Caregivers on the front lines in nursing homes risk health, safety during pandemic

Long-term care workers and members of the Florida's largest healthcare union, United Healthcare Workers East, lead a vigil to mourn the deaths of more than 1,500 nursing home patients and caregivers on Thursday, June 18, 2020 in Tampa.


By SHAWN MULCAHY, AREEBA SHAH AND JOEL JACOBS | Special To The Washington Post | Published: June 29, 2020

In the parking lot of an assisted-living center in southern Illinois, Shalla McBride sat in a Buick stocked with hand sanitizer and Clorox wipes and prayed for her mother to watch over her.

Her mother had reassured the family, McBride recalled, every time she went to work at a nursing home an hour's drive north, hoping to help stave off the novel coronavirus that was sickening elderly residents. "I'll be fine," her mother had said, even as her throat began to hurt, her chest tightened and she lost her sense of taste and smell. The 65-year-old registered nurse died May 2 of covid-19, the disease caused by the coronavirus.

In mid-May, two weeks after her mother died and with an asthmatic toddler at home, McBride pushed open her car door. She had spent 18 months as a resident assistant in the assisted-living center, working, much like her mother, to care for the residents who needed her. McBride said she decided it was no time to quit, despite the risks.

"There was a feeling of peace that washed over me," she said. "Like I'm supposed to be here. This is home. These people are my family."

More than four months into the pandemic, nursing home caregivers say they have been largely left to fend for themselves even as coronavirus outbreaks continue to overwhelm facilities across the country. In recent weeks, a growing number of lawmakers and patient advocates have blamed the homes as well as the government, saying officials have been slow to act, sending inadequate and sometimes defective supplies to facilities vexed by staffing shortages and ill-equipped to control the spread of infection.

The fallout, they say, has been devastating. Tens of thousands of nursing home workers have contracted the coronavirus and at least 200 have died, according to a Washington Post analysis of state data.

The death count is likely low. The tally draws on data from 10 states and the District of Columbia, which separately report fatalities among staff members. The federal government places the nationwide death toll at more than 500, but nursing home administrators in recent weeks have raised questions about the accuracy of the data.

The count does not include coronavirus cases or deaths in other long-term care facilities, such as group homes and assisted-living centers.

At a nursing home in Connecticut, licensed practical nurse Angeline Bernadel , 52, was only weeks away from earning her degree as a registered nurse when she died of covid-19 in early April, the Hartford Courant reported. In Louisiana, registered nurse Shenetta White-Ballard, 44, had a history of respiratory issues but insisted on working during the crisis; she died of covid-19 on May 1, according to the Advocate in Baton Rouge.

In Illinois, registered nurse Krist Angielen Castro Guzman died a day later, leaving behind three children, including an infant son.

"She was a wonderful mother," said Guzman's sister, Kayla Aleksei Clayton. "It's just heartbreaking. I'm watching her husband brush her daughter's hair, and I wonder who's going to do their hair now?"

Lawmakers, industry groups and caregivers say the death count could have been limited if states and the federal government had done more to develop an early, robust and coordinated response for nursing homes and other long-term care facilities.

"There's been a lot of talk about essential workers," said Rob Baril, president of Service Employees International Union 1199NE, which represents nursing home workers in Connecticut and Rhode Island. "They're treated like they're expendable workers."

More than 2,100 nursing homes nationwide reported earlier this month that they lack a week's supply of N95 masks, and 2,200 said they were running short on gowns. The data was made public by the Centers for Medicare and Medicaid Services, the federal agency that regulates nursing homes.

In late April, the Federal Emergency Management Agency announced it would coordinate shipments of gowns, masks, gloves and goggles, providing facilities with enough to last two weeks and prioritizing homes in cities with major outbreaks.

But some homes received expired masks, cloth masks possibly made from T-shirts, ill-fitting plastic gowns or partial shipments that would not last a week, said Lisa Sanders, a spokeswoman for LeadingAge, which represents nonprofit long-term care providers. The shipments came in unmarked boxes with no return address.

"At the outset of this pandemic it was clear that older adults and care workers were at the greatest risk, yet their needs and lives went ignored," Katie Smith Sloan, president of LeadingAge, said in a written statement.

Three U.S. senators recently sent a letter to FEMA Administrator Peter Gaynor, demanding information about the shipments and the allocation of protective gear.

"Since the beginning of the COVID-19 pandemic, nursing homes have experienced critical shortages of PPE, putting residents and workers alike at risk," wrote Democratic Sens. Gary Peters of Michigan, Bob Casey of Pennsylvania and Ron Wyden of Oregon.

A FEMA representative told the Wall Street Journal earlier this month that the equipment complied with federal requirements and that the company that had supplied gowns was working on an instructional video to show caregivers how to use them.

Even with sufficient supplies, experts say, years of understaffing and cost-cutting have left nursing homes vulnerable to widespread infection outbreaks. Staff turnover is particularly high among nursing aides, who often earn minimum wage and lack paid sick leave or health insurance, said Charlene Harrington, a nursing home researcher and professor at the University of California at San Francisco.

"They don't care if they burn through staff," she said.

More than 2,200 nursing homes reported earlier this month that they lacked an adequate number of nurses, and 2,600 reported a shortage of nursing aides, according to the CMS.

In recent months, government inspections by state and federal health authorities found instances where nursing staffs were stretched so thin, they did not have enough time to follow proper hygiene practices, such as washing hands in between patients.

To address potential staffing shortages, the CMS in March waived the requirement that nursing aides receive at least 75 hours of training. The move, advocates say, could exacerbate unsafe conditions by allowing homes to employ unqualified staff members.

In some states, health officials are filling the need for aides through an online certification offered by the American Health Care Association, an industry group representing more than 14,000 long-term care facilities. About 38,000 people in recent weeks have been certified as temporary nursing aides.

Nursing home caregivers say they are committed to staying on the job, despite the risks.

"We have to go to work and deal with it," said Tommy Kegbeh, a nursing assistant in central Massachusetts. "Whether you will be killed or whether you will survive, you don't know."

In southern Illinois, Shalla McBride's mother, Carolyn, was diagnosed with covid-19 on April 23. She had worked for two years at the Eden Village Care Center.

She was hospitalized a week after the diagnosis. The single mother of three who had put herself through college while on food stamps grew progressively worse, her daughter said.

"I was there right before she died, so my last memory is her hooked up to the IV and the ventilator," McBride said. "She looked very, very swollen, and I could see the color changing on her."

Officials at Eden Village did not respond to several calls and an email seeking comment.

After her mother's death, McBride said she debated going back to her job at a local assisted-living center. But in mid-May, she kissed her fiance and 3-year-old daughter, got in her car and drove past the Amish grocer where her mother once ordered ham salad and sourdough bread. Then she pulled into the center's parking lot and prepared to go to work.

Her residents, she said, are like family. But with the virus still raging, she said she worries about her fiance and daughter.

"I don't want anything to happen to me where I could die," she said. "I don't want my daughter to grow up without her mom."

Mulcahy, Shah and Jacobs are graduate students in journalism at Northwestern University's Medill Investigative Lab.

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