A Nurse’s Texts Lay Bare the Coronavirus Horror at Nursing Homes
Three weeks ago Deborah, a 38-year-old health-care specialist, showed up to work at the Parker Jewish Institute, an assisted-care facility in Long Island, New York, nervous about what she would face amid the growing coronavirus pandemic. The situation in New York was worsening by the hour, with hundreds of people testing positive and dozens dying each day, particularly elderly individuals similar to those she helped treat at her facility.
And despite pleas from scientists, academics and local officials working the coronavirus response, the federal government was lagging in helping states obtain essential medical supplies needed to treat patients. In press conferences, Gov. Andrew Cuomo warned that the worst was yet to come and that without the proper equipment more people would become infected with the virus, including health-care workers like Deborah.
On that day at the end of March, Deborah, whose name has been altered because she fears retribution from her facility’s executives, found nurses wearing trash bags as makeshift gowns and treating patients without N95 respirators—one of the best systems of protection for doctors and nurses who come into contact with coronavirus patients. Some supplies such as face shields and gloves did trickle into the facility over the following days. But not enough to protect all of the health-care workers for the duration of the pandemic. Multiple nurses working with the elderly tested positive for the virus and went home, stressing an already overworked staff. Meanwhile, the number of residents with coronavirus continued to rise.
On Monday, the State of New York released a partial dataset of some of the nursing homes and long-term care facilities that are reporting coronavirus cases to the state. Parker Jewish had the third highest number of deaths—38 deaths in total. But as of Thursday, 179 patients there had tested positive for the virus and 48 had died, according to a separate dataset that circulated internally at the facility, which The Daily Beast obtained.
The facility has a capacity of about 530 beds. But nurses there say it is not full and that, despite the outbreak of coronavirus on site, it is still accepting new residents.
“I don’t think anyone is focusing on nursing homes,” Deborah said earlier this week. “But we have a lot of sick people here. We have dedicated units for COVID patients but it’s spreading to the other floors. They gave us some generic masks the other day that weren’t N95 so we’re wearing the same one from last week. We’re scared we don’t have protection.”
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The ongoing crisis at the Parker Institute is representative of a broader problem in New York and New Jersey nursing homes where facilities are struggling to limit the number of deaths as health-care workers continue to cite a lack of proper personal protective gear needed to treat residents.
For weeks, it was unclear just how many individuals in New York and New Jersey nursing homes and other assisted care facilities had tested positive for the coronavirus and how many people had died because of it. Despite the increased focus by officials and doctors on the vulnerability of the elderly population, the states’ coronavirus data sets did not reflect nursing home or long-term care facilities’ numbers.
Then, on Monday, a report by the New Jersey Herald revealed that local police had found 17 bodies in a small morgue inside the Andover Subacute and Rehabilitation Center. The nursing home had struggled to keep up with the uptick in the number of patients dying. The incident sparked immediate questions about whether other facilities were experiencing similar crises.
During his Friday press briefing, Cuomo said 630 people in New York died within a 24-hour period. Forty of those deaths were in nursing homes, he said. And in New Jersey, Governor Phil Murphy said that 384 long-term care facilities in the state have at least one coronavirus patient, with a total of 9,000 positive cases and 1,530 deaths. The number of positive cases jumped by almost 800 overnight, according to the New Jersey Department of Health’ publicly available datasets. According to a tally put together by The New York Times, at least 6,900 people living in or connected to nursing homes in the U.S. have died of the coronavirus.
“The people in the nursing homes are vulnerable to the virus, so the death tolls are going to be higher there no matter what. But the thing about nursing homes is that it’s someone’s home. And executives and staff are not used to treating their facilities like a hospital,” said Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. “Nursing homes don’t have lots of resources to train their staff and ramp up supplies and be nimble. This situation in these facilities is going to get so much worse. I don’t think people are prepared for that.”
Officially, at Parker Jewish Institute, everything is under control. Lina Scacco, a spokesperson for the facility, told The Daily Beast that “everyone” there “has what they need.” She added that she could “guarantee” no one in the facility had worn trash bags as gowns.
“It’s actually disturbing to me that people are telling you that,” she said. “We have spent hundreds of thousands of dollars on personal protective equipment. Whoever is telling you these things…maybe there is something going on in their lives or they are trying to sensationalize things. I don’t trust them.”
Scacco noted that the facility this week had its first resident, a short-term patient, recover from the coronavirus and return home.
