As state touts supply, many nursing home workers still can’t get protective gear
When she worked the night shift, which was often, she would walk through the halls and rip down the protective gowns hanging outside the doorway of each resident’s room in the COVID-19 unit.
“Whatever is in the room is on the gown. It’s contaminated in the hallway hanging,’‘ said the woman, a veteran certified nursing assistant at The Bristol at Tampa Rehabilitation and Nursing Center, a 266-bed nursing home with 38 active COVID-19 cases and nine deaths.
Her defiance, she said, was intended to send a message to administrators who have been rationing protective equipment and making the caregivers who help dress, feed, bathe and carry out many other close-contact and essential daily functions for elderly residents put on a used gown.
“They would give us the medical supply mask, but for us on the COVID floor they should have given us the N95 masks and a face shield,’’ she said, but did not want to disclose her name. “All the department heads had them but they weren’t taking care of the patients. We are, and they told us we had to keep it [our masks] for a week.”
At Hillcrest Health Care and Rehabilitation Center in Hollywood, where two residents died of COVID-19 and eight current residents and staff have tested positive, nursing assistants “have to beg for protective gear,’’ one CNA told the Miami Herald and Tampa Bay Times.
“Yesterday, they had no gloves in the rooms,’’ she said Monday. “Management stored the gloves in their office, and the director of nursing said I’m not giving them any because they will steal it.”
Masks, gowns and gloves are the armor for the front line workers caring for the state’s most vulnerable residents at the 3,800 nursing homes and assisted living facilities across Florida, but as state officials claim to have enough supplies, both staff and administrators say there is a disconnect between the claims and the reality.
Staff told the Herald/Times that protective gear is either rationed or hoarded by management, leaving them exposed and working in fear. Administrators told us they have received some supplies from the state emergency stockpiles, but it is far short of meeting the need and supply shortfalls are constant.
From March 1 to April 30, the number of confirmed COVID-19 cases in nursing homes and assisted living facilities rose from zero to about 3,500. As of Wednesday, there were 3,141 active cases at long-term care facilities and 423 deaths, according to data released by the Florida Department of Health. Of the total cases, more than 1,500 were nursing home staff members.
PPE scarce from the outset
At the onset of the pandemic, personal protective equipment (PPE) was hard to come by, so management would have staff wear cloth masks and bandannas and store used supplies in plastic or paper bags between shifts, said Margarette Nerette, vice president of 1199SEIU United Healthcare Workers East, which represents workers in about 75 nursing homes in Florida (as well as nurses and other staff in about 35 hospitals).
But now, as the state has acquired more supplies, management in many places “is still acting as if there is a shortage,’’ and when the union donated 20,000 KN95 masks to nursing homes in Florida to supplement shortfalls, some homes still wouldn’t distribute them, she said.
“These workers are petrified to go to work every day,’’ she said. “They were not hired to work in a hospital and an ICU, but the infections these residents are dealing with is something they have never seen before, and they worry they can bring it home to their families.”
At The Bristol in Tampa, staff from other parts of the nursing home stay away from the COVID-19 wing.
“Nobody wants to come down to my end,’’ said a veteran CNA there who spoke to the Herald/Times. “They’ll bring the food trays to the door and hand them to me. There’s no training for this.”
She considers herself fortunate because she started showing symptoms of COVID-19 and was told to go home two weeks ago “before the bottom dropped out,’’ and the disease spread to dozens of patients and staff. Her test showed traces of the novel coronavirus but not enough to be considered a positive case. Her doctors are treating her as if she has it and she’s still out sick, awaiting two negative test results.
She misses her patients, and weeps at the thought that many she cared for have died.
“People have been in this building as long as I have been in this building,’’ she said Monday. “They passed away. Tough, resilient people who have been through some stuff who want you to sit and listen to their stories — and they have stories to tell. They were left alone with people not willing to go in there.”
She said she believes if she had been given better protection she could still be there for them.
In a statement to the Herald/Times, The Bristol at Tampa denied there is any problem with supplies but would not answer if they require staff to use masks and gowns on more than one patient or use them for a week at a time.
“Our center has ample supply of PPE, however, we are always happy to accept additional donations,’’ the statement said. “We are following updated and ongoing CDC guidelines while also closely working alongside the Department of Health and regulatory agencies as we navigate this pandemic.”
PPE complaints are widespread
Across the state, workers had similar, persistent complaints of lacking the supplies to stay safe.
At Palm Garden of Port St. Lucie, management “is hiding PPE and making staff constantly ask for it,’’ one CNA said. When officials from the Florida Department of Health arrived last week “all of a sudden there were boxes of masks.”
At Franco Nursing and Rehabilitation Center in Miami workers are supplied with masks but are required to wear them for a week. It’s the same story at Fair Havens Center in Miami Springs. Staff had to “march on the boss” to demand the supplies one morning last week. “This isn’t right,’’ they told us.
At Avanté in Lake Worth staff is required to wear supplies for two or more weeks. They keep their masks in plastic bags when they leave their shift for the day.
And at Hillcrest in Hollywood, where two residents have died and two nurses and three certified nursing assistants have tested positive, the rationing of supplies goes beyond staff to residents who are often supplied with only one incontinence brief a day.
“These are people who are on their last journey on earth and you are not treating them like a human being. You are treating them like an animal,” said the 14-year CNA veteran at Hillcrest who spoke to the Herald/Times. She asked that her name not be used out of fear of retaliation.
