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Seashore Point

    HEALTH CARE

    Nursing Home Reform Languishes on Beacon Hill

    Despite latest failure, 3 lawmakers say long-term care legislation is not dead

    By

    PROVINCETOWN — Massachusetts politicians at both the state and federal level have made recent moves toward tightening regulation of the long-term care industry, especially as private-equity firms continue to buy up nursing homes across the country.

    On Beacon Hill last week, the House and Senate failed to pass a major long-term care bill, however, allowing it to become one of nine bills that had advanced to a conference committee but were then abandoned as the formal legislative session ended in acrimony.

    State Sen. Julian Cyr and the two chairs of the legislature’s Joint Committee on Elder Affairs — Sen. Patricia Jehlen of the Second Middlesex District and Rep. Thomas Stanley of the Ninth Middlesex District — all told the Independent that the long-term care bill might still pass during informal sessions, when bills require unanimous consent from all legislators who are present.

    “I believe we will pass a long-term care bill,” said Stanley. “We have to. It’s just one tragedy after another.”

    As the Independent recently reported, the nursing home at Seashore Point in Provincetown has consistently failed to meet state nursing hour minimums since Pointe Group Care, a for-profit company, bought the facility in 2019. Multiple experts’ analyses of the nursing home’s financials suggest that the owners have directed revenue through a maze of related companies while reporting an overall loss on the operation, according to their Medicare and Medicaid cost reports.

    Former patients and staff at Seashore Point have described to the Independent the harmful consequences of inadequate care.

    The House’s version of the long-term care bill would have given the state Dept. of Public Health (DPH) significant new powers — including the ability to suspend or revoke a nursing home’s license and to impose a third-party temporary manager to right the ship of a failing facility. It also would have doubled the penalties for violations, according to a summary prepared by Paul Lanzikos, co-founder of the advocacy group Dignity Alliance Massachusetts.

    Sen. Jehlen said that the Senate’s version of the bill authorized a tenfold increase in the financial penalties that the attorney general’s office and DPH could impose for violations.

    The House passed its bill in November; it was referred to the Senate Ways & Means Committee, where it languished until July.

    For advocates of long-term care legislation, the result was frustrating but not unexpected.

    “We’d like to see the legislative route be a more effective, fruitful avenue but unfortunately, in Massachusetts, the outcome of the legislative efforts is minimal,” said Lanzikos.

    In addition to lobbying the legislature, Dignity Alliance Massachusetts tries to pressure regulatory agencies to use their existing powers more aggressively — including more vigorous reviews of nursing home financial transactions and imposing “admission freezes” on facilities that fail to meet staffing minimums.

    Lanzikos said that DPH is not adequately funded for such work, however.

    “This sector has been neglected for decades,” he said. “The staffing for the frontline personnel in DPH who do the inspections needs to be beefed up.”

    “It’s like throwing cement against the wall — some of it eventually will stick,” said Jim Lomastro, chair of Dignity Alliance Massachusetts’s veterans group, of their efforts to lobby for reforms.

    The AG Takes Steps

    While the legislature has so far failed to act, Mass. Attorney General Andrea Joy Campbell has taken steps toward reining in mismanagement of the state’s nursing homes. An Elder Justice Unit was created in the attorney general’s office last year, and in June Campbell announced a $4 million settlement with Next Step Healthcare for significant staffing and care failures, the largest nursing home settlement ever achieved by the attorney general’s office.

    Next Step Healthcare has 16 nursing homes in Massachusetts and averages a score of 1.9 out of five “stars” in the government’s rating system. That is higher than the 1.6-star average rating of the 14 homes run by AdviniaCare — the company that operates Seashore Point.

    AdviniaCare’s homes also averaged a higher nursing staff turnover rate, had the same average number of nurse hours per resident per day as Next Step Healthcare, and have been fined the same number of times as Next Step Healthcare, according to Centers for Medicare and Medicaid Services nursing home “affiliated entity” performance measures. Four AdviniaCare facilities are marked with “abuse flags,” while no Next Step Healthcare facilities are.

    A representative from Campbell’s office confirmed that it had received complaints about AdviniaCare — but would not comment on whether an investigation was underway.

    In July, the attorney general announced that the state would take control of three nursing homes owned by Blupoint Healthcare in South Hadley, Whitinsville, and Amesbury because the company stopped paying its staff, according to Commonwealth Magazine.

    Lanzikos said that Blupoint was an example of what happens when the DPH fails to do due diligence before nursing home ownership transfers.

    Chronic Staffing Issues

    The state DPH and MassHealth have also been monitoring staffing levels at Seashore Point.

    A representative from the Executive Office of Health and Human Services, which includes DPH and MassHealth, told the Independent in an email that the Seashore Point nursing home has failed to meet nursing hour minimums in five of the last 12 quarters, and that “recoupment payments” imposed by MassHealth total $45,990.

    The representative would not confirm how much of that amount has been paid. AdviniaCare’s communications team did not respond to questions about whether the $45,990 has been paid back to the state.

    Instead, a lawyer representing the owners of Seashore Point wrote that the facility “is in compliance with federal and state regulations and is unaware of any investigations into the facility.”

    Stricter regulation of nursing homes is only part of the solution, according to Lanzikos. “We want to make sure that the people who are living there are treated with respect, and that services are good quality,” he said, “but we’d like to see many of them living outside a nursing home and back in the community.”

    In April, Gov. Maura Healey settled a class-action suit against the state by six nursing home residents; the settlement included a plan to move no fewer than 2,400 people out of nursing homes and back into the community, according to the Massachusetts Senior Care Association.

    In Congress

    Both of the state’s U.S. senators have introduced bills in Congress that target the ownership of nursing homes by private equity.

    Sen. Ed Markey’s “Health Over Wealth Act,” introduced on July 25, would require greater transparency from private equity-owned health care entities and prohibit private equity from stripping assets from their health care businesses.

    A month earlier, Markey and Sen. Elizabeth Warren introduced the “Corporate Crimes Against Health Care Act,” which creates a penalty of up to six years in jail for executives who financially “loot” nursing homes or hospitals if that looting results in a patient’s death, along with other measures meant to target private-equity executives.

    SEASHORE POINT

    Reviewers Suspect Fraud in Nursing Home Filings

    Experts find evidence of hidden profits in the millions

    By

    PROVINCETOWN — Since taking over the nursing home at Seashore Point in 2019, the current owners have used a complex network of companies to pay themselves hidden profits — possibly totaling over $1 million — while cutting nursing staff hours dramatically, according to expert analysis of the company’s federal and state filings.

    Christopher Cherney, an expert in nursing home administration, reviewed Seashore Point’s cost reports. His investigation found several irregularities, which in his opinion suggest that the data submitted to Medicare and Medicaid may have been fraudulent to hide payments to owners.

    In his analysis comparing the facility’s 2021 Medicare and Medicaid reports, Cherney found that the owners appear to have paid their own companies up to 35 cents of every dollar the facility brought in. The amounts reported to federal and state authorities differ dramatically, however, and Cherney said it cannot be known how much of the payments to their own companies was actually profits. Payments from the facility to other owner-controlled companies, only some of which appear to have been disclosed, could have been potentially as high as $1.5 million in 2021 alone, according to Cherney’s preliminary analysis.

