Senior Citizens in Subsidized Housing Have Been Dying Alone at Home, Unnoticed Because of Coronavirus Distancing

Someone needed to check on Leonard Graves. The 57-year-old lived alone in a senior building on Chicago’s North Side, and no one had seen him in at least two days.

Volunteers called community ambassadors usually checked on fellow residents in the Edith Spurlock Sampson Apartments, a 394-unit Chicago Housing Authority complex. But after the coronavirus began spreading in Chicago, leaders say the CHA suspended the program.

With the help of a building maintenance worker, a worried friend entered Graves’ apartment on March 14. Inside, they found him face down on the kitchen floor. From the condition of his body, it was clear he had been dead for some time. He appeared to have died of natural causes.

Graves’ death — and how it was discovered — offers a heartbreaking snapshot of how the coronavirus pandemic has left some seniors dangerously isolated in public and subsidized housing around the city, with only a patchwork support system in place to make sure they’re OK.

About 10,000 people live in CHA senior buildings, and another 10,000 reside in privately owned properties in Chicago that are subsidized by the U.S. Department of Housing and Urban Development. Unlike residents of nursing homes and assisted living centers, most people in these senior buildings live independently in their own apartments. Building owners and managers — some of them for-profit companies — do not always provide support services and are not required to.

As the coronavirus outbreak moved into Chicago, managers at some federally subsidized but privately owned buildings cut staffing and security. Informal systems of care that residents had organized for themselves over the years were disrupted by social-distancing guidelines and fear of the virus. At CHA buildings, outreach workers were not required to check on most residents until late April, well after Graves and others died alone and unnoticed.

From mid-March through early May, at least seven senior residents were found dead in their units days after they were last seen alive, often discovered by janitors or pest control workers making their rounds, according to investigative reports from the Cook County Medical Examiner’s Office.

These cases are part of a larger spike in deaths in public and subsidized housing. More than 80 senior residents of these buildings died between March 14 and May 10 — four times the average over that same period each year since 2015, according to the medical examiner’s data.

With the pandemic, the medical examiner is investigating deaths that it may not have looked at in the past, making it hard to precisely compare this year with previous ones. Still, even non-COVID-19 deaths appear to be on the rise.

Owners and managers of the senior buildings, including the CHA, emphasize that their residents live on their own. While these buildings are not care facilities, owners say they have increased efforts to contact and assist residents during the pandemic.

Clearly, though, gaps remained.

Reduced Staffing

On March 20, the same day Gov. J.B. Pritzker issued his stay-at-home order, HUD officials in Illinois announced that they would work remotely for the foreseeable future. William O. Dawson III, HUD’s director of public and Indian housing for the state, asked the leaders of local housing agencies to let him know if any of their employees or residents were infected with COVID-19. At the same time, Dawson stressed the need for local officials to handle day-to-day resident concerns themselves. “If you are able to resolve a complaint without referring the participant to the Field Office it would be greatly appreciated,” Dawson wrote in an email obtained by ProPublica Illinois through an open-records request.

A HUD spokesperson said in a statement last week that the agency is “fully operational” and that “addressing issues begins at the local level where they are usually resolved. The public are welcome to contact HUD for further assistance.”

By the middle of March, the managers and owners of some subsidized buildings in Chicago had already cut back their own on-site staff in response to the coronavirus. Among them was UPholdings, a private company that owns Evergreen Towers, a pair of Near North Side buildings for seniors.

“Front desk attendants will not be working temporarily,” the company announced in letters dated March 12 and distributed to Evergreen Towers residents. “Property Management is working to quickly implement a system so that we may efficiently and safely conduct wellbeing checks.”

Jackie Reynolds, a 67-year-old resident leader at Evergreen Tower I, was troubled by the announcement. Each apartment in the building is equipped with an emergency cord, she said; when pulled, it activates a flashing light alert at the front desk. But the system wouldn’t work if attendants weren’t on duty to see the alerts.

