Nursing homes cite shortages of masks, gloves, gowns and other PPE

By Khristopher J. Brooks

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Thousands of nursing homes still don't have enough gloves, N95 masks, gowns and other personal protective equipment to safeguard staff and residents from a potential coronavirus outbreak, according to a report released this week by the U.S. Public Interest Research Group. 

The U.S. PIRG examined data voluntarily submitted to federal health officials by nursing homes in May through August. Almost 3,000 nursing homes said they had less than a week's worth of PPE on hand, according to the data. 

Nursing homes have an essential need for PPE because workers there are caring for seniors and other residents who are at increased risk of severe illness from COVID-19.

"It's critical because an outbreak could wipe out their supply in a day or two," wrote U.S. PIRG's Teresa Murray and Jamie Friedman of Frontier Group, the report's co-authors. "In addition, it's a huge problem because [nursing] homes don't necessarily know when they're going to get more of a particular item."

PPE shortages are once again taking place just as the nation is experiencing a third wave in COVID-19 cases. More than 83,000 new cases were reported on two consecutive days this week, marking an all-time daily high in new cases for the U.S. since the pandemic started. 

It's particularly important that nursing home workers get PPE not only to protect residents and themselves, but to prevent wider spread of the virus among family members when they return home from work or anyone they might come into contact with in public places, the U.S. PIRG said. 

With at least 84,000 deaths tied to them, nursing homes and other long-term care facilities for the elderly have been marked as COVID-19 hot spots, according to a New York Times database. 

Data published this week from the Kaiser Family Foundation shows that nursing homes account for more than 40% of all COVID-19 deaths. The foundation also found that there were more deaths at nursing homes with Black and Latino residents. 

The U.S. Department of Health and Human Services asked nursing homes to report their monthly inventory of masks, gowns, eye protection, gloves and hand sanitizer. Masks and gowns had the highest shortage – particularly in New Hampshire, New Mexico, Vermont and West Virginia. Hand sanitizer was the item they were running low on the least.

Some states experienced a PPE shortage immediately after one-off outbreaks, such as a COVID-19 surge that followed the Sturgis motorcycle rally this summer in South Dakota, Murray and Friedman said. 

In other states, the shortages are harder to explain.

"In states like New Hampshire, cases and deaths dropped dramatically in late June and remained relatively low the rest of the summer [so] there's no immediate indication why PPE was in such short supply," the co-authors wrote in their report, adding, "Overall, the shortages likely were caused by myriad reasons: outbreaks, economics, poor planning or politics or some combination of those." 

 

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Nursing homes cite shortages of masks, gloves, gowns and other PPE

People with hearing loss are challenged in era of masks

By Bill Doyle

Patricia Rushton has been hearing impaired since she was 3 years old, but she’s having more difficulty hearing now than ever.

It’s a problem caused by the pandemic that you may not have heard about.

Rushton, 80, of Worcester, can hear with the assistance of hearing aids in both ears, but she and many others with hearing loss communicate in part by reading lips and facial expressions. That’s not possible with people wearing face masks to prevent the spread of COVID-19.

“I can still understand them,” she said, “but it would be easier if I could read their lips.”

Rushton refuses to complain, however.

“Masks, of course, are most necessary,” she said, “not just to protect yourself, but also to protect the community. So it’s a small inconvenience for a greater good.”

She has been hearing impaired since she was a child and suffered from mastoiditis, an infection in the bones of the ears that destroyed nerve endings. She has a particularly hard time hearing high-pitched sounds.

When she tells people she’s hearing impaired, most don’t remove their masks, they just speak louder.

“That really doesn’t help,” she said. “It’s more enunciation and diction and speaking slowly.”

Of course, masks mask enunciation and diction.

Despite her hearing impairment, Rushton taught for 39 years, including 35 in the Worcester public schools. She retired as chair of the English department at Doherty High School in 2017.

“You can ask the kids,” she said. “I never sat down. I moved around the room and I moved towards them. I would tell them I was hearing impaired and they were very cooperative.”

Rushton doesn’t rank her hearing difficulties during pandemic anywhere near as severe as those suffering from respiratory diseases and heart issues caused by the virus, but losing hearing because of masks is a problem no one saw coming before the pandemic.

