The coronavirus pandemic has affected everyone in some way, but it has hit nursing homes particularly hard. Through the end of October, COVID-19 deaths among residents and staff at nursing homes and other long-term care facilities stood at over 87,000. This accounted for almost 40 percent of COVID-19 deaths in the U.S., even though cases in nursing homes only made up about six percent of cases nationally. In 17 states, the number of residents and workers at these facilities made up at least half of all COVID-19 deaths.
“Since the start of the pandemic, LIUNA and the entire labor movement has been pushing for strong infection control policies and access to PPE for workers,” says LIUNA General President Terry O’Sullivan. “To protect the most vulnerable among us, we have to start by protecting the frontline workers in these nursing homes and long-term care facilities.”
Because COVID-19 presents a greater danger to people over the age of 65 and to people with underlying health conditions, nursing home residents are clearly a high-risk group. Unfortunately, the numbers bear this out, with death rates in nursing homes at 16 percent – much higher than the national average of three percent. In addition to these residents being at higher risk, the indoor setting and relatively dense living conditions are also a likely contributor for increased spread of the virus.
COVID-19 isn’t only affecting residents at nursing homes and long-term care facilities though – it’s also having a big impact on their workers. Over a four week span in August and September, cases at these facilities were almost evenly divided among staff and residents, with 26,945 staff members testing positive compared to 28,405 residents. Studies have suggested that cases among staff are one of the biggest drivers of transmission to residents, since workers need to travel from room to room to perform their jobs. Nursing home staff working at multiple locations may also be contributing to the spread of the virus among residents.
“These are folks who are not getting paid well at all, who don’t have access to sick leave and who may be working between multiple homes to make ends meet, unknowingly transmitting the virus from nursing home to nursing home,” says Bill Sweeney, AARP’s senior vice president of government affairs. “I’m not blaming the staff – they’re doing their very best – but I do blame the nursing home industry and companies that were too slow to provide the testing, the support and the compensation that’s needed to attract and retain high-quality staff.”
A Widespread Lack of PPE and Staff
With the risk from COVID-19 in nursing homes and other facilities so clear, the focus must be on what can be done to better protect residents and workers. Nationwide, a major ongoing issue is the lack of personal protective equipment (PPE). Across the U.S., more than 25 percent of nursing home facilities are reporting shortages of both PPE and staffing. In many states, including Maine, New Mexico and New Hampshire, at least half of facilities reported having less than a one-week supply of N95 respirators, surgical masks, eye protection, gowns and gloves.
We’ve previously written about why facial coverings are helpful to slow the spread of COVID-19, but are not considered PPE and are not a substitute for N95 respirators. N95 and half-face or full-face respirators effectively filter infectious droplets and particles from the air, while facial coverings and surgical masks do not. Face shields and other eye protection help stop airborne droplets from entering the body through our eyes – a key limitation of N95 and half-face respirators. Based on this, it’s no surprise that nursing facilities across the country listed N95s as their most in-demand item.
After a lack of PPE, the main issue affecting many states is a shortage of workers. In eleven states, at least 40 percent of facilities reported not having enough nurses or aides. Having adequate staffing drives better care and reduces person-to-person contact. One reason for the lack of staffing may be the large number of COVID-19 infections. During the four-week study spanning August and September, all 50 states reported COVID-19 infections among nursing home staff. In 19 states, at least half of nursing home facilities reported COVID-19 infections among staff.
Union Facilities a Blueprint for Better Protection
In the middle of this national crisis, a study of over 350 nursing homes in New York state shows that unionization and a focus on safety and health makes a difference. In nursing homes with unionized staff, residents had 30 percent lower death rates compared to facilities without unionized staff. It’s estimated that translated into more than 1,000 lives saved in New York state in the first few months of the pandemic alone.
What’s the reason behind this? First, and perhaps most importantly, union facilities were associated with PPE being more available to workers. Union facilities had about 14 percent greater access to N95 respirators and about seven percent greater access to eye shields. The study notes that union facilities also generally have better staff-to-patient ratios, paid sick leave, higher wages and benefits that reduce staff turnover, along with better implementation of infection control protocols. These differences led to a 42 percent decrease in the COVID-19 infection rate among residents.
These results are why labor unions have continued to advocate for strong infection control policies, adequate staffing levels that protect both workers and residents as well as access to the PPE that we know is effective at stopping the spread of the virus. In facilities across the country, we are seeing that a lack of PPE and a lack of trained staff can have a devastating effect on a very vulnerable group of people. We must do more to protect the safety and health of the residents in our country’s nursing homes and long-term care facilities, and that goes hand in hand with protecting the safety and health of the frontline workers in these facilities.