As the numbers of COVID-19 cases and deaths in nursing homes climb throughout the United States, staff at some Chicago facilities describe dire work conditions and a lack of transparency about outbreaks, a WBEZ investigation has found.
Workers at three different long-term care facilities describe staffing shortages, inadequate personal protective equipment (PPE), a lack of clarity around the extent of the outbreaks in those nursing homes, and conduct that violates guidelines set forth by the Illinois Department of Public Health (IDPH) and the Centers for Disease Control and Prevention (CDC).
The workers from three Chicago nursing homes — Lakeview Nursing and Rehabilitation Center in Lincoln Park, Woodbridge Nursing Pavilion in Logan Square, and Center Home for Hispanic Elderly in Humboldt Park — all asked to remain anonymous for fear of losing their jobs. WBEZ also spoke to a patient at Lakeview who described the conditions at the facility.
Several residents have died at each of the facilities. As one worker put it: “This is a bloodbath. I feel like my heart is breaking.”
On Thursday, workers from three suburban nursing homes in the Chicago area — Bridgeview Health Care Center, Burbank Rehabilitation Center, and Prairie Oasis in South Holland — convened a press conference with their union, SEIU Healthcare Illinois, to describe similar scenes at their facilities, demonstrating that the problems are widespread.
“I love my patients … so when they pass on due to the fact that no one is telling us what’s going on, that hurts,” said Shaundria Foster, a certified nursing assistant at Prairie Oasis.
Read more: All of WBEZ's coverage of the COVID-19 outbreak in Chicago and the region
Greg Kelley, president of SEIU Healthcare Illinois, said nursing home workers “are on the frontlines of this crisis, and they are, at this moment, among the most vulnerable.” He said facility owners have “the responsibility … and the ability to address all of these [conditions] without retaliating against the workers.”
A lack of transparency
Workers at the Chicago nursing homes, Lakeview, Woodbridge and Center Home, told WBEZ that administrators have not made it clear to staff and residents how many people have tested positive or have died from COVID-19. All of the workers said they have kept unofficial tallies to keep track of cases and deaths.
Woodridge has had 22 residents test positive for COVID-19, and the nursing home has suffered three deaths due to COVID-19, including two residents, according to an email Woodbridge administrator Patricia Correa sent to WBEZ on Thursday.
“Woodbridge Nursing Pavilion is doing everything we can to ensure that we stop the spread of this unprecedented virus, COVID-19, within our facility,” Correa wrote. “Resident safety is our top priority.”
However, between last Friday and Monday, Woodbridge workers notified WBEZ that four residents had died at the facility during that four-day span.
One of the Woodbridge workers said families were sent letters on Friday, the day the first resident died, telling them “several residents and staff” have tested positive for COVID-19 in the facility. It is unclear whether the letter was sent before or after the first resident died at Woodbridge over this past weekend.
A resident at Woodbridge Nursing Pavilion is wheeled out to an ambulance. Between last Friday and Monday, workers at Woodbridge notified WBEZ that four residents had died at the facility during that four-day span. Manuel Martinez / WBEZ News
A worker at Lakeview said more than 15 Lakeview residents have died at the hospital after testing positive for COVID-19. The worker said at least six others died in the nursing home with COVID-19 symptoms without being tested.
More than 40 residents have been sent to the hospital and tested positive for COVID-19, according to a Lakeview worker. Many of the remaining residents have exhibited symptoms like fever and coughing over the past three weeks, and several residents currently continue to exhibit symptoms, the worker said.
But when Lakeview administrator Jeff Ingraffia spoke with WBEZ last Friday, he said none of the nursing home’s residents were exhibiting COVID-19 symptoms at that time.
When asked how many residents from Lakeview have died from COVID-19 after being hospitalized, Ingraffia said, “I know they have. I couldn’t tell you exactly how many. My concerns are always HIPAA regulations.” Those regulations mandate that health care professionals shield individuals’ private medical information — but not aggregate numbers that are of interest in a public health crisis.