Residents had already set up a network to check on one another, Reynolds said. “Last year, one of my neighbors on my floor passed away and no one knew about it because no one was doing well-being checks,” she said. As the pandemic spread, she found fewer people willing to make the rounds with her. “Everybody was scared.”

Several weeks later, on April 15, Reynolds noticed a package slip near the building’s front entrance for one of her neighbors, Emily Mandley, who was 88 and had some health problems. Reynolds said she put on a mask and knocked on Mandley’s door three times over the next day and a half. She didn’t get an answer. Reynolds then reached out to her cousin, who works at the building as a maintenance man and was able to get into Mandley’s apartment. As Reynolds had feared, Mandley was dead.

In an emailed statement, a spokeswoman for UPholdings acknowledged that the Evergreen Towers buildings no longer had front door attendants. She said the company is upgrading the security camera systems at both buildings.

In late March, building managers organized a system of daily well-being checks, she said. Residents who don’t want to be contacted were provided with door tags that say “I’m OK” or “Not Home” to let others know they’re fine. “This process is ongoing,” the UPholdings statement said.

But Reynolds said she and other tenants came up with the tag system. In the week after Mandley was found, building managers called to check on residents, Reynolds said. But she hasn’t heard of any staff wellness checks since then.

“No one has come to check on us but one time,” Reynolds said.

Overlooked

As many of the CHA’s employees switched to working from home, outreach workers stayed on site at senior buildings “to provide support, information and referrals” to residents, according to a March 18 email to staff from James L. Bebley, then the CHA’s acting CEO and now its chief operating officer.

The outreach workers, known as resident service coordinators, or RSCs, are staffed by Catholic Charities under a $9 million, two-year contract with the CHA. Under the contract, 54 coordinators work in the CHA’s 55 senior buildings. Some of the coordinators are responsible for properties with hundreds of units.

Before the pandemic, the coordinators focused on organizing activities for seniors and connecting those in need to social services. They were also supposed to check on residents they or building managers deemed sick or frail, especially during extreme weather.

Over the last three months, their work has only become more challenging — and potentially dangerous. One coordinator, who asked not to be named because she wasn’t authorized to speak to the media, said that she initially had to get her own protective gloves and mask so she could help deliver food to residents. Catholic Charities gave masks to coordinators starting April 2, when federal health officials began recommending their use, according to Brigid Murphy, a spokeswoman for the organization.

On March 23, coordinators were instructed to check in every day with the 1,100 residents on the frail list, either by phone or in person, according to the coordinator. A log of the check-ins was supposed to be submitted to their supervisors at Catholic Charities.

But under the Catholic Charities contract, coordinators were not expected to check in with other seniors unless they had specific needs.

“CHA and Catholic Charities really didn’t put much emphasis on checking on non frail residents” at that time, the coordinator wrote in an email. “However, some RSCs such as myself took the initiative to check on all residents.”

Murphy said the coordinators staffed by Catholic Charities were not required to conduct wellness checks of all residents, though they have stepped up to help those who need food or other special assistance. “During the pandemic, our Resident Service Coordinators (RSCs) have provided services without reimbursement above and beyond the duties outlined in our contract,” Murphy wrote in a statement.

In late March, members of the Jane Addams Senior Caucus, an advocacy group, began pressuring the CHA and the city to provide more services to seniors. On March 24, an aide to Mayor Lori Lightfoot emailed Bebley a list of the caucus’ demands, which included conducting daily wellness checks of all residents and staffing every senior building with nurses or health care workers.

All of the CHA’s buildings are managed by private companies. Two days after the email from Lightfoot’s aide, CHA instructed the property management firms to post new informational flyers in building common areas. “It is geared for our older residents to call if they have a need,” Mary Howard, the CHA’s chief resident services officer, wrote in an email to agency officials who worked with the property managers. The flyer was in English and 12 other languages.

