Back in March, as the coronavirus began its swift spread through the state, Hanna Nuamaa went to work and was given a small surgical mask. Nuamaa, who works as a certified nursing assistant (CNA) at The Hermitage Healthcare, a nursing home in Worcester, says staff were told to reuse the same mask for two weeks.
“We fought with them. And they said, ‘OK, one week.’” Nuamaa said. “[Then] a resident tested positive. And then they started to say, ‘OK you’re going to wear the mask for three days.’”
According to the CDC, surgical masks do not provide reliable respiratory protection and should be discarded after every use. Nuamaa was pregnant, and she was worried about possible exposure. As the virus circulated through the nursing home, COVID-positive patients were moved onto their own floor. But staff were rotated between the COVID-positive and negative wards, potentially spreading the virus further, according to several Hermitage staff.
Remembering the first time she was assigned to the COVID floor, Nuamaa said, “I cried and I told them the next time I come in and my name is over there, I’m going to walk out. Because … I have diabetes, and I’m pregnant, and I’m not gonna take those chances.”
Long-term care facilities account for more than half of COVID-19 deaths in Massachusetts; Hermitage has reported 7 deaths out of more than 30 cases. According to accounts by several employees, staffing shortages at the nursing home are dire because so many workers have tested positive for the virus and people are reluctant to cover shifts. Employees pointed to at least one instance when a nurse was assigned to work an overnight shift alone on a floor of over 30 residents.
Next Step Healthcare, the company that owns Hermitage, did not respond to questions about the nursing home’s staffing levels or PPE supply.
Staffing has long been an issue for nursing homes throughout the state. Before the pandemic, 17% of clinical positions in Massachusetts nursing homes were vacant; now that number is around 20%. To help fill the void, the state is offering $1,000 signing bonuses to healthcare workers who apply for vacant positions at long-term care facilities through its web portal.
Most of the open positions in Massachusetts nursing homes are for certified nursing assistants (CNAs). CNAs complete 100 hours of training to provide hands-on care for residents. During the pandemic, they’ve been called on to perform some of the riskiest healthcare work for the lowest pay.
“Across the Commonwealth, the CNA wage is approximately 16 dollars an hour,” said Tara Gregorio, president of the Massachusetts Senior Care Association, an industry advocacy group. She said the shortage of CNAs won’t go away until their wages go up. “That’s just not enough to compete with the Targets, the coffee shops, the grocery stores. So we really need to increase the wage of CNAs.”
In April, the Baker administration infused $130 million, mostly by way of Medicaid rate increases, into the state’s long-term care facilities to help with infection control, PPE supply and staffing. This has helped raise wages for nursing home staff, including CNAs, though only temporarily.
“We are already seeing nursing facilities that may have a base wage of about 15 or 16 dollars [an hour], but through shift differentials and other bonuses, they’re already at that twenty-two dollar [per hour], thousand-dollar-a-week level,” Gregorio said. In order to permanently raise wages for nursing home staff, she added, the state would need to permanently increase its Medicaid reimbursement rates.
Even with the temporary wage increases, filling the void of CNAs is difficult, because the pandemic has put training programs on hold. The Massachusetts Senior Care Association, in partnership with Monster.com and the MIT COVID-19 Policy Alliance, recently launched a program to recruit resident care assistants, or RNAs, who can fulfill some CNA duties. Applicants are required to complete 8 to 16 hours of training and be tested for competency before working under the supervision of a licensed nurse. The program advertises wages between $22 and $25, which Gregorio said was based on the average rates CNAs are earning with the additional pandemic funding.
But each nursing home deploys its raises and bonuses differently, and workers say it can vary a lot. At Hermitage, CNAs and nurses earn 10 extra dollars per hour for shifts on COVID floors.
“The money that we [make] doesn’t commensurate the risk that we put ourselves in,” said one employee who has worked at Hermitage for 17 years, and did not want to be named for fear of endangering his job. “It’s really risky, you know. And we know how this virus has been killing a lot of people.”
Across the state, nursing homes’ PPE supplies have improved with the infusion of state funds. For instance, Hermitage staff now have KN95 masks, which are far more effective in preventing respiratory infection than surgical masks. But workers said they still have to reuse equipment, a problem that is prevalent in Massachusetts nursing homes.
“We know that they’re getting more and more supplies,” said Tim Foley, the executive vice president of 1199SEIU, the union that represents many Hermitage staff. But that hasn’t necessarily translated into better protection for workers, he said. “We still rely on overuse of gowns. We rely on overuse of the masks.”
It’s a nationwide problem. In an SEIU survey of nearly 2,400 nursing home workers, almost 80% believed going to work put their lives at risk. Often these workers face extra risks outside of work, too.
“These are mostly women, and women of color, and immigrant communities,” Foley said. “And we’ve seen and we know that those are the same communities that have been hit more than anywhere else.”
For Nuamaa, the root of the problem is the nursing home administration’s lack of respect for workers like her. “I feel like they don’t respect our job, that’s how I see it,” she said.
CNAs perform some of the most intimate and vital duties in nursing homes. They bathe and dress residents, lift them into bed and monitor their vital signs. This work also puts CNAs at risk for catching the coronavirus.
“We do the hardest job, though, and we are the ones who are … closer to the residents,” Nuamaa said. “So if anything is going to happen, it’s going to happen to us first.”
Like many of her coworkers, Nuamaa said she tested positive for the coronavirus. But even after she was cleared to return to work, she stayed home. She just didn’t feel safe going back.