WBEZ followed up this week with a list of questions regarding the number of cases, deaths, and hospitalizations, but Ingraffia had not responded by the time this story was posted.
A worker at Lakeview Nursing and Rehabilitation Center in Lincoln Park said more than 40 residents have been sent to the hospital and tested positive for COVID-19. Manuel Martinez / WBEZ News
Center Home administrator Juvenal Gonzalez declined to comment but provided contact information for Susan Bledsoe, the nursing home’s legal counsel at iCare Consulting Services LLC. Bledsoe requested that WBEZ share its questions via email and said she would respond. On Sunday, WBEZ received a note from Gary Mack, a public relations professional, saying that he was now representing the nursing home.
“The health and safety of our residents and staff is our highest priority at Center Home for Hispanic Elderly,” Mack said in a statement he sent to WBEZ earlier this week. ”Center Home has worked and continues to work diligently to protect our residents and staff during the COVID-19 outbreak. We are deeply saddened to learn of the death of one of our residents at the hospital and offer our sincerest condolences to their family.”
In an email he sent Thursday, Mack said that one Center Home resident has died at the hospital and that 22 residents tested positive for COVID-19.
However, a worker from Center Home reported, as of Thursday, at least eight deaths related to COVID-19 and more than 40 confirmed cases.
Challenging work conditions
The workers at Woodbridge, Lakeview, and Center Home said the lack of PPE, a failure to implement or enforce strict infection control measures, and staffing shortages contributed to the outbreaks.
Workers at Woodbridge said the facility was so short-staffed that, at one point over this past weekend, the administrator brought in her family members to work as kitchen staff. One of the sources said the nursing home ordered burgers for residents and prepared mashed potatoes for those who cannot chew. On Thursday, Maria Martinez, an admissions assistant at Woodbridge, who is also helping in the kitchen, confirmed this account.
The workers said Woodbridge staff were even discouraged from wearing masks earlier in March, with the administrator telling workers that masks were now 10 times more expensive than they were before the COVID-19 crisis.
More recently, however, some Woodbridge staff members were told to “sign in” to receive masks that they are asked to wear for a week at a time, one Woodbridge worker said.
Correa denied that Woodbridge staff have ever been discouraged from wearing masks. “We have ordered additional PPE supplies and have been successful in having the appropriate supplies as needed,” Correa wrote in an email to WBEZ.
At one point, at Lakeview, the administration instructed staff to “put masks and hair caps in paper bags and reuse them” for an indefinite number of days, a Lakeview worker said.
“We were told to wear the same gowns in and out of most of the rooms,” a Lakeview worker said. “We knew we were spreading it from patient to patient.”
Workers at Woodbridge Nursing Pavilion, Lakeview Nursing and Rehabilitation Center, and Center Home for Hispanic Elderly said a lack of personal protective equipment, like masks and gowns, contributed to the COVID-19 outbreaks at those Chicago nursing homes. Provided courtesy of the Centers for Disease Control and Prevention
At Center Home, one worker said “there is no cohesion” in terms of how workers approach PPE. “There’s some people walking around with what looks like hazmat suits, and then there’s some people walking around with paper masks,” the worker said.
Another Center Home worker said surgical masks are locked away in nurses carts, “and there are not enough gowns for everyone. Many now wear the same gown during their entire shift — in every room — [going between] symptomatic and asymptomatic patients.”
Mack, who represents Center Home, denied those allegations. He said the nursing home maintains an appropriate supply of PPE, including N95 masks, gloves and gowns.
“Masks [are] not locked up. Never have been. [They are] kept in storage or on nurses carts out of view,” Mack wrote in an email to WBEZ on Thursday. “Staff does not wear the same PPE during shift. [Center] Home complies with IDPH and CDC guidelines. It’s not allowed.”
Mack also maintained that the nursing home stays up-to-date with “constantly evolving infectious disease control protocols.”
