Berna Lee got the call from the nursing home in Queens on April 3: Her mother had a fever, nothing serious. She was assured that there were no cases of coronavirus in the home. Then she started calling workers there.
“One said, ‘Girl, let me tell you, it’s crazy here,’” Ms. Lee said. “‘Six people died today.’”
In a panic, Ms. Lee drove from her home in Rhode Island to the nursing home, beginning a two-week scramble for information, as workers at the facility, Sapphire Center for Rehabilitation and Nursing of Central Queens, told her privately that many residents had died, and that most of the home’s leadership was out sick or in quarantine.
Finally, she banged on her mother’s first-floor window to see if she was OK. It was unclear whether her mother understood what was happening, Ms. Lee said.
“I didn’t know how bad it was,” she said. “People told me bodies were dropping.”
The crisis at Sapphire highlights not only the desperate state of nursing homes in the New York region, which have become a center of the coronavirus outbreak, with nearly 2,500 deaths in New York alone, up more than 1,000 in the last week. It also illustrates what relatives of residents said was a deeply troubling lack of information about what is going on inside the homes.
Sapphire has not disclosed how many residents have died in the outbreak, but on Wednesday, the home’s administrator told the local state assemblyman, Ron Kim, that the total was 29, Mr. Kim said.
But the numbers given by the home, Mr. Kim said, did not match what he was hearing from workers there.
“Everyone is trying to tell me that a lot more people died than the 29 they are citing,” he said.
Two workers at the home, which has 227 beds, also told The New York Times that the actual death toll was considerably higher, as many as 60 residents.
State officials, who regulate nursing homes, said the department would provide information about the death toll and the extent of the coronavirus’s spread inside Sapphire and all 613 nursing homes as soon as it was able to validate the data.
Since the first outbreak at a nursing home in Kirkland, Wash., in late February, which killed at least 37 people, nursing homes have proved grimly efficient places for the coronavirus, bringing overworked caregivers in constant contact with frail, older residents.
The work can readily spread disease: When changing a diaper or helping someone into bed, there is no such thing as social distancing.
Factors repeat with deadly regularity: not enough staff, not enough protective equipment and not enough testing, which would enable homes to isolate infected people.
New York State has no minimum staffing requirement for nursing homes, which often means that overstretched workers move from one vulnerable resident to the next, with no time to change into fresh masks and surgical gowns, even if the homes had them.
In New York and New Jersey, funeral directors have been unable to keep up with the death toll at one nursing home after another. Few involved more disturbing circumstances than Andover Subacute and Rehabilitation Center I and II in northern New Jersey, where at least 57 residents and workers have died, 17 of them discovered by the police acting on an anonymous tip.
In Suffolk County, on Long Island, nearly half of all deaths from the coronavirus involved nursing homes or assisted-living facilities.
Families are caught in a vacuum of information, barred from visiting, and nursing homes have a financial incentive to provide only the most benign view of what is happening behind their closed doors.
On Thursday, Gov. Andrew M. Cuomo, responding to the outcry of families, promised an executive order requiring nursing homes to inform relatives about Covid-19 infections and deaths in the facilities.
He also pledged to release information for each nursing home, “to the best we have,” something the state had previously declined to do.
Sapphire’s administrator, Jerry Enella, did not respond to repeated messages on Wednesday and Thursday. On its website, the home says: “We strive to provide the highest quality of care to each of our patients by offering a range of services to meet your needs. Our goal is to keep you as healthy as possible by offering care when you need us most.”
Mr. Kim, the state assemblyman, said he had a heated exchange with Mr. Enella outside Sapphire on Wednesday afternoon. Mr. Enella, he said, defended the quality of care and told Mr. Kim that there were 29 deaths there, one of the highest totals in the region so far.
“It was very clear that the director was not able to handle the situation,” Mr. Kim said afterward. “We went to lend a hand and understand what they need. But they’re all about trying to get damage control and protect themselves.”
On Thursday, State Health Department officials were on the site doing a survey and evaluating conditions at the home, said Michael A.L. Balboni, a former state senator who is a consultant for the Sapphire Care Group.