    Ernest Tosh, a Texas-based lawyer who specializes in nursing home abuse and neglect cases, also reviewed the facility’s data and filings. He found evidence that, in his opinion, suggested that the owners failed to consistently and accurately report “related parties,” the technical name for companies controlled by the facility’s owners or their family members.

    Tosh told the Independent that overpaying related parties is one of the most common ways for-profit nursing homes siphon extra money to owners while maintaining a bottom line that reports only small profits or small losses.

    “If these facilities were actually losing money, why would private equity keep buying them?” said Tosh.

    An analysis of the related companies that Seashore Point did disclose on its Medicare cost reports from 2020 to 2022 found that the owners appear to have pocketed at least $1,204,482 from self-reported overpayments to a management company, rent company, rehabilitation company, and payroll company.

    “You got an additional million dollars of profitability that nobody knew about,” said Tosh.

    Investigators from the Mass. Dept. of Health and Human Services found 11 deficiencies in their last inspection of the Seashore Point nursing home, which has been fined more than $32,000 by the state since 2020.

    Preliminary Findings

    Every skilled nursing facility in the country that receives Medicare or Medicaid reimbursements is required to file cost reports with information about revenue streams, payroll, assets, and expenses. The owners must attest that the reports are accurate under penalty of perjury.

    In his analysis, Cherney used the 2021 reports because 2021 is the most recent year of Medicaid data published by the Mass. Center for Information and Analysis.

    Multiple budget lines in the nursing home’s Medicaid cost report did not pass the “smell test,” said Cherney. One of the most confounding was $266,440 that the facility reported in advertising expenses for 2021. He called that number for a 41-bed nursing home with a 91-percent occupancy rate and without any apparent nearby competitors “unprecedented.”

    “I’m trying to understand this advertising fee, and it doesn’t square with my experience,” said Cherney. “It’s a potential place to hide profit.” If the number reported was accurate, then the nursing home would have spent over $22,000 per month on advertising in 2021.

    The Independent asked AdviniaCare, the company that operates the nursing home, for evidence of advertising expenditures, such as an invoice to a marketing company. The company’s media specialist did not respond to that request but referred instead to a statement saying that AdviniaCare complies with all federal and state regulations.

    Cherney calculated that the reported advertising budget alone would pay for about 26 more hours of nursing care per day on average, an increase of about 25 percent.

    AdviniaCare’s Pleasant Bay of Brewster Rehab Center reported advertising expenses of $661,269, according to its 2021 Medicaid cost report.

    The Seashore Point nursing home also reported spending $71,932 — about $6,000 per month — for software support. Cherney said that makes “no sense” for a 41-bed nursing home.

    Cherney, who serves as an expert witness in nursing home cases in California, said that he came to his preliminary conclusions with a “reasonable degree of certainty with respect to nursing home administration.” But he also said there were still unknowns about Seashore Point’s finances.

    Some of the “related parties,” or owner-controlled companies, disappear in the Medicare or Medicaid reports. According to Illinois business records, Benjamin Berkowitz, one of three current owners of Seashore Point, is a manager of the reported management company called Pointe Group Care LLC. According to Massachusetts business records, he is the manager of 100 Alden St. LLC, which is the rent company.

    Yet in the 2021 Medicaid cost report signed by Berkowitz, he did not disclose either company as a related party. The result is $820,283 in dealings between Berkowitz’s companies not disclosed as related-party transactions.

    AdviniaCare declined to provide an explanation of why these companies were not reported as related parties in the Medicaid cost report.

    “I don’t know what to make of that, except that it is not true,” said Tosh, the expert on nursing home abuse and neglect, when he reviewed the discrepancies between the two reports.

    Seashore Point’s owners, Benjamin Berkowitz, David Berkowitz, and Yosef Meystel, declined the Independent’s request for an interview through their media consultant. The statement from AdviniaCare reads: “We are committed to our patients, residents and employees and that is why we continue to invest in this facility. We are proud to operate the only skilled nursing facility on the Outer Cape — the next nearest nursing home is 31 miles away. In response to the Independent’s questions about information that differs between the Medicare and Medicaid cost reports, the two programs require different information — this is why they don’t simply share the same form. We have provided all of the necessary information and disclosures to the government. The operations of AdviniaCare Seashore Pointe are structured no differently than most nursing homes, and comply with federal and state regulations.”

    The company’s media consultant did not answer questions about the number of employees at the management company, rent company, rehabilitation company, and payroll company that are listed as related parties. The consultant also declined to provide an explanation for the discrepancies between the Medicare and Medicaid reports.

    Standard Practice

    According to a report called “Where Do the Billions of Dollars Go?,” the proliferation of nursing homes using related parties started after a 2003 article appeared in the Journal of Health Law. The article suggested that nursing homes restructure and create multiple single-purpose corporations to protect the owners from civil judgments.

    Since then, the use of companies controlled by shared interests has skyrocketed in the industry. Nearly three-quarters of all nursing homes used related-party transactions in 2015. That year, related-party transactions totaled $11 billion, according to an analysis of Medicare cost reports by the authors of a 2021 Health Affairs article.

    In a research paper released this spring, professors Ashvin Gandhi and Andrew Olenski found that as much as 68 percent of all nursing home profits were hidden by “tunneling,” or “covert profit extraction” using related parties. Gandhi and Olenski found that 77 percent of profit tunneling occurred through rent and management companies.

    Payments made to related parties show up as expenses on the bottom line. So, while Medicare cost reports from 2020 to 2022 suggest that the nursing home in Provincetown made $1,204,482 in overpayments to owner-controlled companies, the nursing home itself reported a net loss of $415,997 for those years.

    “It’s very common for these facilities to report very small positive or very small negative profit margins,” said Olenski. “My suspicion is that often the reason why your expenses are just right at your revenues is that you have chosen the prices of your rent or your management fees to make your expenses right in that range, just right above or just below.”

    “The financial practices employed by Seashore Point are extremely common across the country,” said Sam Brooks, the director of public policy at National Consumer Voice for Quality Long-Term Care, an advocacy organization focused on improving nursing home care. “Ultimately, the blame lies with federal and state governments that fail to ensure that tens of billions of Medicare and Medicaid dollars are going toward resident care and not to owners.”

    “There’s no real enforcement mechanism that the Centers for Medicare and Medicaid Services has to ensure the data you’re submitting is accurate,” Olenski told the Independent.

    “They don’t realize the amount of suffering that is going on in the nursing homes that could be prevented if we understood the financial situation,” said Tosh. “The system is broken.”

    The facility’s previous owner, the nonprofit Deaconess Abundant Life Communities, did not report a single related party transaction in its Medicare cost reports for 2017 or 2018.

    The nursing home at Seashore Point is connected to independent-living condominiums. In a November 2022 letter obtained by the Independent, Benjamin Berkowitz informed the condominium owners that concierge fees at the condos would increase from $250 to $600 per month for a one-bedroom apartment. Berkowitz cited “significant losses over the past several years” that Seashore Pointe Service Co., LLC, another of his companies, incurred in his decision to hike the fees.