Each of these facilities was contacted by the Herald/Times; except for The Bristol, each chose not to comment or respond to our questions.
DeSantis talks about supply chain
At a news conference in Sarasota Tuesday, Gov. Ron DeSantis said Florida has now sent to healthcare workers, first responders and long-term care facilities “more than 22.5 million masks, nearly 10 million gloves, 1.6 million face shields, a million shoe covers, 450,000 gowns, 200,000 containers of hand sanitizer, 85,000 goggles and 38,000 coveralls.”
“So it’s been a massive logistics operation, really focusing on supporting those front-line healthcare workers,’’ he said. “It seems like the supply chain is starting to work a little bit better than six weeks ago.”
Last week, at another news conference he acknowledged how fragile the situation is in elder-care homes. “It’s a very tough issue because you can have asymptomatic staff go in there and it spreads with the other staff and this thing just spreads like wildfire,’’ he said.
Compounding the problem has been the absence of information from many facilities to their workers.
Some long-term care facilities “have not been sharing information with staff, such as how many or if there were COVID cases in the building, which makes it very difficult to protect yourself or feel safe,’’ said Dale Ewart, executive vice president at 1199SEIU, the state’s largest union of healthcare workers. “Withholding data can be as dangerous as not having or hoarding PPE, for both residents and caregivers. Our members have been working in fear for their patients, themselves and their own families.”
The industry has acknowledged the shortages of protective gear and has asked the state for help.
“PPE continues to be very vital to the fight for the coronavirus, however it’s still very difficult to procure. While the state has been excellent in getting some of it, the need is constant,’’ said Veronica Catoe, chief executive officer of the Florida Assisted Living Association, the industry trade association. “Costs are very high, and if you are a small provider they don’t get the bulk discounts.”
She said she fears that the shortages facing nursing homes and ALFs will only get worse as the state reopens “because they are going after the same supplies stores and restaurants are going to want.”
‘There is no help coming’
Last week, the union sent a letter to Agency for Health Care Administration Secretary Mary Mayhew calling for better information and protections for healthcare workers, especially in facilities where workers were dealing with PPE shortages.
“Our expectation is that daily every staff person will be provided with a fresh surgical mask, and that staff assigned to COVID-positive residents or Patients Under Investigation will be provided with an N95 respirator, gown, gloves and face shield,’’ they wrote.
In response, the Department of Emergency Management called facilities asking for the status of their supplies but little has changed, union officials and several administrators said.
“As far as PPE, we have always been on our own ever since our first call with our state of Florida surgeon general when he informed us we were on our own,’’ said Doug Fresh, CEO of St. Mark Village, an elder-care community in Palm Harbor that includes assisted living facilities and skilled nursing units. He said he has had nine residents die in his skilled nursing wing.
“There is no help coming from the state or the feds,’’ he said. “My wife repurposed herself and became our PPE purchasing agent. Her qualifications were that she knows her way around Amazon. Currently the big shortage is getting gowns.”
Some facilities have received supplies from the state warehouse through their local public health unit, said Doug Adkins, executive director of Dayspring Village, a mental health assisted living facility just south of the Georgia line in Boulonge, Florida. It had a new staff member who showed no symptoms test positive, so the person spent just two days on the job.
“Our local EOC [emergency operations center] provided two months worth of surgical masks at our current burn rate,’’ Adkins said. “When we’re done with that, they are asking us to go buy some ourselves, but there’s no funding. Where are we going to get the money? We’re still being paid at the 2014 rates.”
When a home is running low on supplies, it is expected to fill out a form and submit it to the local emergency management agency, demonstrate it has tried to purchase the supplies on its own, and tell how much it has left, said Catoe of the assisted living trade group.
Despite the requests, not many are filled, she said. She checks the distribution list daily. “I’ve not heard from anyone recently that has received anything in the ALF world,’’ she said. “They are trying to distribute it but when you look at hospitals and nursing homes first, ALFs are lower in the hierarchy of needs.”
In March, Catoe sent a letter to Mayhew at AHCA, asking for uniform guidance and direction on the need for personal protective equipment. “Our facilities want to do the right thing,’’ she wrote, but then was given piecemeal direction “via a mix of email, conference calls, and social media postings. “We understand the need to act quickly, but a single source of uniform direction is absolutely essential at this time.”
About the same time, the healthcare workers union also made an appeal. It has asked the state to require that every healthcare worker with direct access to patients be provided with Level 1 surgical masks, and those with more risk of exposure to COVID-19 patients be provided with 3M-brand N95 respirator masks.
It also asked that when shortages “force hospitals and nursing homes to fall back on sub-optimal protocol, employers must better explain what they are doing and why, and what steps are underway to return to proper procedure.”
The union has also called on the DeSantis administration to ask the federal government to expand the production of essential equipment, “including a requirement for factories to produce PPE under the Defense Production Act, and distribute according to greatest need, rather than the highest bidder.”
Both Catoe and the union say they are still awaiting answers.
As he has done at many news conferences, DeSantis on Tuesday underscored the risk facing elders in Florida, saying that 60% of all fatalities in Florida are among residents 75 and older.
“Those who are 85 and older represent 5% of the documented positive cases in the state of Florida but 30% of the fatalities,’’ he said. Those between the age of 75 and 84 represent 8% of the positive test results and 30% of the fatalities. “So we understand who the most vulnerable groups are.”
McClatchy DC reporter Kevin Hall contributed to this report.
This story was originally published May 6, 2020 at 10:44 AM.