Tom Wade, 71, of Worcester, has worn a hearing aid in his right ear for nearly a decade and had an appointment on Thursday to get new hearing aids for both ears. He said he was never trained to read lips, but the natural tendency to do so helped him understand the gist of what most men said. He still, however, had trouble hearing women whose voices are higher pitched. The pandemic made things worse for him.

“I really can’t hear anyone with a mask,” he said. “I have to continually say, ‘What? What?’ Most people will talk at a higher volume so eventually I can understand it, but people talking in their normal tones I can’t hear anything with their masks.”

Wade said he supports the wearing of face masks and he wouldn’t ask anyone to remove them so he could hear them better. He believes his hearing loss is more frustrating for others who have to repeat themselves than it is to him.

This is a problem that Wade never expected to have. Who figured people to have to wear face masks?

“It’s very true,” he said, “but people are very accommodating and understanding, which is nice. We’re all going through the same crisis. Everyone’s trying to do the right thing or I should say most people are. It’s a problem, but it’s not a problem, because of the consideration I receive from individuals.”

Bruce Chansky, 72, of Worcester, wears hearing aids in both ears. Working in the music business contributed to his hearing loss.

He finds it easier to understand people when he can see their faces, but masks hide much of them.

“It sounds like they’re mumbling,” he said. “The mask muffles their voices.”

Chansky believes people should wear masks in public even if it makes it harder for him to hear them. Staying six feet away from him without a mask would help him hear better than getting closer and wearing a mask.

“That would be the ideal situation,” he said.

Chansky doesn’t like the feel of a mask and he finds it restricting, but he wears one in public buildings.

Difficulty hearing through masks is a problem for many.

“I hear it from pretty much every patient every day,” Dr. Aaron Remenschneider, an ear, throat and nose physician for UMass Memorial Medical Center said, “working in a clinic where patients all have hearing loss, even from mild hearing losses to severe hearing losses.”

Dr. Remenschneider cited a study before the pandemic that found N95 masks reduced clarity of hearing among normal hearing people by 17 to 20 percent.

“That means one in five words they didn’t understand,” he said.

Obviously, it’s even worse for the hearing impaired. So if necessary, Dr. Remenschneider remains 10 feet away in his clinic, lowers his mask and speaks clearly while looking directly at his patients. He recommends his patients inform people wearing masks in public that they need them to speak louder and more clearly to them.

Dr. Gary Blanchard, geriatrics director at St. Vincent Hospital, has begun to see his patients in person again. Most of them are in their 80s and many are hearing impaired. So it’s a daily challenge to communicate with them while he wears a required mask.

“Many visits, it’s really a barrier,” he said.

So he writes his main points on a whiteboard and he speaks into a pocket talker, a microphone that is connected to earphones worn by the patient.

Zoom and FaceTime visits can be challenging with some patients, but they allowed Dr. Blanchard to communicate easier with his hearing impaired patients because the volume could be turned up and he didn’t have to wear a mask so they could read his lips.

Blanchard said his patients have frequently commented about the challenges of hearing people wearing masks. The solution for physicians could be wearing clear, see-through masks that provide protection, but allow people to read their lips.

“I think that’s probably the best way to thread the needle,” Blanchard said.

But there’s a shortage of suitable clear masks for physicians.

Connie Camelo is UMass Memorial Medical Center director of Interpreter Services, whose staff often communicates with persons who read lips. The provider and interpreter wear clear masks at UMass so they can communicate better with such patients, but Camelo said only one clear mask company is approved by the Food and Drug Administration. So UMass doesn’t expect to receive more clear masks until September or October.

“That is a huge problem,” Camelo said. “We are all trying to escalate it to the Mass. Commission for the Deaf (and Hard of Hearing) to see what else can be done for the population that is being affected by the lack of masks.”

Camelo said 55 percent of communication is visual for everyone and miscommunication without clear masks can lead to medical error. If a discharged patient misunderstands a physician and doesn’t follow medical advice, it could result in an avoidable return to the emergency room or admission to the hospital.