    As previously reported by the Independent, the condominium owners have filed a lawsuit against Pointe Group Care, the corporate owner of Seashore Point, claiming fraud and elder abuse.

    A MANAGEMENT ISSUE

    Patients Suffer at Outer Cape’s Only Nursing Home

    AdviniaCare at Seashore Point fails to meet state minimum-staffing standards

    By

    PROVINCETOWN — This past spring, a Provincetown resident who the Independent has agreed not to name to protect the person’s privacy checked into the Seashore Point nursing home for rehabilitation after breaking a leg. Three family members described what happened to their loved one there as “horrific.”

    The Seashore Point senior living and residential rehabilitation facility at 100 Alden St. in Provincetown. Although the company that owns it, Pointe Group Care, calls the facility “AdviniaCare at Seashore Pointe,” the sign in front of the building spells “Point” without an “e.” (Photo by Jack Styler)

    During a two-and-a-half-month stay, the patient had to be taken to Cape Cod Hospital for multiple infected wounds. When the family decided to remove the patient from the facility, their loved one was on the verge of collapse and had to be rushed to the hospital again. Doctors diagnosed respiratory failure, Covid, a urinary tract infection, sepsis, and a drug-resistant Staphylococcus aureus infection (MRSA).

    The three family members, one of whom is a doctor, said the infection was life-threatening.

    If left at Seashore Point any longer, the patient “would have died,” said one family member.

    “It was horrific because you just knew it wasn’t right, and it was right before your eyes,” said another. “And you couldn’t do anything about it.”

    According to another former patient, a former employee, a complaint investigation report, a state inspection report, and federal staffing data, this family’s experience of substandard care at Seashore Point’s rehabilitation facility was not an anomaly.

    Since a for-profit company, Pointe Group Care, bought the nursing home at Seashore Point in 2019 from the nonprofit Deaconess Abundant Life Communities, public records show the quality of care has been in steep decline.

    According to public data, the nursing home at Seashore Point, now formally called AdviniaCare at Provincetown, has failed to meet state-mandated nursing-hour minimums 552 times — about 55 percent of all days — since the requirements went into effect on April 1, 2021.

    The most recent year reported, 2023, was the facility’s worst on record. The nursing home did not meet the state minimum of 3.58 care hours per resident per day on 215 of 365 days that year, according to data analyzed by the Independent and by a certified public accountant who analyzes data for state nursing home investigations.

    The 41-bed nursing home, located on the first floor of the Seashore Point complex at 100 Alden St., is the only skilled nursing facility on the Outer Cape. It provides short-term stays for rehabilitation as well as long-term care for patients suffering from serious cognitive impairments, such as dementia, who need around-the-clock attention.

    The federal Centers for Medicare and Medicaid Services (CMS) “Nursing Home Compare” tool gives the AdviniaCare at Provincetown facility a two-star rating out of five. The Mass. Dept. of Health and Human Services (DHHS) also rates it below the state average.

    Inside the Home

    Pointe Group Care denied the Independent’s request for a tour of the nursing home. State inspection reports, a former resident, and a former staffer all report serious problems there, however.

    On Feb. 7 of this year, CMS and DHHS completed a complaint investigation following an incident in early January. According to their report, a certified nursing aid (CNA) attempted to assist a resident into a “Hoyer lift,” a mechanized swing used to move patients in and out of beds and wheelchairs.

    The lift usually requires two staff members to operate. The CNA, however, transferred the resident into the lift and then into a reclining wheelchair alone, then left the patient in the reclining wheelchair unsecured and went to find another staffer for help.

    When the CNA returned the reclining wheelchair had tipped backward, causing the resident’s head to hit the floor.

    The resident required seven staples to treat a “deep gash” on the head, according to the report. Pointe Group Care was fined $11,333.

    In a standard inspection by CMS and DHHS on Feb. 15, 2024, investigators found 11 deficiencies. Inspectors noted that one resident had fallen six times in nine days and observed another resident “at risk for developing pressure ulcers,” or bed sores.

    In 2022, Anika Costa, a Provincetown native, stayed in the nursing home at Seashore Point for one week while recovering from a knee replacement. On her first night, Costa said, she used the button next to her bed to call a nurse for pain medication. No one came. Eventually, Costa lifted herself out of bed and into a wheelchair to find help.

    When she reached the hall, she saw that three of the four beds in her corridor also had their call lights on. “That occurred more than once,” said Costa.

    The family of the resident who went to the hospital with multiple infections reported similar issues. On multiple occasions, their relative called home to ask family members to phone Seashore Point’s front desk and let them know that they needed to go to the bathroom, said one family member.

    Costa told the Independent that she also had to help herself to the bathroom because the staff either did not respond or were not able to take care of everyone. She said she witnessed unattended medicine carts, overflowing dirty laundry, and the doors of the nursing station left unlocked.

    Costa also reported that she heard from nurses and family members of residents who said they were buying and bringing in their own care-giving supplies. Costa said shampoo, wet wipes, and cloth bed pads were especially in demand.

    Kristin Hatch was director of social work at the nursing home when it was being run by Deaconess and then worked there part-time after the Pointe Group bought the property. She confirmed that there were times when staff bought their own supplies for patients.

    Hatch told the Independent that there were very good nurses at Seashore Point during the years she worked there. “Everyone who works at Seashore Point cares about the residents,” she said.

    But she was not surprised to hear that the facility had been consistently failing to meet staffing minimums, and she said she believed care quality had dropped.

    “I am positive that it is not because of the staff,” Hatch added. “It’s a management issue.”

    Pointe Group Care runs 14 nursing homes, 11 of them in Massachusetts.

    “The administrator for Seashore Point was also the administrator in Salem and almost everything in between,” said Hatch. “So how many days a week is she actually there?”

    A doctor visited the facility only once per week when she worked there, Hatch said. The social worker position has not been filled since she left two years ago. An employee at Seashore Point told the Independent that the nursing home administrator and social worker positions have been combined.

    Hatch quit working for AdviniaCare because of declining quality, she said. When the Independent first contacted her with questions about Seashore Point, her immediate reply was, “It’s about time.”

    Connected Companies

    The nursing home and independent-living condominiums that make up Seashore Point were built after Provincetown sold the town-owned Cape End Manor nursing home in 2006 to Deaconess, a nonprofit founded in 1889.

    After 13 years of running it, Deaconess sold Seashore Point and its land to three men: Benjamin Berkowitz, David Berkowitz, and Yosef Meystel. Ben Berkowitz owns 36 percent, while David Berkowitz and Yosef Meystel have trusts in their names that each have 32-percent ownership.

    Seashore Point is one of a number of nursing homes in which the trio have controlling stakes.

    According to ownership data from CMS, Benjamin Berkowitz partially owns 15 nursing homes, most of which are in Massachusetts or Florida. David Berkowitz, through his trust, has an ownership stake in at least 68 homes from Florida to Illinois to Massachusetts. Meystel has a portfolio of at least 70 homes.

