.

B MANN: And I understand we're all on the clock, and sooner or later, we have to go. But not like that - she didn't have to go this way.

ANDERSON: Ernestine's death was the first in a wave of at least 16 others at the facility. Four families, including Ernestine's, have filed lawsuits against the company, which denies any wrongdoing. In an email to Cascade families on April 17, the president of the company, Judd Harper, wrote, quote, "many of you have asked why Arbor Terrace Cascade experienced these results. We wish we could tell you. Our protocols and processes are exactly the same in all of our senior living communities."

To be sure, some of the outbreak at Arbor Terrace Cascade can be chalked up to bad luck. The company did have infection control policies in place before the pandemic. But there were other factors that made this place vulnerable. In early March, Cascade employees like Jazmine Heggins, a resident assistant, were beginning to feel nervous.

JAZMINE HEGGINS: Are there going to be any masks? Are there going to be more gloves? Will we have this protection? Because these are things that they're saying that we need.

ANDERSON: State records say that even by March 27, when the outbreak had already begun, the facility did not have enough masks, other personal protective equipment or hand sanitizer. The company denies that it didn't have enough PPE. But by then, it was already too late. Fifteen staff members were reporting influenza-like symptoms according to those records. Heggins woke up exhausted on a Friday in late March. Later that weekend, she knew she was sick with something. She asked her supervisor what she should do. The response - tough it out.

HEGGINS: I was, like, y'all told me not to come into work, and I'm telling you that I'm sick. So what do you want me to do? And they were, like, you have to come in.

ANDERSON: In a statement to NPR, the company said staff were always instructed not to work when sick.

HEGGINS: It was like they were telling us one thing, but then they really meant, like, it doesn't actually matter. We just have to tell you this.

ANDERSON: Assisted living facilities in general are vulnerable to infectious disease. Today, nearly 40% of all U.S. COVID-19 deaths have happened at these types of facilities. African Americans have higher rates of diabetes, high blood pressure and heart disease. Those are all risk factors for COVID-19. That meant that once the virus got inside, the residents of Cascade might have been hit harder.

Location matters, too. A facility surrounded by more COVID-19 cases is more vulnerable, and the neighborhoods around Cascade had a lot of cases early on. That's a pattern across the country. A study last summer found Black neighborhoods, regardless of income, had more COVID-19 cases in the early months of the pandemic.

ANDRE PERRY: Racism transcends class. Middle-class Black neighborhoods are treated differently than middle-class white neighborhoods.

ANDERSON: That's Andre Perry, a fellow at the Brookings Institution.

PERRY: Many Black neighborhoods simply have less community wealth.

ANDERSON: And near Cascade, even though the median income is about the same as Atlanta's, the median home value is roughly $100,000 less. Wealth matters when bad times come.

PERRY: And we know that wealth is a protector of sorts - that when we have these economic or health crises, wealth enables us to shelter more. And that difference can mean life or death.

ANDERSON: The Arbor Company told NPR that each community has its own budget and that funds are not shared across facilities. Marcus Davis, a former maintenance director at Cascade, said Cascade always seemed to be short on money. Davis remembers a company-wide event a few years ago. The other locations showed up in nice, newer vans.

MARCUS DAVIS: We pulled up, and this van was, like, dilapidated on the side. It had Arbor Terrace at Cascade, but it had bubbles where the paint was peeling off. When it rained, the water came inside like it was a bucket.

ANDERSON: Davis says they'd been asking to get the van fixed for years. Later, The Arbor Company did purchase them a new van. In 2017, when Hurricane Irma was coming toward Georgia, he says they asked the company for a generator.

DAVIS: We've asked for that several times throughout our budgeting, and the answer was always, no, you don't need one.

ANDERSON: He says Cascade's power went out for two days. The staff bought glowsticks to put around residents' necks. Eventually, he says the corporate office got them a portable generator. These might sound small compared to the pandemic, but Davis says...

DAVIS: If you're always short-changing something, if you're always the last to be a part of something, you can't help but fail.

ANDERSON: In April, Ernestine Mann's family held a graveside service for her. The funeral took place on a bright, sunny day. Ernestine's family stood by her coffin under a green tent. They passed out white roses. Pastor Gary Dean gave a short sermon. So far, he's led 10 funerals for people who have died from the virus. They've all been small.

DEAN: I just feel so bad for all of them because you can't celebrate their life the way it needs to be.

ANDERSON: The gathering was mostly family. A few dozen other people still came. They stood at a distance among the graves or by their cars.

JEFF: (Singing, unintelligible).

ANDERSON: McKinney's husband, Jeff, sang a hymn.

JEFF: (Singing, unintelligible).

ANDERSON: In normal times, Ernestine's funeral would have been standing room only, with family and friends, her sorority sisters and the many students she taught across three decades. That day, at least one former student was there - the undertaker - representing the many other lives Ernestine had touched.

Meg Anderson, NPR News.

(SOUNDBITE OF KHRUANGBIN'S "FRIDAY MORNING") Transcript provided by NPR, Copyright NPR.