But a Center Home worker said they have observed conduct that would appear to violate IDPH guidelines on how to handle isolation rooms and inconsistent enforcement of closing common areas.
“I have seen symptomatic patients open the door and walk from wing to wing,” said a worker from Center Home. Particularly, the source added, symptomatic residents with dementia have been roaming the hallways and common areas — “touching carts, doors, everything” — with little enforcement from the facility staff. According to IDPH guidelines, symptomatic patients should “only leave their room as required for medical procedures not available on site.”
Numerous staff members have called in sick at Lakeview, and many at Woodbridge have quit, according to workers at those nursing homes.
In recent weeks, at least 40 Lakeview workers have called in sick, leaving the administration scrambling for staff, according to a worker at Lakeview. A resident at the facility, who also asked to remain anonymous for fear of poor treatment by staff, said there has been “a lot less one-on-one care” after the COVID-19 outbreak began.
“One [nursing assistant] had to run a double shift — two separate eight-hour shifts back to back — to cover an entire floor by herself,” the Lakeview resident said. “That’s been a common practice lately.”
Ingraffia, Lakeview’s administrator, said staffing shortages are prevalent in all nursing homes.
“There’s not enough nurses. there’s not enough CNAs,” he said. “I have a staffing shortage just like every other building in the state of Illinois.”
A Lakeview worker said that staff members, if they had tested positive for the virus, were required to take 30 days off, which would likely discourage employees from disclosing that they had COVID-19.
“This is a scare tactic, as no [one] has that much [paid time off],” a Lakeview worker said.
The latest guideline from the CDC indicates that employees can return to work after at least seven days after the onset of symptoms, or three days after symptoms improve — whichever period is longer. At one point, the CDC had recommended that employees return after 14 days, but the guideline has been lowered in recent weeks.
A lack of testing
According to sources at two of the nursing homes, Lakeview and Center Home, there has been no testing for COVID-19 done in-house. All the positive diagnoses of COVID-19 for residents at those facilities were made after they were sent out to the hospitals, sources said.
IDPH’s COVID-19 guideline to long-term care facilities had been that once a COVID-19 case is confirmed in a nursing home, other residents there need not be tested, but the staff should assume the highly contagious coronavirus has already spread. The guidelines instruct nursing homes to treat those other patients as if they were positive for COVID-19, but upon treating them for COVID-19 symptoms, that information must be reported to public health authorities.
Illinois Department of Public Health Director Dr. Ngozi Ezike said the state will increase testing at targeted facilities with no known outbreaks and increase testing of staff at facilities with known outbreaks. Courtesy of Facebook Live
As for testing more residents, Lakeview administrator Ingraffia said, “We don’t generally test unless people have symptoms. If someone’s exhibiting symptoms, then we would generally send them to the hospital and the hospital would test.”
Dr. Vivek Gupta, Lakeview’s medical director, said the decision to test residents is up to the nursing home, but the lengthy wait times to get results from swab tests may be discouraging some facilities from using in-house tests.
“You need to send tests somewhere, and the results don’t come in an hour,” Gupta said. “It takes days for the result to come, and [for] most patients, at that time, it’s too late.”
Still, according to a Lakeview worker, some staff have expressed a desire to see more residents get tested in-house.
“We’re the people that are in charge of their lives. I just want Lakeview to test everybody and try to protect us and isolate the people that they can,” the source said. “I think it’s too late for a lot of people … but there are still people who aren’t showing symptoms.”
The Lakeview resident who spoke to WBEZ is one of those patients without symptoms. The resident said that many of the “alert residents” have also requested testing. “Once we knew about [COVID-19] … we were asking for testing and have been denied,” the resident said.
Earlier this week, IDPH Director Dr. Ngozi Ezike announced that the state will implement a “two-pronged approach for testing,” ramping up testing at targeted facilities with no known cases, and increasing testing of staff at facilities with known outbreaks.