    Pointe Group Care, the company behind the AdviniaCare brand, was registered as a limited liability corporation in Illinois by Benjamin Berkowitz in March 2016. Since then, Berkowitz and his associates have bought and managed 14 nursing homes under the name “AdviniaCare” in Massachusetts and Florida.

    According to CMS nursing home performance measures, 28 percent of AdviniaCare homes have an abuse icon, meaning the facility has a deficiency that has harmed a resident in the last year or potentially could have harmed a resident within each of the last two years.

    AdviniaCare facilities average 1.6 “stars” on the agency’s five-star scale and have been fined over $1 million by the government for care deficiencies, according to the latest CMS reports.

    AdviniaCare also operates AdviniaCare Pleasant Bay in Brewster, which has a history of quality issues and has accrued $169,000 in fines since 2020. The most recent standard inspection by DHHS found 29 deficiencies at Pleasant Bay.

    The worst-rated nursing home in the group is AdviniaCare Newburyport, which has been fined more than $228,000 and been cited for 67 deficiencies in just five years.

    Official Response

    In a statement, Nury Carreno, the regional director of operations for AdviniaCare, said, “AdviniaCare Seashore Pointe provides high quality care to its short-term rehabilitation patients and long-term residents. As the only nursing home on the Outer Cape, it plays a critical role for older Cape residents. It is well staffed, with a four-star staffing rating on Medicare.com. Unlike many nursing homes, it is fully staffed by employees and does not currently use any outside staffing agencies. It has a consistently high patient census with a low rate of hospital readmission. To use one or two examples of residents with complications or an employee error to make a sweeping statement about this center, as the Provincetown Independent seems intent on doing, would be unfair.”

    The four-star rating referenced in Carreno’s statement is from the CMS “care compare” tool, which experts say is not always reliable.

    “CMS care compare is not a great gauge of quality,” said Sam Brooks, director of public policy at the National Consumer Voice for Quality Long-Term Care, an advocacy organization focused on improving nursing home care.

    “It’s a relative measure based on how a facility performs in comparison to other nursing homes,” Brooks said. “If you look at the actual staffing numbers, this facility is likely staffing well below what they should be.

    “The cornerstone of quality care is staffing,” Brooks said. “You see that not in star ratings but in clinical outcomes.”

    ELDER AFFAIRS

    Seashore Point Residents Sue Owner, Claiming Fraud and Abuse

    Pointe Group Care is accused of exploiting residents and charging unreasonable fees

    By

    This article was updated on Oct. 26.

    PROVINCETOWN — When Robert Compton purchased his condominium at the Residences at Seashore Point four years ago, he imagined an ideal retirement. Seashore Point offers “independent living”; residents attend events together, eat together, and make decisions as a community. Compton, now 74, sold his house on Bayberry Avenue with the expectation that, at Seashore Point, “somebody else is going to cut the grass and water the lawn and make sure that the heat’s working.”

    The owner of Seashore Point, Pointe Group Care, has been accused of elder abuse and fraud. (Photo by Elias Duncan)

    But for the last two years, he’s been locked in a conflict with Pointe Group Care, the for-profit owner of Seashore Point, about what services it provides residents and at what cost. In 2019, the group and its subsidiary, Provincetown Holding Company, purchased the property, along with the attached nursing facility, AdviniaCare at Seashore Point, from the nonprofit Deaconess Abundant Life.

    Compton says the free parking residents were promised now costs $275 a month, and condo fees have jumped from $250 to $600 a month. Elderly residents on fixed incomes, he says, did not plan for these higher costs and cannot afford them.

    Five residents at Seashore Point filed suit on April 6 in Superior Court, accusing Point Group Care of “unchecked elder abuse, fraud, and manipulation.” Compton is the lead plaintiff; the others are Robert MacDonald, Robert Hanna, Michael Peregon, and Walter Winnowski.

    The suit argues that Pointe Group Care manipulated the value of its ownership of units at Seashore Point to fraudulently claim a majority of seats on the condo’s governing board and thus control the board’s decisions.

    The suit also alleges that fees at Seashore Point have grown substantially in the last year even as Point Group has cut services. Compton says the fees subsidize the attached nursing home, which lost $1,129,040 in 2020, according to the company’s tax filings. The plaintiffs claim residents are paying 96 percent of the condominium’s $1.4 million budget for 2023 though Pointe Group Care owns roughly 48 percent of the property.

    “We have worked very hard to find a resolution to the unit owners’ concerns, with no success to date,” said David Ball, a spokesman for Provincetown Holding Company. “We are confident that the facts and the law are on our side.”

    Parking Fees

    The conflict began when Pointe Group Care purchased Seashore Point in November 2019 from Deaconess Abundant Life, the nonprofit that had owned the property for 14 years. The change from a nonprofit to a for-profit owner, according to court documents, made the condominium contract untenable.

    In early 2020, Pointe Group took control of the outdoor parking area, according to Compton. Only 35 spots in the lot are available to residents of the 81 condominium living units, the suit alleges. Without free parking in the lot, residents are compelled to pay for parking at the Pointe Group Care-owned parking garage. As of 2023, according to the suit, the garage charges a one-time “license issuance fee” of $5,000 to use the garage plus $275 per month. The plaintiffs claim that cumulative license and parking fees paid by residents for the garage will total about $175,000 in 2023. Pointe Group Care says it anticipates earning $108,900 from monthly garage fees this year.

    The case hinges on Pointe Group Care’s claim that it owns an inflated percentage of the property, according to the suit. Most of Pointe Group’s property consists of “service units,” including the nursing home and the garage. Compton says Point Group Care overestimates the value of the service units, which are worth less per square foot than residential units. That enables Pointe Group to claim a larger stake than it really has, he says.

    According to court documents, Pointe Group also calls several spaces “service units” that actually communal space. This practice began with Deaconess Abundant Life, which also referred to these communal spaces incorrectly as condominiums, according to the suit. These spaces “have no rooms or defined physical boundaries,” the plaintiffs charge, yet Point Group devised a fee based on these “fraudulent” service units, thus charging residents to “walk through hallways and lobbies,” the suit says. According to state law, all owners of the condominium are entitled to own common areas and facilities together in proportion to their total ownership.

    The Concierge Fee

    The final straw for residents was a “concierge fee,” the suit argues, for security services, monitoring of emergency alert systems, social programs, and some transportation, under a residency and services agreement established in 2015. The fee is mandatory for residents, though its value is not listed in the agreement. The plaintiffs say it is currently $631 per month.

    Compton says the fee is foisted on unsuspecting new residents. After purchasing a unit, he says, “You’re all excited. You want to move in, and you want to get the key. And that’s when they say, ‘Oh yeah, well, by the way, you have to sign this service agreement. And you can’t have your key or parking space until you sign.’ ”

    According to Compton, Deaconess Abundant Life, the previous owner, had supplied the services said to be covered by the concierge fee in the service agreement. But when Pointe Group Care took control, the services began to dwindle. This was partly because of the pandemic, when social distancing made use of common spaces and community programs nearly impossible. Yet Point Group continued to charge residents a “residency and lifestyle” fee each month.

