Jean Baker and her mother, Joan Bruns, lived just 10 miles from one another, but they endured the pandemic apart. Baker's weekly visits to see Bruns at Elderwood at Burlington, the nursing home in the city's New North End, ended abruptly in March when such homes began indefinite lockdowns.

During phone calls, Baker could hear the isolation wearing on her 87-year-old parent. Physically ailing but mentally "very sharp," Bruns became increasingly lonely. Some days she refused to get out of bed, Baker said.

Mother and daughter finally saw each other in August, when Bruns was briefly hospitalized. At the time, more frequent visits seemed on the horizon, as new COVID-19 cases remained low in Vermont. It was, instead, their last.

The coronavirus struck 150-bed Elderwood on November 24, two days before Thanksgiving. Bruns tested positive six days later. Her mother wasn't showing symptoms, Baker said, but when she called that day to check in, Bruns didn't answer.

The next morning, nursing aides walked into Bruns' room and discovered her body, Bruns' doctor told Baker. She'd died alone, before her daughter and the doctor even got a chance to discuss her treatment plan.

"Elderwood did so well for so long," Baker said. "It's unfortunate that things took another turn."

A spike in new coronavirus cases this fall, driven initially by social gatherings, has spawned a series of outbreaks in Vermont's long-term-care communities, killing 31 residents in the last month and infecting more than 375 residents and staff.

This still-unfolding disaster in the state's eldercare industry is every bit as severe as the spring onslaught that claimed 32 residents, and it's significantly more widespread. While the first wave of infection was confined primarily to two nursing homes in Burlington, the second one has stricken nine facilities, including five less-intensive residential care and assisted-living homes.

As residents, families and staff of Birchwood Terrace Rehab and Healthcare and Burlington Health & Rehabilitation Center learned in the spring, outbreaks in such environments do not only kill the most vulnerable elders. They are mass-casualty events that unfold in slow motion, bringing weeks of pervasive dread and anguish. European researchers recently found that 43 percent of care home workers surveyed after the spring wave showed significant symptoms of anxiety and posttraumatic stress disorder.

The crisis has returned to Vermont just before the homes' residents and staff are expected to begin receiving doses of COVID-19 vaccine later this month. While the world outside their walls turns its attention to an immense immunization drive, their isolation feels more acute.

"We're trapped in this glass bubble," said Serena Baker, a floor nurse at Elderwood who is not related to Jean Baker, "and we kind of feel a little forgotten in there."

Elderwood, the third-largest nursing home in Vermont, is battling the state's largest outbreak yet seen in an eldercare facility, with 116 cases and 12 deaths. The home did not record a coronavirus case in the spring, even as nearby Birchwood Terrace was overwhelmed. Once the virus got inside, however, it spread rapidly. The ensuing crisis has engendered fury among some families and caregivers, who are in disbelief at how a home could be hit so hard so far into the pandemic.

Nursing homes are vulnerable to outbreaks for many reasons, including the fact that the virus can spread before anyone shows symptoms. But 11 Elderwood caregivers told Seven Days that the facility was also ill prepared and that decisions in the first days may have compounded the problem. The caregivers, who spoke on the condition of anonymity because they feared professional reprisal, said dangerously short staffing and inadequate personal protective equipment hampered the outbreak response.

"They had enough time to educate their employees; they had enough time to get the PPE needed; they had enough time to implement a plan so that, when COVID hit Elderwood, they would know exactly what they needed to do," said one of the caregivers, who became infected and quit. "But Elderwood dropped the ball."

According to Elderwood, the first case was discovered in a patient who had been transported to an emergency room and tested positive there. A second staffer said she had worked with that patient but was not told to quarantine. She said she continued to work directly with other residents, wearing a surgical mask and gloves, until three days later, when she and her coworkers were tested on-site for COVID-19. She tested positive and later became ill.

"I was exposing them, probably," the caregiver said of other residents.

The state delivered nearly 1,500 N95 respirators after learning of the initial cases, said Monica White, director of operations for the Vermont Department of Disabilities, Aging and Independent Living. While many of Elderwood's workers had been professionally fitted for the more protective respirators before the outbreak struck, some more recent arrivals had not. The staffers said they weren't fit-tested and issued N95s until three days after the initial case was reported to the state.

"We shouldn't have been standing in line for an N95 when COVID is already in the building," a third caregiver said.

Elderwood is a corporate chain that operates nursing homes and assisted-living facilities around the Northeast. The company did not make a local manager available for an interview, citing the urgency of patient care. Spokesperson Chuck Hayes said the company is "not aware of any staff working with confirmed COVID-19 residents who were not equipped with and properly fitted for N-95 masks." Some employees who had cared for the first infected resident may not have been instructed to quarantine by contact tracers because they were wearing PPE at the time. "This is standard practice across healthcare settings and in alignment with [Centers for Disease Control and Prevention] guidelines," he wrote in an emailed response to questions.

