In the latest poll results from the California Health Care Foundation, low-wage nursing home workers overwhelmingly see their workplaces as epicenters of transmission of COVID-19 for themselves, their families and the residents they serve.
Three out of four surveyed workers said they have had known or suspected COVID-19 cases among staff at their facility. Twenty percent of the respondents said they either can’t get tested or can get tested only some of the time, and four months into the pandemic, one in four say they still don’t have adequate access to face masks or other personal protective equipment.
Arnulfo De La Cruz speaks daily with front line workers in nursing homes around the state in his role as executive vice president with SEIU 2015, which he describes as California’s long-term care workers union. The organization represents 25,000 employees in the skilled care industry.
This industry, De La Cruz said, offers a microcosm for understanding why COVID-19 has so disproportionately affected the poor and people of color in the United States.
“The majority of nursing home workers in California are women and women of color,” De La Cruz said. “The work that our members do who are Black and Latino is essential. They have not had the luxury to shelter in place for the last four months or so. They’ve been showing up and going to work and making sure that California runs.”
Yet, he said, they haven’t been given access to testing by their mostly for-profit employers. All too often, he said, the response they have received when they asked over the last few months for on-the-job testing is that they should take advantage of opportunities for testing in their communities.
These certified nursing assistants, food service workers, housekeepers and other low-wage workers are caring for elderly people at the highest risk of dying if infected with the new coronavirus, the pathogen that causes COVID 19, De La Cruz said, and they could be asymptomatic and unaware they are spreading the disease.
“We’re nowhere near the capacity that we need, both in terms of access to testing and in terms of the response time after you have a test administered,” De La Cruz said.
‘Very dangerous’ to skilled nursing facilities
Kristof Stremikis, director of market analysis and insight at the California Health Care Foundation, said skilled nursing facilities are a hotspot for COVID-19: “Statewide, if you look at the numbers … less than 5 percent of the COVID-19 cases are in skilled nursing facilities, but it’s about 40 percent of deaths, so it’s very very dangerous to the population in skilled nursing facilities.”
The foundation has done this survey and many others to help Californians and state leaders get a handle on how COVID-19 is affecting the state’s health care system during the COVID-19, Stremikis said. While other polls gauge the impact of the pandemic on California residents, he said, this survey and others like it look at the impact on health care workers.
The market research firm Truth on Call posed questions to 353 employees at California skilled nursing facilities, all of them SEIU 2015 members, from June 5 to July 12.
Stremikis said he was struck by how many of the survey responses were in line with data collected by other agencies. For instance, he said, 60 percent of the respondents said their facility has had a case of COVID-19 among residents, and that’s roughly in line with the California Department of Public Health’s report that about 55 percent of the facilities in the state have had a case among residents.
“This is a population and a setting that we need to make sure we’re doing absolutely everything we can to protect,” Stremikis said. “The data by themselves were just pretty shocking when I saw the numbers, I mean, three-quarters of respondents saying staff in their facilities have had the disease. When you combine that with the CDPH data, we’re talking about 11,000 workers who have now tested positive for the disease. This is an epicenter.”
Like De La Cruz, Stremikis described nursing home workers as extraordinarily at-risk amid the COVID-19 pandemic.
“There was a report a couple months ago now that found that more than half of workers at skilled nursing facilities have family incomes under about 200 percent of the federal poverty level,” Stremikis said “That’s about $40,000 for a family of three, and in a place like California, it’s challenging to live from month to month on an income like that. These are certainly vulnerable workers.”
Social scientist and public health researcher David Williams of Harvard University has said that there’s typically no viable option for such workers to practice self-isolation at home because they simply don’t have the space to do so. Their tight living spaces often house multiple people of different generations, he said.
Making things worse, Stremikis said, is that these low-wage workers often must work at several different nursing homes or in other low-wage jobs in order to make ends meet.
Workers become ‘a vector for transmission’
“They themselves become a vector for transmission,” he said, “and one of the things we need to do in order to combat transmission is to make sure we can test everybody, make sure we can test residents but also make sure we can also test staff anytime they are coming in for a shift. They should be able to get those results in minutes. You can’t wait days in this case. We really need to double down when it comes to ensuring that everybody can get tested and tested regularly.”
Deborah Pacyna serves as director of public affairs for the California Association of Health Facilities, an organization that represents 900 skilled care facilities and 400 intermediate care facilities for people with developmental disabilities.
She said that CAHF has been advocating for personal protective equipment and COVID-19 testing for residents and caregivers since the beginning of the pandemic.
“These front-line workers have put their lives on the line for our residents, at great risk to themselves and their own families,” she said. “In the early days of the pandemic, many workers did not have access to basic supplies including masks and gloves because of supply shortages.”
In late May, the state public health officials told nursing home operators to test all staff and residents at least once. Even if no cases of COVID-19 were found, each home must continue to test 25 percent of residents and personnel every seven days, ensuring that all staff members are tested once per month.
Baseline testing has now been completed, Pacyna said, and going forward, some facilities will have to test their residents and staff more often than once a month. Initially, she said, many local public health agencies were going to nursing homes to perform tests, but as cases of COVID-19 once again surged, they pulled back.
“Some workers have to go offsite to get their tests,” Pacyna said. “Nursing homes have contracts with labs to do the testing, but the results are often delayed up to 5 days which is not sufficient to stop the spread of the virus. Recently, CMS (the Centers for Medicare & Medicaid Services) announced it will be sending point of care testing kits to all nursing homes, but that will take some time.”
Nationally, two trade groups representing nursing home operators and assisted living facilities sent a letter to U.S. governors this week urging them to expedite processing of tests and to provide additional support with procuring personal protective equipment, especially N95 respirators.
This second-wave of transmission has come back very aggressively, once again threatening to disrupt supply chains and overwhelm health care organizations, said De La Cruz, and testing and PPE supplies must be addressed on a larger and longer-term scale before nursing home workers and residents will truly be protected.