    The plaintiffs claim they now pay for all these services themselves. Compton says that support for social programs is lackluster, with residents putting on all social events themselves — for instance, he runs the movie screenings. He says that Pointe Group Care doesn’t offer additional community services “other than once a week they vacuum.”

    In July 2021, Pointe Group approached the residents and offered to sell them its service units in the independent living facility for $1.5 million. The residents couldn’t afford that price, Compton says, because “we’re all retirees living on Social Security and IRAs.” After that, Compton and other residents consulted attorneys Edward Allock and Sean Regan of the Braintree firm Allock & Marcus, and Pointe Group “backed off,” Compton says. “Everything was quiet for a year.”

    Nearly a year and a half later, in November 2022, Pointe Group Care approached the residents again, this time offering to sell its service units for $700,000. A Nov. 17, 2022 letter from Ben Berkowitz, CEO of Pointe Group Care, obtained by the Independent informed residents that in 2023 the concierge fee would be increased to “make up for the significant losses over the past several years.” Alternatively, Point Group offered to sell 26 service units to residents, claiming “the proposal benefits all parties.” Compton says Berkowitz rejected an offer to negotiate an agreement.

    In January 2023, Pointe Group Care raised the concierge fee from $250 per month to $600 per month, says Compton. The services agreement says Point Group can raise condo fees and service fees but not the concierge fee, he says.

    “We categorically deny these assertions,” wrote David Ball, the Provincetown Holding Company spokesman. “Fees for some services, which were held steady during the pandemic, have been increased to account for increased operating costs, just as the cost of gas and groceries has increased due to inflation as well. We have adhered to the complex terms of the agreement we made when we purchased this property.”

    Most residential unit owners at Seashore Point support the lawsuit, according to Compton. In its response to the suit, Pointe Group Care states that, as of 2023, 24 unit owners are not paying any concierge fees, and 18 are paying the rates from before the increase. In total, 42 owners of the 81 residential units are not paying the new fee, the company says. Compton says that around 53 owners of residential units are contributing financially to the legal fund.

    The suit is set to go to trial in August 2026, according to Compton. Ultimately, he says, the residents would like to come to an amicable resolution.

    “Nobody wants to go to court,” he says. “Can we just sit down and come up with something reasonable that these retirees can afford?”

    Editor’s note: Because of an editing error, part of the response to the lawsuit sent by David Ball to the Independent was omitted from an earlier version of this article, published in print on Oct. 26.

     

    ELDER AFFAIRS

    Seashore Point Residents Say Condo Agreement Is Fraudulent

    The basic residency contract created by Deaconess Abundant Life is at issue

    By

    PROVINCETOWN — The owners of two units at the Residences at Seashore Point are about to file suit against the company that controls the senior living community and its adjoining skilled nursing facility, alleging that the condominium agreement governing the property is void and was based on fraud.

    Plaintiffs Diana Lu and Bertram and Marla Perkel claim that Seashore Point’s condo board is controlled by the Pointe Group Inc. of Norwood via an illegal subterfuge that was originally devised by Deaconess Abundant Life Communities, the previous owner of the property, which took it over from the town 14 years ago.

    Bertram Perkel, known as “Buddy,” is a retired New York City lawyer and former chair of the Truro Zoning Board of Appeals. The Perkels moved to Seashore Point two years ago.

    seashorept
    Two owners of apartments at Seashore Point claim that its condominium agreement is void and was based on fraud. (Photo Nancy Bloom)

    The Lu and Perkel complaint alleges that the condo agreement fraudulently defines common areas of the building, such as the lobby, hallways, and closets, as “units,” and endows the owner of those “units” with majority control of the board. But Massachusetts law, they claim, requires that “units” in a condominium be habitable — and virtually all of the “units” owned by the Pointe Group are not.

    The complaint seeks a declaratory judgment that would remove control of Seashore Point from the Pointe Group and give it to the owners of the 81 apartments there.

    In an Oct. 2 letter to the other residents, Buddy Perkel wrote, “After discussions with counsel, I believe that the Residency Agreement itself is unenforceable for any purpose, failing as both a violation of condo law and as a contract….” He asked that other residents help pay the expenses of filing suit in Mass. Land Court.

    According to a draft of the complaint, a copy of which was obtained by the Independent, Seashore Point is controlled by a seven-person board. Only two members of that board are elected by the residents. The other five are chosen by the owners of 33 “service units” and the “garage unit.”

    Almost all of the so-called service units are closets, corridors, lobbies, and other uninhabitable spaces that would normally be considered common areas, Perkel said. Since all of the service units and the garage unit are owned by the Pointe Group, it is guaranteed control of the board, which awards management contracts and determines fees and assessments.

    The complaint alleges that the residency and services agreement at Seashore Point, “which charges an additional fee for the use of service units, is unconscionable and is a method to subsidize Pointe Group, Inc.’s portion of the common expense….”

    Chris Hannon, chief operating officer of the Pointe Group, did not respond to a telephone message from the Independent seeking comment this week.

    Fire Sale Price

    Seashore Point also includes a 42-bed rehabilitation and long-term care facility, the only one of its kind on the Outer Cape. With more than 100 employees, it is one of the largest employers in Provincetown.

    The nursing facility was formerly run by the town as Cape End Manor. After years of mounting operating losses, it was taken over in 2006 by Deaconess Abundant Life, a nonprofit based in Concord. Deaconess sold Seashore Point to the Pointe Group, under the name Provincetown Holdco LLC, on Nov. 1, 2019, for $1,519,862. The property is currently assessed by the town at $6,556,400.

    The condominium agreement now at issue was originally created by Deaconess when it assumed ownership and oversaw the construction of 43 new residential units in 2008 and an additional 38 units in 2014.

    Why was Seashore Point sold last year at such a bargain price — less than one fourth of its assessed value?

    “Deaconess had to get rid of it,” Perkel told the Independent. “They were bleeding money. They made a profit by giving it away.” The sale, he said, included a number of vacant apartment units that Pointe Group was able to sell and thus recover more than the $1.5 million it paid for the entire property.

    At the time of the sale, Christopher Sintros, the president of Deaconess Abundant Life, said, “We have every confidence that Pointe Group is the right organization to lead the Residences at Seashore Point into the future.”

    Sintros did not respond to a request for comment relayed to his assistant this week.

    Perkel wrote to the other residents that Pointe Group now “wishes to cut the condo budget in half, reducing our condo fees by 50 percent. That would have the effect of also reducing the Group’s condo expenses by that same percentage. The condo operations, however, cannot be supported under a budget like this and the budget proposal addresses that problem by an off-budget reference to ‘purchased services.’ Past experience suggests that the Group intends that these usual condo expenses will be passed on to the residential owners exclusively.

    “I believe that they are again contemplating the use of the Residency Agreement, under which most of us pay the concierge fee, as the vehicle to effect this,” Perkel’s letter continued. “Under this scenario, the ‘concierge’ fee would have to be increased by an amount sufficient to cover the budget gap they created. This could mean that we are all saddled with our proportionate share of approximately $50,800 per month to cover this estimated $610,000 budget gap.”

