STATEN ISLAND, N.Y. -- As the coronavirus (COVID-19) rages at hospitals on Staten Island and across New York City, nursing homes on the borough have become a new de-facto front line treating the communitys most vulnerable population in an effort to temper influx into the Islands two hospital systems.
However, interviews with four nursing home health care workers all of who requested anonymity for fear of reprisal in as many nursing homes reveal that concerns over inadequate personal protective equipment (PPE) are making the battle of aiding elderly patients under unfathomable circumstances a scary task.
Its like a med-surg unit, one nurse said without the equipment.
Concern for Staten Islands nursing homes has also been expressed by Borough President James Oddo, who previously said: In a growing volume, were going to have real issues at our nursing homes echoing what he was told by Dr. Ginny Mantello, the boroughs director of health and wellness.
To avoid further filling up available beds and ICU rooms at Staten Island hospitals, both Oddo and Mantello said nursing homes play a critical role in lessening the burden on the hospital system.
The least we can do is say the ones that are not critically ill and not in an ICU setting and not on a ventilator should be sent to the next-step-down level, Mantello said, which is not a triage tent, its not a building we stood up to take patients, its not a dormitory or a hotel its a nursing home.
To handle that increased pressure, Oddo said: You need supplies, masks, etc., or youre going to have that virus spread into the nursing home, which eventually bleeds back into the hospitals."
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NYC on pause: A month into the battle against deadly coronavirus
PPE TREASURED COMMODITY
Much like hospitals across New York City, personal protective equipment (PPE) for front-line workers in nursing homes has become a treasured commodity, though some nursing home health care workers say not enough is being done to protect them.
In an interview with the New York Times, Scott LaRue, the president of ArchCare, which runs Carmel Richmond Nursing Home in Dongan Hills, said there were around 150 cases of the coronavirus and a number of deaths across the five nursing homes run by the Archdiocese. I cant test, I dont have PPE, he said. What am I supposed to do?
While hospitals most notably have been a focus of officials in terms of providing adequate PPE, nursing homes have not received the same focus.
Exposure is exposure, said one nurse at a skilled nursing facility on the borough, comparing the challenges faced by nursing home nurses compared to those working in a hospital. Just because your patient is more critical and on the vent and mine isnt doesnt mean that Im less exposed to COVID than you are, she said.
The nurse, who said her nursing home has upward of 50 probable coronavirus cases, said multiple nurses within the home have also tested positive underscoring the need for proper PPE, which she said is extremely limited. Not a single worker has N95, not a single person, she said, and up until a couple days ago, we had absolutely no eye protection" repeating a sentiment expressed by multiple other nursing home health care workers interviewed by the Advance/SILive.com.
The nurse said she is not only concerned for her coworkers many of whom are scared of transferring the virus to their families but also for otherwise healthy residents. Its scary because I feel like our population is vulnerable, and we just dont have anything to deal with" the virus, she said.
Another health care worker at a different Island nursing home said while she has recently seen PPE become slightly more available, she is still required to store PPE in a zip lock in my trunk to use for the next day.
I just know we are working extremely short staff due to staff getting ill, she said. PPE has gotten a little better but we need more, she said.
Oddo previously has said the hunt for PPE has been far from simple, but told the Advance/SILive.com that multiple nursing homes have received additional supplies.
OVERFLOW SITUATION
Still, the situation within nursing homes appears dire. As of April 5, there have been 3,243 confirmed cases of the coronavirus in 278 of New York States 613 licensed nursing homes, along with 702 deaths which accounts for nearly one in every five coronavirus deaths in the state.
A letter from the citys Health Department dated March 31 said that nursing homes should prepare for even more dramatic increases in COVID-19 cases in the coming days and weeks.
Staffing will be critical to meet the increase in demand that your nursing home will experience, the letter continues. When you have exhausted your traditional staffing channels, such as registries and agencies, there will be few options remaining.
To meet these needs, the NYC Departments of Health and Emergency Management created an online referral program that enables volunteers to fill vital staffing needs. The citys Health Department did not respond to an inquiry requesting the amount of volunteers that have been placed in Staten Island nursing homes.
Recent guidance from the state Health Department, as previously mentioned by Oddo and Mantello, ordered patients to be returned to nursing homes after becoming stabilized at the hospital; however, as hospitals become more backed-up, the nurse at the skilled nursing facility said the patients are being released from the hospital sooner and sooner.
Once theyre stabilized they come right back, the nurse said, adding that elderly patients can rapidly decline, even after being stabilized.
Because of the overflow at hospitals and the likelihood that some patients will be sent immediately back, or not be prioritized because of their age, she said, We basically have to sit and think, are we going to send this person to the hospital?', whereas usually we send them right away if theyre a full code referring to the medical terminology for cardiac failure.
Thats the biggest change, she said, saying that nurses now have to think: Is there a point in sending this person?"
LACK OF MASKS
One nursing assistant at a borough nursing home said that her and her coworkers do not have N95 masks to deal with patients, and another who works as a dietary aid said her coworkers have only been provided with blue surgical masks to deal with patients.
While saying its not a problem of dealing with people, thats what we signed up for, the nursing assistant said the lack of proper PPE made me feel like they dont care about me, they dont care about the workers.
For the dietary aid, coming into contact with items like food trays makes her worried she could bring the virus home with her, potentially infecting her child and mother, since it has been known to live on some surfaces for days.
Im concerned because my mother has COPD and I have a child in the house, she said, adding that her nursing home currently has two floors quarantined as a result of the virus, but feels it could easily infect other residents on different floors.
And while those quarantined floors have disposable equipment for residents to eat, she said she saw six instances on Sunday where the trays were sent back down to the kitchen, potentially exposing a slowly-dwindling staff.
Nursing homes are attempting to take precautionary steps amid the coronavirus crisis, including having health care workers be required to have their temperature taken before starting their shifts; however, some steps are becoming unrealistic amid rising coronavirus case totals.
With multiple nursing homes attempting to adopt isolation measures to keep infected residents safe from otherwise-healthy residents, the heavy influx of patients has caused nursing homes to be on overload, one nurse said, making proper isolation very difficult."
Patients are sent to hospitals, if they dont need ventilators they come back for isolation, she said.
EFFECTS OF ISOLATION
The effect of that isolation is also a hidden factor in the battle being waged inside nursing homes.
They dont have visitation anymore and its hard for both them and their families, one nurse said, referring to the state-mandated order to restrict visitation at the homes. Theyre older, theyre lonely.
The emotional effects of the coronavirus extend to the families of nursing home residents, separating them from loved ones in the midst of the uncertainty borne from the virus.
One New Jersey resident, who requested her name not be published due to her familys connection to the nursing home, said her aunt worked at a Staten Island nursing home where her grandmother also lived, which often gave her family a connection to their matriarch.
However, her aunt has recently become ill and was ordered to stay home forcing the family to only contact their grandmother via phone.
Were freaking out because my aunt, when my aunt worked there, she saw my grandma every day and now shes not even able to see her," the woman said. The womans grandmother, who has not been tested and is currently not sick, doesnt understand the severity of the virus, she said.
The family, like many others with loved ones in nursing homes, cannot feasibly remove their grandmother from the home at this time. We would love to take my grandmother out, but I dont think we can, the woman said. My grandmother definitely requires 24-hour help."
An added-element to that decision is the long waiting lists often associated with getting a family member into a nursing home. We waited a long time to get her in there, the New Jersey woman said.
Im noticing a lot of changes in our long term patients who are healthy, said one nursing home worker. They are sad and lonely, she said, adding that she tries to Skype with the residents family when she has time.
We try our best to be there for them with love and support, she said.
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