Privately, things seem far more dire. Over the course of three weeks Deborah, who The Daily Beast independently confirmed worked at the Parker Institute, shared pictures revealing the personal protective equipment shortages in the facility and outlined how the increasing number of coronavirus cases there made it nearly impossible to ensure that residents were receiving adequate care. The situation was made worse by a number of health-care workers testing positive for coronavirus and leaving the workplace to recover, Deborah said.
On March 29, after this reporter put a call out on Twitter for information from nurses and doctors treating coronavirus patients, Deborah reached out to The Daily Beast for the first time. Over the course of three weeks, she spoke with The Daily Beast, sometimes at night after her shift ended, other times in the morning when she was just getting to work.
The initial call took place after she had worked a shift at the Parker Institute. She said she was growing increasingly concerned that the lack of essential medical supplies and the uptick in the number of health-care workers leaving the facility was putting residents at risk. By that juncture, the idea of not speaking up seemed like a dereliction of her duty to the patients, she said. Already, several residents in the Parker Jewish Institute had tested positive for the coronavirus and it appeared as though the virus was spreading throughout the facility.
“We come to work because we feel bad for the patients. But it feels like everyday somebody doesn’t because they are sick or quit and you have to work with less staff. Then you learn somebody else is dead. There’s lots of neglect happening like wounds not being changed,” Deborah said. “I have a patient that still has stitches in them from a surgery a month ago.”
On that first call, Deborah noted that nurses were wearing trash bags as gowns and taking care of residents without N95 respirators. A similar scene had gone viral on Twitter three days earlier when nurses from Mount Sinai West Hospital in New York City posted a picture of themselves in similar trash bags and cleaning gloves. The healthcare workers at the institute did eventually end up receiving N95 masks, Deborah said, but that was over a month ago and they haven’t received new ones since then.
The day after the first call, Deborah called again. She said she had been told the personal protective equipment was in storage in the basement of the facility but had not been distributed onto the floors. Three days later, that glimmer of hope faded. She texted: “Hey, it looks like we just ran out of [personal protective equipment]. A nurse told me to put on a patient gown and a trash bag.”
As the days rolled by, Deobrah and her colleagues continued to find ways to protect themselves by doubling up on surgical masks as the number of patients testing positive for the virus continued to rise. Deborah described a scene of a facility scrambling to catch up to a disease they didn’t understand and couldn’t beat back.
“The hospital next door is sending Covid patients to us. I thought they were telemetry patients but I think they lied to us,” she said, adding that the facility was not removing short-term patients because “they need the insurance money.”
Nursing Homes Balk at Taking Back Patients From Hospitals
This is a fairly common practice, Barnett said. “In almost every nursing home… most of their beds are taken up by people who live there. But a small slice of their beds are taken up by people who are getting rehab after being in the hospital,” he added. “They lose money on long-term care residents. So they need to have these short term residents. In the current state… it’s possible nursing homes are desperate to hold on to revenue that they are trying to cling on to these residents and not send them home until they are forced to.”
By the end of the first week of April, Parker Jewish had begun moving residents who had tested positive for coronavirus to a select floor to prevent community spread, both Deborah and a spokesperson for the facility said. That week, Deborah said health-care workers in the facility had received personal protective equipment after inquiring about the lack of masks and face shields. But not everyone received a new set of equipment each day.
Last week, Deborah shared a picture of her N95 mask she received at the beginning of April. She had been wearing it, by that point, for two straight weeks.
“We’re short staffed. Patients falling,” she told The Daily Beast in a message, adding that a nurse had accidentally pulled out a patient’s catheter line. “She bled all over the place. They sent her to the hospital. Another COVID patient went to the hospital yesterday. I think our coworker might have it now. He left work early today because he couldn’t stop coughing.”
On Tuesday, Deborah said her directors told her team to pick up new N95 masks from the personal protective equipment pile to replace the month-old ones they had been wearing. But the masks were not N95. They were regular surgical masks. “We decided to wear the old masks with another mask on top,” Deborah said, adding that two of her coworkers were out sick. “They’re waiting on results,” she said.
There was one perverse upside, however. “We won’t run out of gowns now because people keep quitting,” said Deborah, adding that she had considered leaving herself in the past few weeks.
It wasn’t until Thursday that Deborah and her colleagues understood the true scale of the outbreak in the facility. A list of residents who had tested positive for the coronavirus circulated among the staff, showing that the institute had taken in new residents that ended up contracting the virus and that some of those individuals had been transferred to a nearby hospital. Twenty-two out of the 179 patients who had tested positive had an additional marker: “Expired.”
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