“It’s more than just the mask,” Camelo said. “It’s about patient care and patient safety.”

Clear, see-through masks are available online to the general public, but relatively few people wear them.

“I’ve never seen anyone wear those,” said treatment coordinator Jordan Green, who works with new patients at Hearing & Brain Centers of New England in Worcester.

Green said people with hearing loss struggle with the clarity of speech.

“It’s not that they can’t hear people speaking,” she said, “it’s really their inability to process what’s being said. So they’re relying more on visual clues and context clues to pick up the message. So when they have hearing loss that’s being untreated, it’s even more difficult now when people are wearing masks because they can’t rely on those visual clues.”

Green recommends hearing devices that pinpoint the cause of the problem rather than merely amplify sound, so people won’t have to rely as much on visual and context clues, including reading lips.

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People with hearing loss are challenged in era of masks

‘It was a horror house.’ Workers at N.J. nursing home said they didn’t have masks, sanitizer as crisis escalated.

Outside the Andover Subacute and Rehabilitation Center, where police said 17 bodies were stored in a makeshift morgue at the nursing home in Andover, N.J. April, 16, 2020 Ed Murray

By Rodrigo Torrejon

Long before the anonymous tip that led to the discovery of 17 bodies in a makeshift morgue at Andover Subacute and Rehabilitation Center, there were problems at the state’s largest nursing home.

There weren’t enough supplies. Staffing was short. Protective equipment was in short supply.

And as the coronavirus outbreak began to engulf the facility in Sussex County, two nurses, one former and one current, recalled how they would move the sick from room to room with no masks, deal with filthy floors and corridors and handle beds that were not disinfected even after residents died in them.

“It was a horror house,” said one nurse, who said she tested positive for COVID-19 and spoke on the condition of anonymity, for fear of losing her job.

The coronavirus crisis has ravaged nursing homes across the state. Nearly 30% of New Jersey’s COVID-19 related deaths were in long term care facilities or nursing homes, according to Monday’s state department of health statistics. As of Monday afternoon, a total 45 people had died at Andover, with 190 positive cases of COVID-19, according to DOH numbers.

Neither nurse was at Andover Subacute when the makeshift morgue was discovered on April 13. One had already left and one was out on disability. But both said they were working when more and more patients became ill and started to die.

Trying to care for more and more ailing patients without even the most basic protective gear, some nursing home workers would fall ill themselves, fighting an uphill battle against a lethal disease as it ravaged residents who they tried to keep safe.

At the same time, they said there was a stunning lack of transparency and information, even among staff, as the crisis escalated.

“Early on, they said they were preparing,” said the current nurse. “But they never disclosed an exact number to us. Everything was kept kind of hush hush amongst management.

According to the nurses, the situation was already out of control in the weeks leading up to the Easter weekend when 15 residents died.

Andover Subacute and Rehab is owned in part by Chaim “Mutty” Scheinbaum through Lakewood-based Alliance Healthcare Holdings. Scheinbaum also has ownership stakes in nursing homes in Pennsauken and Cinnaminson in New Jersey, and two other nursing homes in Pennsylvania.

In a statement released by Scheinbaum responding to questions from NJ Advance Media, the 37-year old CEO of Alliance said across the country, the virus has hit nursing home patients and their health care professionals the hardest.

“With one of the largest nursing home populations in the state, Andover Subacute II is on the front lines of this crisis, cooperating with public health officials to prioritize patient safety,” he said.

Andover has two separate buildings: Andover I, a smaller facility that serves those with less serious medical issues, and Andover II, a larger unit with many dementia and Alzeimer’s residents, and others suffering from schizophrenia and other mental problems.

BRINGING BODY BAGS

Andover Subactute has been in the spotlight since the discovery that the nursing home was holding 17 bodies in a makeshift morgue April 13, the day after Easter Sunday.

The facility’s existing morgue was little more than a small holding room with a window and an air conditioner, meant to hold two gurneys.

“They’re calling it a morgue,” one of the two nurses said. “It was nothing more than what we called a holding room. Where a patient expired that’s where they went before the funeral home picked them up. It’s disgraceful.”