According to sources at two Chicago nursing homes, Lakeview Nursing and Rehabilitation Center and Center Home for Hispanic Elderly, there has been no testing for COVID-19 done in-house. All the positive diagnoses for COVID-19 at those facilities were made after residents were sent out to the hospitals, sources said. Courtesy of the Centers for Disease Control and Prevention
Thus far, it has been difficult to precisely gauge the impact of COVID-19 on Illinois nursing homes. On Sunday, for the first time, the state published confirmed cases and deaths at individual nursing homes. But that list doesn’t capture everything. For instance, it doesn’t include any cases or deaths at Woodbridge.
Other sources of data help fill in the gaps, but they, too, have been incomplete. A WBEZ analysis of records from the Cook County Medical Examiner’s Office, as of Thursday morning, shows more than 330 COVID-19 deaths linked to nursing homes and other long-term care and assisted living facilities in the county.
But some nursing home deaths are never examined by that office. Spokeswoman Natalia Derevyanny said that the medical examiner’s office only receives the cases that are sent to them.
"We have to be notified — that's the only way we know of a death," Derevyanny said. She added that if there are deaths in nursing homes of residents with COVID-19 symptoms who were never tested, those cases likely would not show up on the medical examiner’s ledger.
As for Lakeview residents who died in-house, Gupta, the medical director at Lakeview, said those residents were not classified as COVID-19-related deaths because, without being tested, he “did not have confirmation.”
Because of this lack of testing, Gupta said the actual number of COVID-19 deaths at Lakeview — and at nursing homes throughout the state and country — is likely much higher than what has been reported, as current numbers do not account for all deceased who were never tested.
A bad situation made worse
Experts say while the spread of the coronavirus in nursing homes is tragic, conditions in these facilities were rife for outbreaks — especially for such a highly infectious disease like COVID-19.
Dr. Dheeraj Mahajan, a geriatrics section chief at Advocate Illinois Masonic Medical Center and a physician who works at nursing homes, said those facilities are hampered in their fight against COVID-19 due to their congregate settings, nurse staffing levels, nursing qualifications, strained resources and their limited experience dealing with infection control.
Nursing homes are “not really geared towards managing a pandemic-level pathogen, something that is so aggressive like coronavirus that is so selectively lethal to the [elderly] population,” said Mahajan, who is certified in infection control.
And with state and federal health authorities already slammed with soaring numbers of COVID-19 deaths in hospitals, nursing homes have not been the focus of their oversight until more recently, long after the outbreaks started, Mahajan said.
“[IDPH] obviously has a nursing home division, but as with any health department, the first focus was in hospitals. That’s where the initial fire [was],” Mahajan said.
Nursing homes are hampered in their fight against COVID-19 due to their congregate settings, nurse staffing levels, nursing qualifications, strained resources and their limited experience dealing with infection control, said Dr. Dheeraj Mahajan, a physician who works at nursing homes and is certified in infection control. Manuel Martinez / WBEZ News
He added that nursing homes are businesses with an incentive to underreport COVID-19 cases and deaths.
“There are people who just don’t want to let the hospitals and the community know that they have an outbreak because once you declare you have an outbreak, you lose your business,” Mahajan said.
During this public health crisis, the nursing home workers who spoke with WBEZ said transparency is key.
“There’s so many factors out of anyone’s control,” a Lakeview worker said. “The core problem is they’re not willing to test people or disclose what’s happening.”
The resident at Lakeview said, considering the circumstances, the nursing assistants and nurses are doing the best they can, “but I don’t think the management is handling the COVID-19 crisis the way that the [health authorities] envisioned.”
A worker at Center Home for Hispanic Elderly called the residents “sitting ducks.”
The source described an “eerie” atmosphere with “people in their rooms, lying in bed.”
“It’s heartbreaking because … this is their home, and their home has been compromised,” the worker said. “And there’s nothing they can do, but they don’t even realize how unsafe everything has been.”
Esther Yoon-Ji Kang is a reporter for WBEZ’s Race, Class and Communities desk. Follow her on Twitter @estheryjkang.