Howard and Eric Garrett, chief property officer for the CHA, also sent a letter to the presidents of the local advisory councils, the tenants’ groups for each CHA development. The letter said property managers were still working on site at each development, and that resident service coordinators were available by phone, if not always in person. The letter did not mention wellness checks.

No Help Needed

For weeks in February and March, 25th Ward Alderman Byron Sigcho-Lopez forwarded the CHA complaints his office received about inadequate heat, security concerns and poor communication with residents of Las Americas, a 211-unit building for seniors in the Pilsen neighborhood. CHA officials repeatedly promised to follow up with the building’s managers and its resident service coordinator, emails show.

On March 27, Sigcho-Lopez emailed again, this time proposing to organize more well-being checks at senior buildings, including Las Americas.

His message made its way to Howard. In an email to her colleagues, she noted that the CHA already had an outreach program: “Catholic Charities is in our buildings conducting more than 1100 wellness checks a day.”

But at that time coordinators still weren’t required to conduct regular checks of residents unless they were on the “frail” list.

Still, Scarleth Lever Ortiz, director of the CHA’s office of diversity and inclusion, discouraged Sigcho-Lopez from proceeding with his plan, reminding him the CHA already had resident service coordinators doing outreach while practicing social distancing.

“We think it may be confusing to have others do the same, and we are trying to limit the number of persons who come to our buildings,” she wrote.

In an interview, Sigcho-Lopez said his office has continued to make check-in calls. “Our seniors, if anything, need more attention, not less,” he said.

Daniel La Spata, alderman of the 1st Ward, on the city’s near Northwest Side, said CHA leaders also rejected his suggestion that they add staff to check on residents at senior buildings. During an April 3 video conference with CHA officials, La Spata said he asked if the agency could place a nurse or health care worker at each senior residence during the pandemic. He said he was told no because the presence of health care staff at senior buildings “would only create panic.”

His conclusion: “I think we need stronger systems of accountability in place.”

It was mid-April before the CHA decided to conduct regular checks of residents who weren’t on its sick and frail list. Even then, not everyone involved with carrying out the checks was communicating with one another. First, CHA employees who were working at home were asked to start calling tenants to supplement the work of the coordinators staffed by Catholic Charities. But in early May, the coordinators were also directed to check in with every resident at least once a week, even though they weren’t told who was being contacted by CHA employees, according to the coordinator who spoke with ProPublica Illinois.

In a statement, CHA leaders said they have worked during the pandemic to make sure seniors are not cut off from essential needs. Over the last month, the agency says, it has expanded its check-in system, which now reaches 3,000 seniors a day, including the most vulnerable.

“The health and safety of residents are the highest priorities for CHA and the City of Chicago, most notably seniors, whom we commit significant staff and resources to support their daily activities,” CHA spokeswoman Molly Sullivan wrote in a statement.

In the past, officials at the CHA have stressed the agency is a provider of housing and is not fundamentally a social service agency, though it offers residents some education and support programs and is widely viewed as more than just a landlord.

Advocates remained concerned that some residents were not being reached. Maria Hadden, alderman of Chicago’s far North Side 49th Ward, introduced an ordinance at the April City Council meeting that would require managers of CHA and other senior buildings to conduct more wellness checks, maintain staffing levels and limit access from nonresidents during health emergencies. It was assigned to the council’s Health Committee, which is next scheduled to meet on June 4.

Hadden said she understands that the CHA now has a system for conducting checks. “But a lot of residents haven’t heard from them,” she said. “It’s not time to sit on our hands.”

Fatal Gaps

In its statement, CHA leaders did not answer questions about deaths in their buildings. But by the time the ordinance was introduced, they were aware that gaps in the work of resident service coordinators could have fatal consequences.

