Incredibly, nursing homes are still not prepared to meet the needs of residents. In California, nursing homes are so unprepared that the supply of the safety masks are gone, replaced by face covers fashioned from pillowcases. In lieu of sterile isolation gowns, staffers at the Los Angeles Jewish Home for the Aging are sewing sleeves onto the cloth garments typically used by patients. Underneath, workers don a trash bag for heightened protection. They are using raincoats as PPE. Cleaning supplies are dwindling.
“This is just one raincoat that we have to keep reusing,” Lim said last week between shifts at the Healthcare Center of Orange County, a 100-bed nursing facility in Buena Park. “A lot of people are using it.”
In thousands of facilities that are home to California’s elderly and infirm, this failure to plan and be prepared are placing them at risk for death. Nursing homes and assisted living centers are fast becoming a locus of outbreaks, driving up mortality rates and straining public health resources. Yet institutions and public health officials said shortages abound: of protective gear, testing kits and, increasingly, of staff, who are sick or afraid to show up to work. With family visits halted, workers — many of whom shuttle between multiple facilities — are a potential source of infection in nursing homes but are essential to feeding, bathing and caring for the state’s vast aging population.
“This is an infectious disease that moves quickly,” said Matt Feaster, the epidemiologist for the Pasadena Public Health Department who is leading the city’s response to confirmed cases at nine residential care facilities. “A small problem can become a big problem.” Nationally, outbreaks in nursing homes and assisted living centers have propelled the crisis. Long-term care facilities have accounted for at least 221 deaths in Washington, or about half of the deaths in the state. In New York, more than half of nursing homes have positive cases, and more than 1,700 people in such facilities, about a third of nursing home residents with COVID-19, have died.
“The speed at which our elderly patients go into respiratory failure is staggering,” said Sydnie Boylan, a registered nurse at Hollywood Presbyterian Medical Center. “The patients go downhill so quickly, and once they go on a ventilator, most of them don’t come off.” Prevention is the key. Proper staffing with adequate safety interventions with well-trained staff can keep the residents safe and healthy. With most facilities essentially on lockdown — ending family visits and new admissions — focus has turned to the staff, the one group that circulates through a nursing home, sometimes several.
“Everyone is anxious,” said a certified nursing assistant at a South Pasadena nursing home. Her concerns centered on colleagues who work at multiple facilities, scraping by at $14 or $15 an hour. Her boss has begun scrutinizing their employment lest they inadvertently bring the virus with them.
“We do not make enough with just one job,” she said. “You need a good two full-time jobs, working seven days a week.” Many employees stopped showing up for work after becoming disillusioned and panicked by the industry’s handling of the outbreak.