    On Monday, Perkel said that a final version of the complaint was being prepared and that he expected the suit would be filed within about two weeks.

    FAMILY

    Covid Changes Connections Across Generations

    Ironically, it’s harder when grandparents and grandchildren live near one another

    By

    Every Monday night, Sue Eldredge meets her daughter and granddaughter over Zoom for dinner. In a way, that’s a lot more togetherness than they had before the pandemic, when she kept in touch with them over the phone or by email.

    She has also seen her four-month-old great-grandson in person, while wearing a mask and maintaining social distance. Eldredge said, if the pandemic continues into fall, she will most likely see her grandkids indoors, though they’ll all be wearing masks.

    Eldredge lives in Orleans, at Rock Harbor Senior Housing. For her, interacting with family in the same ways she did before would not be worth the risk of being sick. Sally Levine, another resident of Rock Harbor Senior Housing, agreed. Like many people in senior housing, they are adjusting to new rituals.

    Where the distances are greater, staying in touch didn’t change too much. Buddy Perkel, who lives in Provincetown at Seashore Point, has grandchildren living on the West Coast whom he has not seen in person during the pandemic. They use FaceTime to stay in touch.

    But although it has started some good routines, the pandemic has changed lots for grandparents and their grandchildren who live near one another. It’s hard not to hug.

    Maya Braga De Lima and her grandmother
    Maya Braga De Lima, left, with her grandmother Mimi Butts. They live right next door to each other. (Photo André Lima)

    “My grandparents live extremely close to me, so whenever I needed a cup of flour or a ride when my parents were busy or at work, I would always just walk over to my grandparents’ house,” said Maya Braga De Lima, 13, of Wellfleet. “Before the pandemic, the level of contact between my grandparents and me was pretty high.”

    “Because she lives close,” said Iona Kaplan, 13, “before Covid I was seeing my grandma about once every two weeks.” Saffron Jalbert, from Orleans, also a 13-year-old, said she was seeing her paternal grandparents almost every day, since they live right next door to her. She saw her maternal grandparents almost weekly.

    When the pandemic started, levels of contact between family members fell quickly — and that wasn’t easy. Kaplan said at the height of the pandemic she was not seeing her grandmother at all, because “we were unsure how to handle Covid.”

    “I saw my grandparents on my mom’s side every week over FaceTime, and my grandparents on my dad’s side from across the yard,” Jalbert said.

    “Occasionally my grandmother would come over to drop off something while wearing a mask, Braga De Lima said. “I never saw my grandfather because he has ongoing health issues, and a pacemaker.”

    Gradually, grandparents and grandchildren have begun seeing each other more frequently. Maya says her grandmother drives her to work and drops off mail, but she still has not entered their house.

    For people in assisted living, the rules of distancing and levels of contact are determined by the facilities. For three months at the beginning of the pandemic, residents at The Terraces in Orleans weren’t allowed any visitors at all.

    Now, The Terraces are allowing only outdoor visits, per order of the state. They push two picnic tables together to create six feet of distance, with the resident on one end and the visitor on the other. During Bingo, all residents are in the same room, but they sit at separate tables that are six feet apart.

    Sally Levine, at Rock Harbor, saw her granddaughter from Brooklyn, N.Y., when she drove down for Levine’s birthday. They wore masks and maintained a distance of around 10 feet, but they talked — for two hours.

    Saffron Jalbert has now resumed seeing her dad’s parents every day, and she sees her mom’s parents every week, maintaining social distance. Her grandmother, Judy Jalbert, who lives in Orleans, has 12 grandchildren, ages 10 to 37. Because they all live on the Cape, she was used to seeing them, and even having the younger ones come for sleepovers.

    “We’ve done a lot of texting,” the elder Jalbert said. “You know, sending pictures, and articles, and ‘Hi, Grandma,’ and that type of thing. Happy birthday notices.”

    The summer weather has helped with visiting safely. For Jalbert that’s meant meeting in the yard, six feet away, and wearing masks. Fortunately, she has a lovely view of the water and a garden, so she and her husband are able to get out and walk around.

    Still, the isolation is getting old. “It’s getting a little too much now, I think.”

     

    STUCK

    Marla Perkel Tells of Overnight Ordeal

    ‘I’m afraid of a lot of things, but not my woods’

    By

    PROVINCETOWN — When her red convertible got stuck in the mud on a dirt road on the Truro-Wellfleet line, Marla Perkel, 84, survived the night by walking, napping, and finally scooting, using her shoes to protect her hands.

    Perkel, who needs a walker or two canes to get around, had neither when her Toyota Solara became mired on a fire road off George Nilson Road in Truro at about 4:30 p.m. on Thursday, June 18. As the temperature that night went from a high of 78 to a low of 55 degrees, Perkel attempted to walk to a main road.

    She had not taken her mobile phone on the ride.

    “I guess I walked through the night and somewhere along the way, I lost my footing and I fell down — and my problem is, I cannot get up very well,” said Perkel, a former New York City mounted policewoman. “I got up twice but immediately fell down again.”

    As someone who started living on the Outer Cape part-time in 1974 and has been here full-time for many years, Perkel knows the landscape by heart. She was driving around that evening visiting her favorite spots in preparation for selling her beloved car.

    “I was feeling very, very bad about selling it,” she said, “so I went on some old paths that I knew well.”

    She didn’t count on getting stuck. As the night went on, Perkel took two naps, but became so cold that her teeth chattered, so she had to keep moving, no matter how slowly.

    She eventually heard the birds beginning to sing. She also heard police sirens, which she figured were for her.

    “I kept calling out, but they couldn’t hear me,” she said.

    At the point of total exhaustion, she stopped moving at 9 a.m. just as four hikers came along.

    The walkers, Janet and Richard Kaiser of Harwich, Lilo Kimball of Centerville, and Susan Jilson of Sandwich, “were so wonderful,” Perkel said, as were dispatchers, police, and firefighters in Provincetown, Truro, and Wellfleet.

    “I said my husband is just about crazy at this point, and he was very, very upset, and he’d called all the police and tried to get help for me,” she said. “The hikers gave me a phone and I called him.”

    The hikers half carried her out of the woods; an ambulance crew found her in good enough health to go home.

    Buddy Perkel, her husband, was waiting for her at their condominium at Seashore Point in Provincetown.

    At Seashore Point, friends, family, and neighbors received her joyously. Perkel said she feels foolish but grateful to dispatchers Sarah Bartholomew, Andreia Ribas, and Samantha Dewitt, as well as to Sgt. Chris Landry, Sgt. Tom Koumanelis, Officers Jason Sullivan, Mike McCauley, Samantha Voltolini, Shannon Beloin, Tom Roda, and Sarah Lake, and Lt. Scott Holway.

    “I’m afraid of a lot of things, but not my woods,” said Perkel. “I guess I’m too stupid to be scared.”

    CURRENTS

    This Week in Provincetown

    By

    Meetings Ahead

    All meetings are held remotely. To watch a meeting go to provincetown-ma.gov and click on the meeting you want to watch. Follow the link to the agenda for instructions on how to watch or participate.