The township police had been asked to supply 25 body bags on Easter and found five bodies being stored in a room in Andover II, Police Chief Eric Danielson had said. The day after, police found 12 more bodies being stored on site, officials said.

Even before the pandemic hit the nursing home, supplies were scarce, said employees. They would ask for supplies and were told they weren’t coming since the bills were not being paid, said one nurse.

And when the nursing home received a shipment of protective gear from the Sussex County Sheriff’s Office, the home’s administration made it clear that it was not available tor everyone, said one nurse.

The first shipment of protective gear from the Sheriff’s Office arrived at the center April 1, according to a statement from the Sussex County Department of Health and Human Services.

“It was kept under lock and key,” said the nurse. “It was not distributed to the nurses, short of the isolation wing. It was kept under lock and key. We were told ‘Go figure it out. If you want your own PPE, you have to get it.’”

After nurses approached the home’s administrator, demanding answers as to how they could get protective equipment, an employee responsible for ordering supplies allegedly chastised the group, telling them to watch the news to see how scarce protective gear had become, the current nurse said.

Eventually, by early April, staff were given one mask each, said the current nurse. The employees were told to wash and spray the mask with Lysol before reusing it.

Although Scheinbaum would not address the question of whether employees were initially denied protective gear, he acknowledged the lack of protective gear at the facility.

“Like virtually every other healthcare facility across the region, Andover Subacute II has faced challenges due to a general lack of PPE, as well as staffing complications caused by front line workers becoming ill,” said Scheinbaum.

At the same time as nurses were struggling to keep themselves safe while treating sick residents, they were being told to swab their patients as part of the tests for the coronavirus, said the two employees. The testing, which requires healthcare workers to get close to a patient and swab their nasal cavity, was ordered without even the basic training required, they said.

The lack of protective gear and training led to a backlog of residents that needed to be swabbed, said the former nurse. One man died before he could be swabbed for COVID-19, said the former nurse.

“There was no swabs available and he expired before that swab could be done,” the nurse said.

As the outbreak snowballed, nurses were moving patients from one wing to another, sometimes transferring residents who were on the ground floor to the second floor, and from the third floor back down to the ground floor, said both the current and former nurses. They did this with no protective gear, said the current nurse.

“Talk about cross contamination? Oh my god. Oh my god,” said the current nurse.

As workers scrambled to move sick patients from one area of the hospital to the other, they struggled with waning staff, said both employees. For the 11 p.m. to 7 a.m. shift, there was one nurse covering two wings of the facility, with more than 50 residents in each, one nurse said.

While Scheinbaum did not address staffing for specific shifts, he said that the illness affecting employees has caused the facility to operate with a smaller staff than usual.

“While Andover Subacute II has a full complement of licensed and qualified staff, unfortunately some of its front line workers have been impacted while fighting this pandemic and are unable to return to work at this time,” he said in the statement. “The facility is working with the Department to find replacements for those people who have become ill, has already retained a licensed nursing home administrator consultant along with a certified infectious disease consultant, and is otherwise working to ensure that the facility has qualified professionals to deal with this unprecedented health emergency.”

Scheinbaum said that staff was given updates regularly, but did not specify if staff were notified of new positive cases of COVID-19 as they were reported.

“We communicate regularly with our staff directors in daily meetings and conference calls to provide the latest updates on what is happening across our facility,” his statement said.

Separately, both employees said it was extremely difficult to get information to residents’ families.

“We had families calling continuously,” said the current nurse. “They didn’t want anything disclosed to families. They weren’t sharing the details with us staff. It just goes on and on.”

At least three relatives of residents previously told NJ Advance Media that it was almost impossible to reach anybody at the home. Francesca Veen said it took her four hours to get through to the home to check on her grandmother.

The facility has been barred by the state Department of Health from admitting any new patients, and the state ordered Andover to retain an infection control expert and key consultants.

One of the two nurses, though, said somebody needs to be held accountable.

“The owners, the administration. It was horrible. It was downright criminal how they went about everything,” said the nurse.

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‘It was a horror house.’ Workers at N.J. nursing home said they didn’t have masks, sanitizer as crisis escalated.