As cases increased, the home lost workers to infection and resignations. That has meant that, at times, one nursing assistant has done the work of four, caregivers said. Physical therapists helped fill in some gaps, as did staffers from the University of Vermont Medical Center and volunteers, but many of the caregivers said that patient care remained diminished.

The home and state regulators say that the staffing levels, while reduced, have complied with federal requirements. "No clinician practiced above their license and resident safety was not compromised at any time," Hayes said.

White confirmed that a state surveyor conducted an on-site inspection of the home last week. She would not say whether the surveyor was following up on complaints, though some family members told Seven Days they had reported issues. Results of the inspection were not available by press time.

Serena Baker, the floor nurse, said that she worked alongside just one LNA in her unit on December 9 and 10, down from the usual four or five, but that employees and managers have joined together to ensure residents aren't neglected.

"I just feel like everybody is doing the absolute best that they can," she said.

Still, some families say they have struggled to get information about what's going on inside the building.

"The lack of communication is unbelievable," said the close relative of an infected resident, who requested anonymity because she feared that the home would retaliate against her loved one. She said she's received just two robocalls from the company with general updates about the outbreak. A recorded message, played for Seven Days by a family member of another Elderwood resident, assured that "we are well prepared to care for your loved one safely and effectively with adequate staff."

Lorna-Kay Peal's husband, Michael Smolin, had lived at Elderwood for almost four years before the 89-year-old retired chemical engineer became infected with the coronavirus on November 28. Before March, Peal visited him almost daily, in part because, she said, he was the victim of documented instances of emotional and physical abuse at the home. She became his watchful advocate before COVID-19 locked her and other family members out.

Elderwood did not keep Peal abreast of Smolin's changing condition, she said. Peal was shocked when she got a call on December 3 from a staffer informing her that her husband had died.

Peal said she put down her phone and raced through her house, screaming. "And finally I just took the phone and hung up," she said.

Then Peal, who felt she had been denied her opportunity to visit with her husband during his final moments, drove straight to the facility and asked to see his body. A staffer helped dress her in PPE so she could go inside, she said.

"I should have been kept aware of what was going on," Peal said. "They owed me that. I owed it to Michael."

The state worked throughout the summer and fall, when cases in Vermont were low, to gird homes for future outbreaks, said White, the state regulator. The state helped coordinate N95 fit-testing at licensed homes, conducted infection control reviews, held Q&As and consultations with facility leaders, set up a rapid-response team that could assist homes through outbreaks, and more. The federal government, meanwhile, began providing performance payments to reward homes with few coronavirus cases. Elderwood received the largest payouts of any home in Vermont in September and October — $20,398 total.

On November 12, as cases were increasing in Vermont, state regulators urged homes to begin testing employees more frequently than the once-a-month regimen required by federal regulators. This month, Vermont distributed less reliable but quick-turnaround antigen tests to homes for daily staff screenings and recommended weekly laboratory tests for all staff.

Last week the state also announced a $1.4 million emergency staffing program to help homes manage the severe staffing shortages that tend to follow an outbreak by deploying up to 40 crisis staffers. Planning for the partnership with TLC HomeCare in South Burlington began in early November, White said.

Many of the homes have already turned to hospice nurses from Bayada Home Health Care to help ease sick residents' pain. The company's "COVID teams" were caring for about 50 hospice patients across several Vermont nursing homes last week.

"Isolation is making things really rough for these folks," said Sequana Skye, a 64-year-old Bayada nurse who is overseeing 16 hospice patients with COVID-19 at Berlin Health & Rehab in Barre.

During her first visit to the home on a chilly fall night, Skye watched a man set up a lawn chair by a window to visit a resident inside. "It was heartbreaking," she said.

Hospice nurses are doing their best to attend to ailing residents, but the sheer number has limited what Skye can do. "I can't sit in a room with Mary Jones for half an hour and hold her hand, because there are too many other people I need to attend to," she said. "That's, from a nursing perspective, really difficult."

Joan Bruns, the mother who died at Elderwood this month, had been most proud of her own hospice work, one of several jobs she had held in health care, her daughter said. Though Jean Baker was not able to be with her dying mother at Elderwood, she said she takes some solace in knowing she did not suffer for long. "I'm grateful for all they did for her," she said of the home. "She had a good team."

After her mother's passing, Baker remembered a conversation they'd had by phone back in March. "She said to me, 'I could die before this is all over,'" Baker recalled. At the time, Baker thought her mother was being melodramatic.

"I can remember thinking, This is crazy. This will all be over by August or September," Baker said. "I had no idea how right she was."