    Thursday, April 30

    • Water & Sewer Board, 2 p.m.

    Tuesday, May 5

    • Conservation Commission, 6 p.m.

    Wednesday, May 6

    • Historic District Commission, 4 p.m.

    Thursday, May 7

    • Zoning Board of Appeals, 6:30 p.m.

    Conversation Starters

    Coronavirus Update

    As of April 27, Provincetown had two confirmed active cases of coronavirus, one death, and 25 additional cases considered recovered.

    Seashore Point Has No Positive Tests

    As of April 27, testing for the coronavirus at the Outer Cape’s only long-term care facility has found no positive cases among residents or staff at Seashore Point’s nursing home, Advinia Care, said David Ball, a company spokesman.

    Advinia Care is owned by the Pointe Group, which also owns the Pleasant Bay Nursing & Rehabilitation Center in Brewster, where 60 of 92 residents tested positive in three rounds of testing at the facility, according to an April 20 report by the town of Brewster.

    Town Clerk Moves to the Schools

    Darlene Van Alstyne, the town clerk for the last three years, will be leaving her job to become the administrative assistant to Provincetown Schools Supt. Suzanne Scallion.

    Her last day is April 30, she said.

    Van Alstyne was the town’s licensing agent for six years and the assistant town clerk for four before becoming town clerk when Doug Johnstone retired.

    Assistant Town Clerk Ana Ruiz will run the office until a replacement is hired.

    “It’s a tough job, but it’s really fun to do,” Van Alstyne said. “Putting together the elections is a lot of work, but come election day, it’s the funnest day of the year.”

    She’s also a fan of the hand-crank ballot box and hopes Provincetown sticks to hand-counting, even though all other Cape Cod towns have decided to use electronic tabulators.

    “People really enjoy coming in, touching that paper, and hearing that ding,” she said. —K.C. Myers

    currents

    This Week in Provincetown

    By

    Meetings Ahead

    From provincetown-ma.gov, click on the calendar or the list on the meeting you’re interested in. When event details are in view, click on the link provided. From there click on the agenda for the meeting. Instructions on viewing and participating are included there.

     Monday, April 27

    • Select Board, 7 p.m.

     Tuesday, April 28

    • Licensing Board, 5:15 p.m.

    Conversation Starters

    Coronavirus Update

    As of April 20, Provincetown had three confirmed active cases of coronavirus and one death from complications related to Covid-19; 22 additional cases are considered recovered and have been cleared from quarantine by the public health nurse.

    Testing at Seashore Point

    On Monday, April 20, Pleasant Bay Nursing & Rehabilitation Center, a facility owned by the same company that recently purchased Seashore Point in Provincetown, reported that 60 of its 92 residents had tested positive for the coronavirus.

    The Pointe Group, which bought Seashore Point last year and renamed the nursing facility Advinia Care, participated in on-site testing provided by the state, said David Ball, the Pointe Group’s spokesman. The residents and staff of the nursing facility at Seashore Point were also tested but the results were not available at the Independent’s deadline Tuesday, Ball stated.

    The Pointe Group agreed to the testing voluntarily in order to see who had the virus. This information is useful since many cases are asymptomatic, but those patients may still be able to transmit the virus, according to a company spokesman.

    Though the testing at Seashore Point was done voluntarily, town boards of health can order long-term care facilities to test all of their residents, said Sean O’Brien, emergency management coordinator for Barnstable County. But there must be a good reason to set mandatory rules, said Steve Katsurinis, chair of the Provincetown Board of Health. There was no compelling reason to order mandatory testing at Seashore Point, Katsurinis said, whereas at Pleasant Bay many patients had complained of symptoms prior to the April 10 testing, according to the Cape Cod Times.

    Over half of the deaths in the state are at long-term care facilities. Age is the biggest predictor of the outcome of the coronavirus, Katsurinis said.

    Anyone concerned about nursing home residents and Covid-19 may call the state Dept. of Public Health’s Nursing Home Family Resource hotline at 617-660-5399. The hotline is open from 9 a.m. to 5 p.m. seven days a week to answer questions and connect people to resources.

    To see the number of positive tests at specific hospitals and nursing homes, the state offers a list updated daily at 4 p.m. at: mass.gov/info-details/covid-19-response-reporting.

    To check Seashore Point’s cases look under Advinia Care in Barnstable County. —K.C. Myers

    CORONAVIRUS

    In Oldest County in State, Gray Areas of Elder Care

    Residents of independent living centers have few protections in pandemic

    By

    PROVINCETOWN — Last Friday, March 20, Seashore Point condominium owner Bruce Mason had just returned from a meditation class with other residents. At the same time in Yarmouth Port, Fran Turgeon was packing up to leave her apartment at Heatherwood, a senior independent living community, after receiving notice from management that the first case of coronavirus had been confirmed there.

    Both 84-year-olds own their condominiums in multi-unit complexes filled mostly by elderly occupants — those at greatest risk from the highly contagious virus.

    Yet management’s approaches to that risk were very different at the two complexes. The reasons for those differences, and the lack of consistent policies to protect vulnerable people from an epidemic, have many older residents of the Outer Cape and their loved ones worried.

    At Heatherwood, residents have been instructed to self-isolate since March 15, said Turgeon, formerly of Eastham. They’ve been told not to walk the hallways for exercise, which normally happens frequently, or to congregate in groups. Heatherwood stopped serving meals in its dining room on March 15 and began delivering them to residents’ doors. After lunch on March 20, the kitchen was shut down completely, with management citing a lack of staff.

    At Seashore Point, groups led by outside teachers have been canceled, Mason said. But the condominium owners still had use of a coffee bar and could gather in the mail area and use the gym, said Barbara “Mae Bush” Stevens. Seashore Point stopped service in the dining room only on March 19, but meal delivery continues there.

    Despite what seem to be stricter precautions, it was the Heatherwood residents who got the memo: “We regret to inform you there is a confirmed case of the coronavirus at Heatherwood.”

    The memo, from Director Scott McClellan, described the patient only as someone “at Heatherwood” without specifying whether the person was a resident or a staff member or how management might proceed with determining specific contact risks or related protocols. McClellan advised residents to “stay in your home to help all of us stay safe. This is a good time to reach out to your family and let them know there is a confirmed case at Heatherwood. Your family may choose to have you stay with them until this crisis passes.”

    Management then informed the 190 or so homeowners that meal service would end that day. Many Heatherwood residents are over 80 years old and some require significant help, including prepared meals.

    Turgeon said she was leaving immediately because she no longer felt comfortable there, not knowing whom to avoid contact with.

    Chris Hannon, chief operating officer of Pointe Group Care, which bought Seashore Point last year, said, “We are doing everything we can to prevent coronavirus at this property and we take it very seriously.” Management has provided training and information on social distancing, he said, but, “the independent living residences are not specifically covered by any state or federal guidance beyond that issued for society at large.”

    Home Alone

    Barnstable County has the oldest population in the state, with the number of people over 65 at least double the state average. According to the U.S. Census, seniors make up 32 percent of the population in Provincetown, 41 percent in Truro, 34 percent in Wellfleet, and 38 percent in Eastham.

