Since suffering a traumatic brain injury five years ago, Eliot Loshak, 87, has been unable to get out of bed on his own. His eyesight is heavily damaged, and he needs help from the staff at his Manhattan nursing home just to call his only daughter, Pam.
With the coronavirus now spreading through the nursing home, Pam Loshak fears for her ailing father — and for the staff members at the Mary Manning Walsh Home, who don't have enough personal protective equipment to slow transmission of the disease, despite their hands-on care for those most vulnerable to the virus.
ArchCare, which runs the facility and four other nursing homes in the New York area, has been forced to outfit staff members in rain ponchos and beautician gowns to stretch their dwindling supply of protective gear, according to Scott LaRue, president and CEO of the company, which is affiliated with the Archdiocese of New York. Employees are given one N95 mask — meant to be single-use — to last an entire week.
"I don't feel safe," an aide at one ArchCare facility said, declining to be named for fear of retaliation.
More than 200 of ArchCare's 1,700 nursing home residents are infected with the coronavirus, and more than 20 have died, LaRue said. At least 10 staff members are also infected, with one in the hospital on a ventilator.
The risks are so serious that LaRue is advising family members to pull residents out if feasible. "If you have the ability to take your loved one home, and that's possible, I would encourage you to do so," he said. "There will be better isolation and better limited contact in a home than there would be in a nursing home."
LaRue says just a few families have done so, as the medical and personal needs of most residents are too complex to handle at home.
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The ArchCare aide said that staff members are only being given one disposable gown for their entire shift, even if it becomes soiled, and they must constantly circulate between residents who are infected and those who are not.
"How do you expect to use the same gown? We are cleaning them, wiping their mouths, there's stuff on us," the aide said. "I feel like I'm spreading the virus."
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While one area of the nursing home where she works had once been designated for infected residents, there are now so many who are sick that they are mixed in throughout the entire facility, the aide added.
Pam Loshak, 42, a publicist who lives in Harlem, is painfully aware of the risks her father faces if he stays at his nursing home, but she doesn't know where else he could go. Eliot Loshak needs a motorized lift and two people just to move him to a chair, and he frequently suffers from health problems that require expert attention.
As nursing homes hit by coronavirus, families face difficult decisionsApril 2, 202002:14
"I live alone in an apartment — there's just no way I could give him the care he needs," Pam Loshak said.
She is grateful to the nursing home staff for carefully tending to her father, but is pained to think of what could happen as the virus spreads. Her father already has respiratory problems because fluid builds up in his lungs while he's bedridden, she explained. If her father gets infected, she fears, "he would die for sure."
'It is impossible for us to stop the spread'
Over the past week, coronavirus infections at nursing homes have skyrocketed: More than 400 long-term care facilities around the United States now have infected residents, according to the Centers for Disease Control and Prevention — a 172 percent increase in a single week. In New York state, one in four nursing homes have cases of the virus; 1,228 residents have tested positive and 224 have died, according to a spokeswoman for the state health department.
But nursing homes have been unable to get enough protective gear and tests, in part because overwhelmed hospitals are getting the supplies first, industry executives and groups say.
"We seem to be a second-tier priority," said Stephen Hanse, president and CEO of the NYS Health Facilities Association-NYS Center for Assisted Living, which represents long-term care facilities.
That has made it harder for nursing homes to slow the transmission of the coronavirus among staff members and elderly residents. Those over the age of 70 and with underlying health conditions are significantly more likely to die from the virus.
In Washington state, which reported the first coronavirus cases in the U.S., 35 people died after an outbreak at the Life Care Center of Kirkland, a skilled nursing facility. A CDC report found that a lack of personal protective equipment and staff members who continued to work while sick helped fuel the deadly outbreak, which quickly spread to other nursing homes in the area.
In recent days, similar cases have exploded across the country. At one facility in Stafford, Connecticut, three residents have died and at least six employees are now infected, with staff reporting a lack of protective gear and limited testing. At two nursing homes in southwest Pennsylvania, infections are mounting among both residents and staff, who say they don't have enough masks to protect themselves. In Louisiana, where 13 residents have died in a single nursing home, one 130-bed nursing home reported having no personal protective gear at all.
"We're in a situation where it is impossible for us to stop the spread of the virus," LaRue said. "They say this is our highest-risk population — the one we have to protect the most — and they're not giving us what we need to do that."
Employees are trying their best to keep scarce equipment clean and to limit visits to the rooms of different patients, the ArchCare aide said. But it is impossible to avoid hands-on contact while assisting residents with eating, bathing, toileting and other basic tasks, in addition to the medical care they regularly receive from staff doctors and nurses. One supervisor suggested that staff members use garbage bags to protect their gowns, the aide said.
Protective gear is especially critical in nursing homes since many residents have physical limitations or dementia that prevent them from being able to cover their mouths when they cough, or from wearing a mask themselves.
