For nearly two months, many nursing homes nationwide have been on virtual lockdown.
Families of residents are not allowed inside, vendors have to drop deliveries outside and the only people coming in and out are health care workers and assistants.
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Despite all that, the outbreaks continue — possibly spread by the same nursing home workers who are risking their lives to tend to some of society’s most vulnerable. In response, many workers are significantly increasing their own vigilance, nursing homes are adding safety measures, and the testing of residents and workers is steadily increasing, though experts say much more is needed.
“Many residents are asymptomatic, and so are the staff, so they don’t always know that they have it,” said Charlene Harrington, professor emeritus at University of California, San Francisco’s nursing school.
More than 23,000 people in the U.S. have died in long-term care and nursing home facilities since the first coronavirus outbreak in a nursing home was reported in Washington state in February, according to a tally by The Associated Press.
On March 13, federal officials limited visits to essential healthcare workers and told facilities to halt communal dining and group activities and screen staff for fevers or cough. Many of the outbreaks have come since then, including in California, Texas, Minnesota and West Virginia, among other states.
There is no national tally on the number of nursing home workers, ranging from nurses to assistants, who have had the virus, in part because many don't necessarily feel sick or get tested. In most cases, it's impossible to confirm how the disease was brought in or how long it was at a facility before manifesting itself in patients or workers. But with families and vendors barred, and many residents not allowed out of their rooms, most circulating comes from workers tending to patients.
Across the country, facility staff post supportive messages on social media and are touted by their employers as heroes. And while they bravely head to work, many fear they’ll contract the virus there and bring it home to their families — or that they could pick it up unknowingly at the supermarket and transmit it to their elderly patients.
Jeffrey Ravago, a 36-year-old certified nurse assistant, said his temperature is taken before each shift at a Northern California skilled nursing facility and outside work he only goes to Costco to buy essentials.
“The only way for it to get in is through us, because we’re basically locked down right now, and we’re being very careful,” he said.
Mark Parkinson, president of the American Health Care Association, said officials were slow from the start to help prepare and protect the country’s skilled nursing and assisted living facilities. While the initial focus was on urgent hospital needs, workers in these centers struggled for weeks with a lack of personal protective equipment and limited testing.
“The inability to access a sufficient supply of masks has made it virtually impossible to stop the virus inside of buildings,” Parkinson said.
The organization is also pushing for expanded, rapid testing for all facility residents and workers because many can still carry the virus without showing symptoms.
Neighboring nursing homes in Riverside, California, underscore the difficulty in keeping the virus out from a host of facilities.
So many staffers failed to show up for work at Magnolia Rehabilitation and Nursing Center — some sick, some reportedly scared — that 82 residents were evacuated on April 8.
Several employees said the facility, which had a below-average rating from federal regulators and was slated for a program aimed at improving troubled centers, had problems before the virus infected nearly three dozen residents and five staff. Employees’ paychecks had bounced, prompting protests. Some staff were dismissed and others quit.
“It has been understaffed since the day I got the job,” said Gary Glaser, a certified nurse assistant who said he worked at Magnolia for four years and was out sick with a stomach bug in the days leading up to the evacuation.
While visitation stopped in early March, Magnolia was still receiving patients from hospitals, including a man with pneumonia who later tested positive for the virus, according to a worker who requested anonymity, fearing a backlash.
A facility administrator from Magnolia declined comment.
Around that time, the virus had also reached a facility next door. Valeria Viveros, a 20-year-old certified nurse assistant at Extended Care Hospital — which has a five-star rating from federal regulators — was rushed to the hospital on April 4 after being sick for about a week, her uncle said.
That was a day before county officials reported 30 patients and staff tested positive for the virus and the same day they conducted widespread virus testing at Magnolia. Viveros died within days.
“More than likely, she probably got it from work. Where else?” uncle Gustavo Urrea said.
Trent Evans, a lawyer for Extended Care, said the facility was grieving the loss and had taken numerous precautions, including limiting visitors, since early March.
To combat outbreaks, many nursing homes have increased efforts to improve workers' safety and protect residents.
Phylene Sunga, administrator at Lone Tree Convalescent Hospital in Antioch, California, said her facility has ramped up cleaning and all workers, including office workers, wash hands hourly. Therapists change their clothes and wash their hands every time they travel between facilities, and the 99-bed center asked staff to limit shopping after work to a single stop to try to limit their exposure.
“Our staff are dedicated and they're still coming to work when others don't have to,” Sunga said.
In California, some counties, including Riverside, have started deploying teams to provide training and equipment and try to prevent a staff shortage before the virus hits or assist them if it does.
Still, the challenges are enormous. And cases crop up so quickly that by the time health officials are called the priorities are to limit contagion and ensure residents have care.
At Redwood Springs Healthcare Center in Visalia, California, officials got involved after residents already had virus symptoms, and the source of infection — which has affected a third of staff and two-thirds of the patients — is still unknown, said Carrie Monteiro, a Tulare County spokeswoman.
Two healthcare workers at the facility showed symptoms on March 29 and received positive test results two days later, said Dave Oates, a spokesman for the center.
April Verrett, president of Service Employees International Union Local 2015, said many nursing home workers use public transportation to get to their jobs and must still shop for groceries for their families. They take all the precautions they can, but it is a challenge, said Verrett, whose union represents nursing home workers.
"This is not a workforce that can self isolate at home,” she said. “If you are around other people, you spread it.”