“Please note during this time of COVID we have begun to find residents deceased in their apartments,” Catholic Charities officials wrote on April 14 in an email to employees working in CHA buildings. “Immediately CHA is contacting Catholic Charities to see if a well-being check was completed on the resident by the RSC and holding us accountable. We are held very much accountable for contact if the resident is on the sick and frail list.”

The email also told workers that if they couldn’t reach a resident with two phone calls, they should let the property managers know so they could conduct a well-being check of the apartment.

The email was sent to remind the coordinators that they needed to check on residents on the sick and frail list, Murphy wrote in her statement, even though the people found dead were not on the list “and therefore, our RSCs would not have made wellness phone calls to them.”

At that point, several deaths in CHA and other subsidized apartments had already gone unnoticed for days before being found. No one claimed responsibility for checking on those residents.

A particularly sad and gruesome situation unfolded on April 22, when a resident at Hollywood House, a high-rise senior building in Chicago’s Edgewater neighborhood, called the property manager to report that maggots were crawling out of her kitchen vent. Other residents of the high-rise senior building had noticed a strong, foul odor in the 12th floor hallway. A maintenance worker eventually opened an apartment where he found 72-year-old Oscar Medina sitting in his kitchen, dead, according to an investigative report from the medical examiner’s office.

Owned and managed by the Heartland Alliance, a prominent social service agency, Hollywood House is home to both market-rate and low-income renters, with 51 of its 197 apartments subsidized through federal vouchers. The building has also received city funding.

Medina had lived at Hollywood House for 13 years, neighbors said. He had immigrated from Cuba more than four decades ago and was known for being kind and friendly.

Yvonne Requena, one of his friends in the building, said her family is from Belize and they bonded over their similar cultural backgrounds. They both liked music and dancing, and they would sometimes eat together and talk in the building’s dining room. “He would say hi to everyone he meets — a very nice man,” she said.

But Medina spent most of his time by himself. “He didn’t really talk about family,” said Requena, who is 73. “He would go and walk outside all night, even when it got cold. Or he would sometimes get on the bus and ride the bus all night.”

In recent weeks, as coronavirus infections spread, Hollywood House closed its dining room. Medina, a diabetic who sometimes had breathing problems, rarely left his apartment except to get sandwiches from the convenience store on the first floor. “I said, ‘They’re high in sodium — you can’t eat that every night,’” Requena said. “He stopped going out. He just stopped taking care of himself because he was depressed.”

A few weeks ago, Medina told Requena he was concerned that nonresidents might be able to come into the building because no one was working at the front door during much of the day. It was the last time they spoke.

Some Hollywood House residents say more should be done to communicate with tenants. The property manager is only in the building two days a week, they said, and a social worker has been working remotely to limit person-to-person interactions.

“Some people said she’s called them, but she hasn’t called everyone. She hasn’t called me,” said resident Nanna Cross, 77.

Cross, who is a member of the Jane Addams Senior Caucus, said she knows of a nearby senior building where tags outside each unit indicate whether anyone has opened the door that day. Hollywood House needs a way to conduct wellness checks, especially during periods when many tenants rarely leave their apartments, she said.

“That hasn’t been happening in our building, and it’s been real upsetting,” she said.

A spokesman for the Heartland Alliance said in a statement that the company has staggered work shifts at its buildings since the stay-at-home order, but “maintenance staff and security are on-site daily.”

“Although Hollywood House is an independent living facility where residents may choose to seek services from outside partners, for the well-being of our residents we have elected to initiate periodic resident wellness checks. In fact, these checks have been bolstered during the COVID-19 pandemic,” the statement read. Since many residents are elderly, “although it is hard, it is not uncommon to experience multiple resident deaths in a year.”

Medina was last seen alive a week before his body was found, according to the report from the medical examiner. It was at least the second time since March that a resident at Hollywood House had been discovered days after dying, according to medical examiner records.

Requena learned about Medina’s death from another neighbor.

“It hit me so hard,” she said. “It’s very sad that when you live alone, something like this can happen.”