    Care for seniors has never been more important. The U.S. Centers for Disease Control and Prevention report that 8 out of 10 coronavirus deaths in the U.S. have been people over age 65.

    The gray areas of elder care for those who remain in their own homes are pronounced. Caregivers (often elderly spouses) are in as much danger as the frailest member of the family, and yet they feel most obligated to keep up with their normal activities, said Molly Perdue, co-founder of the nonprofit Alzheimer’s Family Support Center.

    All 50 monthly self-help groups of the support enter have now been canceled, she said. She and her staff of 22 part-timers are instead calling group members and other clients frequently.

    “If anyone is sick, we call them every day,” said co-founder Melanie Braverman.

    Under unprecedented circumstances, the nonprofit is trying to be practical, Braverman said. The most important step is to create contingency plans in case a caregiver gets ill. Compiling  medication lists and arranging food and medication deliveries so someone else can step in is critical.

    Many seniors depend on home health aides, and asking them to stay away is not practical, Braverman said. Rather, she advised, ask the agency providing the aides what their policies are: do they take employees’ temperatures and otherwise screen them, and do they provide protective gear? The state Dept. of Public Health (D.P.H.) has issued guidance and a checklist for in-home care providers, including restrictions on nonessential visitors, temperature taking, and use of personal protective equipment.

    Nursing Homes and Assisted Living Rules

    Coronavirus rules are much clearer at nursing homes and assisted living facilities. On March 15, the D.P.H. banned all nonessential visitors and advised staff and visitors who are not restricted — those necessary for medical assistance or people coming to visit a dying relative — to be screened. Anyone with a fever is not to be allowed into nursing facilities.

    The same rules apply at assisted living communities, which generally offer help to residents for all non-medical living needs — dressing, cleaning, cooking, and medication — though the residents still live alone in separate apartments.

    At Chatham’s Victorian Assisted Living, all residents’ temperatures are checked daily, said Celeste Fox, the executive director. Also, staff and visitors must wear masks, she said.

    “The mailman won’t let us take his temperature, so we have him leave the mail between the first door and the second door,” Fox said. “We have two sets of doors at the main entrance to our facility, and he leaves them in the little room in between.”

    Residents can leave only for essential medical appointments and are driven by family members.

    Elder Wisdom

    Gladys Johnstone, who lives at the recently renamed AdviniaCare nursing facility at Provincetown’s Seashore Point, turned 98 on March 18. Her birthday celebration was going to be a huge family affair involving relatives from all over the country. Instead, it was scaled down to just her and her son, Doug Johnstone of Provincetown. He visits with her through her first-floor window.

    Though everyone is worried about older residents, Gladys herself said she’s just slightly bored.

    Gladys is Provincetown’s oldest registered voter and holder of the Boston Post Cane. At her age, she said, “You realize you cannot control it and you never could.”

    Provincetown resident Ilona Royce Smithkin, who turns 100 on March 27, said nearly the same thing. Living alone on Commercial Street, Royce Smithkin has hired help five days a week, and friends who don’t hug or kiss. She is not stressed out.

    “Life goes on, the world is pretty crazy, but we have to make the best of it,” she said. “Each day it’s a surprise. Every day when I wake up, I move my hips and I move my lips and I say, ‘Wow. I’m still here.’ ”

    Devin Sean Martin contributed reporting for this article.

    THIS THING CALLED LOVE

    Buddy and Marla Perkel’s Long Run

    After nearly 60 years, the kindest intimacy happens

    By

    On Dec. 10, 1960, Marla Perkel arrived at a party in Manhattan with a date named Charlie. There she met Bertram “Buddy” Perkel, a labor lawyer whose blind date had disappeared shortly after he arrived. They started talking about dance. Marla was going for her Ph.D. in genetics at Columbia University and was a flamenco dancer, studying for several years under Angel Cansino, Rita Hayworth’s uncle. Buddy loved dance. When it came time for Marla to leave the party, Buddy followed her and Charlie into the lobby.

    “At the time,” Buddy says, “Art Deco buildings in New York City had large urns filled with very old, dusty eucalyptus branches in their lobbies. I took those branches, and I gave them to Marla. Then I walked her to the car that Charlie had brought her in, an MG with two seats, and when Charlie got into the driver’s seat, I sat down in the passenger seat and took Marla into my lap.”

    The three of them — Buddy, Marla, and Charlie — drove to Marla’s apartment. At that point, Buddy says, “Charlie got fed up. He was such a gentle soul. He got back in his car, and I walked once around the block and went back up to Marla’s.”

    Was Marla surprised? “Not really,” she says. “I fell in love that night.”

    “We saw each other every day after that,” Buddy says. “When I wanted to see her, I had to go to Columbia and sleep in a cot at the lab.”

    Marla concurs. “It was a lot of work, and Buddy helped me,” she says.

    Buddy and Marla were married exactly eight months later, on Aug. 10, 1961. They would have married in June had Marla’s parents not been Republicans and Buddy a Democrat. “My parents did not intend to be at my wedding,” Marla says. “So, it was very small, only 24 people at my sister-in-law’s home, which was downstairs from Mrs. Roosevelt’s.” Buddy’s older sister and Eleanor Roosevelt were close friends. “My family was very Republican, and back in Ohio, we knew very few Democrats,” Marla says. “Mrs. Roosevelt helped give me away.”

    After the wedding, “We got in our car and drove to Provincetown,” Buddy says. “We had our honeymoon at little Seascape House, which is gone. It’s now the Surfside Hotel.”

    Buddy and Marla Perkel
    Buddy and Marla Perkel, at their Seashore Point apartment, with a memento from their travels. (Photo Marcia Geier)

    For their 10th wedding anniversary, Buddy surprised Marla with the gift of a summer home in Wellfleet. Since then, they’ve spent more and more time on the Outer Cape, and have lived here year-round since Buddy retired. They recently moved into the Residences at Seashore Point in Provincetown.

    How have they managed to stay together for nearly 60 years? “I think it’s the remembering of everything we have,” Marla says. “Whenever we would get into a problem period, which you do, it’s important to come back to what you really mean to each other.”

    “I’m tough to live with,” Buddy says. “I raise my voice before I even think of raising my voice. We once had a pretty bad argument, on the beach in Wellfleet. Marla said, ‘I think we should separate.’ And I said, ‘No.’ Nothing says you’re perfect all the way.”

    “I was tired of him yelling at me,” Marla says. “I was tired of the kids, even. Then I realized it doesn’t mean a thing. You just know that you love each other, and you have to be together. I have serious health issues now, and Buddy is very, very, very good. He tries to help me whenever he can, and whenever I need him, which is quite often now.”

    Buddy considers the last 20 years to be the best of his life. “Something happened,” he says. “We got more intimate. We got twinned at the hip. I mean, the nicest, kindest intimacy happens. No reason, you can’t prepare for it. There was like a Vulcan mind meld, if you remember Star Trek.”

    “Buddy just had his 90th birthday,” Marla says. “He’s six years older than I am. It makes you think, what’s left? What do we do from now till then? We just have to live. And that’s what we’re trying to do.”

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