“They are still trying to determine what the actual numbers are,” Mr. Balboni said. “What’s going on right now is to find out what has happened and for what period of time.”
“Determining the cause of death is never that simple in the middle of a pandemic,” he said.
Workers at the home maintained that the toll at Sapphire was higher than 29 deaths.
“You come to your shift and this person’s gone, this person’s gone,” said one worker who spoke on condition of anonymity for fear of being fired. “We were losing five or six residents a week, then four or five a day. Last week on my shift it was about eight of them passed away. My God.”
This information was not shared with families debating whether to remove their relative from the home.
Berna Lee, the daughter from Rhode Island, said on Thursday that her mother was weakened by a fever and pneumonia, but was hanging on.
“I just want her to get better and I can go home,” Ms. Lee said.
Robin Kim, whose mother was in the home after brain surgery and the onset of dementia, said that in March her mother’s nurses disappeared without explanation. She only later learned they were out with the coronavirus. Yet on April 6, she said, a Sapphire social worker told her she did not know of any cases in the building.
Ms. Kim stopped asking about the coronavirus for fear of alienating the workers. But it did not save her mother.
Ms. Kim’s mother, Tae Ak Lee, known as Clara, died on April 13, with a nurse holding her hand for the last hour of her life. The last Ms. Kim saw of her was in a storage room at the nursing home, wrapped in a bedsheet, with two other bodies on tables beside her and the air-conditioner turned up high.
Other family members of residents have also struggled to get basic information.
Andy Liao, whose mother, Qun Xiao, has been in the nursing home since 2018, said he used to visit his mother multiple times a week. But after families were barred from visiting, a nurse helped him to video chat with her regularly.
He grew worried when she developed a fever and slight cough in early April and lost her appetite. A nurse told Mr. Liao his mother had “normal pneumonia.”
“Are you sure it’s not Covid-19?” he said he asked.
“They don’t know because the patients in that center are not allowed to get tests,” the nurse told him.
Then the nurse fell ill, and Mr. Liao said he did not speak to his mother for days. He made repeated calls to the facility, desperately trying to reach any available nurse.
But the phone just rang and rang. Finally, on April 8, he got through. A social worker helped him video chat with his mother, 84, who was very weak. It was the last time he’d speak to her. His mother died later that evening, he said.
Mr. Liao still doesn’t know if it was Covid-19 that killed her. But he said he heard that “many staff and the patients passed away very quick.”
He doesn’t blame the home, but he worries about the patients who are left inside.
“There aren’t enough workers. The management might not be able to do that much,” he said. “It’s the same problem all over New York — many, many people die, and they don’t know what to do.”
New Jersey’s homes have been similarly ravaged. Gov. Philip D. Murphy on Thursday asked the state’s attorney general to begin an investigation of the Andover nursing home, where the bodies were found piled in a small holding room, and of all other long-term care centers that had “experienced a disproportionate number of deaths.”
“This is completely unacceptable,” Mr. Murphy said.
Medicare and Medicaid officials were also sending surveyors to do a full review of Andover Subacute, New Jersey’s largest nursing facility, the state health commissioner, Judith M. Persichilli, said.
The owner, Chaim Scheinbaum, disputed the police account about finding 17 bodies; he said there were only 15. He also said that staffing levels were “solid.”
“The back up, and after-hours holiday-weekend issues, plus more than average deaths, contributed to the presence of more deceased than normal in the facility holding room,” he said in a statement.
Pat Wiegand’s brother, Raymond, has lived at Andover for 15 years. She said she had gotten no information about the outbreak from the owner.
But she said she had called regularly and was grateful to the overworked staff members who have updated her on the condition of her brother, who is 70 and developmentally disabled. His roommate, she recently learned, had a fever.
“So far nobody has lied to me; nobody has not taken my calls,” Ms. Wiegand said. “Right from the beginning they said to me: ‘This is a war zone. We’re getting no help from the government.’”
Michael Rothfeld, Jesse McKinley and Jeffrey E. Singer contributed reporting. Susan Beachy contributed research.