"Nursing homes and all long-term care providers desperately need PPE," the American Health Care Association, which represents nursing homes and other long-term care facilities, said in a statement Monday.
Last week, ArchCare executives made an urgent plea to New York City for 28,000 gowns and 28,000 face shields to protect their nurses, aides and other employees.
The city's emergency management department sent less than 1,000 of each — not even a full day's supply for ArchCare's five facilities, LaRue said.
When asked about the shortages facing New York City nursing homes, a spokesman for the city Department of Health and Mental Hygiene said officials are "working furiously" to supply them with protective equipment.
"These facilities will get weekly supplies of personal protective equipment based on need, as well as emergency orders should the need arise," the spokesman, Michael Lanza, said. The state health department said it was "communicating regularly with nursing home providers and industry leads" about their needs for protective gear.
Last week, New York state officials and a local hospital association helped ArchCare track down 4,000 gowns and 4,000 face shields, but that doesn't come close to meeting the need, LaRue said.
Supplies have been scarce on all levels of government: Many states, including New York, have only received a fraction of the personal protective equipment and other critically needed supplies that they have requested from the federal government's stockpile, prompting growing calls for President Donald Trump to use a wartime law to broadly coordinate production and distribution.
The Trump administration, however, has narrowly limited its use of the law and continues to tell states to buy the supplies themselves from private vendors. But the massive demand for masks, gowns, face shields and other equipment has created chaos as states, hospitals, nursing homes and other facilities are all competing to purchase the same critically needed supplies.
On Monday, ArchCare finally found a vendor who agreed to sell $237,000 worth of face shields and hazmat suits, shipped from China within a week, according to an invoice provided by the company.
But the deal fell through at the last minute after ArchCare discovered that a bank account set up to receive the funds was "opened with fraudulent documentation," according to a company email.
ArchCare and other nursing homes are now appealing to private donors to help fill the need.
"Everyone we serve has the right to the same resources, and their life is just as valuable as anybody else's," LaRue said.
A widespread problem
Nursing homes are also facing a lack of testing, which makes it even harder for them to contain the virus. While more private labs have begun offering coronavirus tests, testing at nursing homes remains highly limited because of a shortage of swabs and other components needed to conduct the tests, as well as restrictive state guidelines.
On March 21, New York state issued an advisory stating that any nursing home residents or health workers in the New York City area with symptoms of acute respiratory illness "should be presumed to be COVID-19," and that testing for those residents "is no longer necessary."
That has made it impossible to identify and isolate all the residents who are infected from those who are not, LaRue said. "If I had my druthers, I'd do widespread testing, and I would test every employee."
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ArchCare struggled last week to find just 30 tests from a private lab, which quickly ran out.
The problem is widespread, according to the American Health Care Association: "We have heard from many providers about residents and staff getting declined when trying to be tested. This is extremely worrisome."
Highland Care Center, a nursing home in Queens that is not owned by ArchCare, had a resident hospitalized with the coronavirus last week. Other residents are also showing symptoms, which the facility reported to the city health department, but they still haven't been tested, the facility's administrator, Don Morris, said. "We don't know if they are coming to test."
A 'frightening' lack of communication
As the virus overtakes nursing homes across the country, many families feel helpless and increasingly cut off from their loved ones.
To protect residents from outside infection, New York and many other states have banned visitors from nursing homes. Updates from the management may be limited and sporadic: The Centers for Medicare and Medicaid Services requires nursing homes to notify family members if their relative has a confirmed coronavirus infection, but not if others in the facility have tested positive.
External oversight is also limited: The federal government has temporarily suspended routine health and safety inspections to focus on high-risk facilities, and state ombudsmen are also currently barred from visiting nursing homes and most assisted living facilities.
At ArchCare's Mary Manning Walsh, families were notified Monday that staff-assisted videoconferencing with residents would be suspended for safety reasons, and they were asked to limit calls to the facility. "I ask for your patience in knowing that if someone is not getting back to you immediately, they are directly treating our community," Michael Monahan, the facility's director, wrote.
In an email accompanying the notice, Carlotta Gladding, a member of the residents council, urged families to be patient as staff members are "doing their utmost best to provide safe care for your loved ones."
But Gladding, whose 105-year-old aunt is at the facility, acknowledges how difficult it has been for families to be cut off from residents as the virus has spread.
"It's nerve-wracking and frustrating and frightening, especially since you may have no communication with your loved one," she said.
Pam Loshak has limited her own phone calls to spare the staff and last spoke with her father in mid-March, when visitors were first banned. She told him to try and cover his mouth if he had to cough, but she knew even that would be tough, given his weak muscles and limited motor control. She tried to be as reassuring as possible, and let him know she was OK.
"Just sit tight," she told him.
Editor’s Note: Suzy Khimm, an author of this article, is related to a resident at the Mary Manning Walsh Home.