On the Isle of Skye off the western coast of Scotland, residents thought they had sealed themselves off from the coronavirus. They shuttered hotels. Officials warned of police checks. Traffic emptied on the only bridge from the mainland.
But the frailest spot on the island remained catastrophically exposed: Home Farm, a 40-bed nursing home for people with dementia. Owned by a private equity firm, Home Farm has become a grim monument of the push to maximize profits at Britain’s largest nursing home chains, and of the government’s failure to protect its most vulnerable citizens.
Today, all but seven of the residents have been stricken. More than a quarter are dead.
The virus has ravaged nursing homes across Europe and the United States. But the death toll in British homes — 14,000, official figures say, with thousands more dying as an indirect result of the virus — is becoming a defining scandal of the pandemic for Prime Minister Boris Johnson.
By focusing at first on protecting the health system, Mr. Johnson’s strategy meant that some infected patients were unwittingly moved from hospitals and into nursing homes. Residents and staff members were denied tests, while nursing home workers begged in vain for protective gear.
“We were witnessing horrendous images in Spain and Italy, so a lot of attention was paid to maintaining and securing the National Health Service,” said Dr. Donald Macaskill, the chief executive of Scottish Care, which represents nursing homes. “The N.H.S. was prioritized at the expense of social care.”
At Home Farm, set above a silvery loch on a northeastern finger of the island, employees do not know how the virus got inside. But early in the pandemic, they expressed fears to their bosses about the company bringing in workers from outside the island. And they fretted over the half-dozen new residents who were deposited in empty beds, some of them from hospitals and others from their own homes.
Problems funding nursing homes, a bugaboo in British politics since Margaret Thatcher privatized them in 1990, hobbled Mr. Johnson’s predecessor, Theresa May, whose proposal to raise resident fees was nicknamed the “dementia tax.”
Now Mr. Johnson is feeling the heat. In the House of Commons, he faces a weekly barrage over nursing homes, including accusations that he lied about government guidance playing down the chance of outbreaks.
“People in nursing homes, they don’t have the same voice as I have,” said John Gordon, a member of the local council from Skye, whose 83-year-old father is one of 10 Home Farm residents to have died. “The government has failed our old people.”
Britain’s hospitals are revered for providing free, universal health coverage. But the nursing home system is a decidedly American export, with corporate giants based in offshore tax havens often paying workers the minimum wage and trying to wring profits out of an aging population.
For-profit nursing homes now control even more of the British market — 86 percent — than the American market. And the biggest chain, HC-One, which owns Home Farm, has been hit hard. Cases have broken out in two-thirds of its 328 homes. Four employees and 934 residents have died.
Among the dead was Colin Harris, 66, a witty Home Farm resident with dementia and Parkinson’s disease.
In the months before Mr. Harris died on May 6, staffing was so thin that his incontinence pads were often left wet, eroding the skin on his thighs, Mandie Harris, his wife, wrote in a complaint. His dentures came unglued when he ate.
After a video call on April 8, Ms. Harris complained to HC-One that she saw aides without protective gear and a resident’s husband walking down the corridor in street clothes. “Where is the infection control?” she asked. In response, the company told her in an email that the man was being hired as a cleaner and that Mr. Harris’s “teeth appeared clean and secure.”
Inside the home, staff members were becoming panicked, said three workers, who spoke on the condition of anonymity because they had been instructed not to talk publicly. In early April staff meetings, they pleaded for better protective gear, and in some cases ordered their own.
But management told workers to wear masks only around suspected coronavirus patients — an approach that Ms. Harris, in her complaint, compared to “closing the gate after the horse has bolted.” The company told her that aides who wanted masks were provided with them starting April 9. Not until April 18, a week before the outbreak, were masks required.
Even so, managers sometimes refused to wear masks themselves, including on medicine rounds to residents’ rooms, complaining that they itched, the three workers said.
Soon after a nationwide lockdown went into effect in March, a new deputy manager arrived from Kent, in southeastern England. HC-One has said she isolated before starting work. But that was before she made the 650-mile journey to the island, the employees and HC-One said. She eventually became sick and stopped working, the company said.
Feeling unprotected by management, employees cleaned the home obsessively and enforced their own distancing rules. When residents were startled, as they often were, aides held their hands and stroked them. Sometimes employees broke down crying.
“People were petrified,” one of the employees said.
For HC-One, the nursing home business has been lucrative, as the company paid more than 50 million pounds, or nearly $61 million, in dividends from 2017 to 2019.
But staff members at Home Farm suffered. During 12-hour shifts, they sometimes made do with no more than one nurse and two aides on an 18-bed floor, employees said. The residents’ help buttons buzzed incessantly.
Staffing shortages were so dire, regulators said in January, that Home Farm stopped accepting new residents. An inspection found that the home was unclean, staffing was uneven and “the level and quality of care and support people received was not always adequate.”
HC-One said it “faced chronic recruitment challenges,” forcing the home to rely on temporary workers.
But as the pandemic raged in Britain, the moratorium on new admissions at Home Farm was lifted. When employees complained about the risk of transmission and even volunteered to temporarily move into the home to avoid carrying the virus inside, management said beds needed to be filled with paying customers, two workers said.
HC-One said that, like other homes, it was asked to help hospitals by admitting some patients.
In late April, employees’ fears were realized: An aide tested positive. Employees said they learned the news not from management, but from Facebook, where the aide’s mother posted about it.
Residents, too, were showing symptoms, like slackening appetites and high temperatures. By April 27, a Monday, staff members were adamant that residents needed help. Management urged them not to worry, arguing that it was just the flu, the three workers said.
At the time, testing was scarce: Not until days later did Scotland say it would offer tests to any nursing homes with cases. So only four of the home’s 36 residents were initially given tests. Blanket tests later that week revealed the calamitous extent of the outbreak: 28 residents were infected, along with 26 of 52 staff members.
Residents’ families said administrators were slow to acknowledge the likely spread. Up until her husband’s positive result, Ms. Harris said, management told her he was being treated as though he had a chest or urinary tract infection. Later, Ms. Harris said management insisted he was tired, but nothing worse, only for her to see him on a video call “looking deathly.”
HC-One attributed the number of infections in part to Home Farm being “one of the first care homes where everyone was tested.” The company said it was “confident the manager acted appropriately with regards to Mr. Harris’s health.”
The police are now investigating the deaths of three residents. The local health service has stepped in to help run Home Farm. Regulators tried this month to take HC-One’s license in court but have since backed off.
In the absence of details about the outbreak, islanders said, rumors multiplied and staff members were unfairly blamed.
“It’s a well-connected community,” said Keith MacKenzie, the lone reporter for the local West Highland Free Press during the outbreak. “But of course in well-connected communities, it’s not always the right information that gets circulated.”
But nursing home finances are difficult to trace. The HC-One group includes 62 companies, 19 of them registered offshore, and its parent company is based in the Cayman Islands.
“It’s money before care all the time,” Ms. Harris said. “The staff they did have worked so hard, but they’ve been let down.”
On the afternoon of May 6, nurses called Ms. Harris to tell her that her husband’s breathing was failing. She hurried over. Zoe Docherty, their daughter, was already in protective gear, holding her father’s hand.
Ms. Docherty asked that her mother be allowed inside; management had said they could take turns visiting. But she and a nurse disagreed about how to choreograph the swap, and at Ms. Docherty’s frantic urging, the nurse left to consult colleagues.
Meanwhile, Mr. Harris died, with his wife looking through the glass from outside.