‘This is what you signed up for.’ Nursing home staff say safety concerns were dismissed as outbreak grew.

Empty soap dispensers. An ongoing shortage of masks and gowns. Employees pressured to come into work even if they had symptoms of COVID-19.

The coronavirus pandemic has ravaged nursing and long-term care facilities, whose vulnerable patients account for nearly 60 percent of the 1,099 deaths state health officials have so far linked to the virus.

What follows is one staffer’s description of the outbreak at Colonial Heights Health Care and Rehabilitation Center, a more than 190-bed facility located 30 minutes south of Richmond where staff say they’ve been told more than 40 patients tested positive.

The Virginia Mercury confirmed the details of the account with one additional staff member and two former staff members who said they quit recently because they were so disturbed by the way the facility was responding to the disease. They all spoke on the condition that their names not be used, saying they feared professional repercussions for speaking out.

In a statement, Colonial Heights Health Care said state health officials had reviewed their response to the virus and found no deficiencies. “We continue to work directly with local and state health departments and follow all guidance from Centers for Disease Control (CDC) protocols to ensure our residents and staff are protected,” they wrote.

Administrators repeatedly referred back to the statement rather than answer specific questions about the employees’ account.

The facility told WTVR last month that at least two patients had died — a number staff say has since risen. The facility would not provide updated numbers about infections or deaths and the Virginia Department of Health has so far refused to release data about outbreaks at specific health care facilities.

The following interview has been lightly edited for length and clarity.

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Virginia Mercury: What was your first warning that this was going to be a problem for your facility?

I would say mid-to-late March, we started getting admissions of people with respiratory symptoms that seemed to closely match, you know, this virus that we had heard about. That’s when we started getting concerned.

The COVID-19 test was available then, but it was still really difficult to get people tested. So we would have admissions of people from the hospital, admissions for short-term rehabilitation and they would demonstrate these symptoms, but they weren’t getting tested before being admitted.

So they were asking us to go see patients who, under how things are understood now, would absolutely have been tested and been cared for with protective equipment. But they would not allow us to use protective equipment to go see them.

What was the argument as this is starting against using masks or whatever protective gear you might have on hand?

When we expressed to our boss our level of discomfort and the wish to wear a face mask, to wear a contact gown — we were met with resistance. We had meetings and they basically said there’s no way a hospital would send someone with the coronavirus into the facility. There’s no way that would happen. If the doctors in the hospital didn’t think this person needed to be tested, then there is no need and we should care for them just like we care for everyone else.

Were there any tense moments between administrators and staff? How are these conversations playing out?

We raised concerns in staff meetings. (An) administrator said, if you’re not comfortable seeing these patients, you don’t have a job here. They really tried to minimize our concerns and they said phrases like, ‘This is what you signed up for.’ And it felt kind of manipulative, honestly. They talked down to us and they accused us of fear mongering and of not wanting to do our job.

What was the supply closet looking like at this time? Did you have the protective equipment on hand? Could you have dipped into that supply at that point?

At that point in time, I’m fairly confident we did not have N95 masks. But we did have surgical masks, which are much less protective — but they are something. And we also had contact gowns.

And they said don’t wear those — you can’t wear a surgical mask when you’re caring for these people with these respiratory symptoms?

Yeah.

When did y’all get your first N95 masks?

Early April, maybe.

Tell me about the PPE shortages. So basically you started with none on site. When did that shift and do you feel like you have what you need now?

Well we certainly don’t have what we need now. There are strong restrictions. At first we were supposed to get a new one every 10 days. Now, we are given one mask and wear it indefinitely until it breaks. That’s where we are now.

That’s a long time for a product that’s supposed to be single-use.

Yeah. I remember clearly after wearing it for weeks and feeling it sagging off my face, which meant the elastic bands were really shot and it really wasn’t doing that much good — because they need a seal for it to be operating effectively. You had to go to the administrator, who was the safeguard of the PPE, to try to get a new one. I’m on my third mask now.

Another thing that is just like, gross — these contact gowns, we use those indefinitely. It’s a yellow, breathable, cloth gown you would put on to work with someone with an infectious disease and you would take off and throw away under normal circumstances. Our system is, you write your name on it and hang it on a single hook shared by everyone else who sees that patient. And so all of these gowns just hang on any one of two to three hooks in a room. And it’s not uncommon to see someone else wearing your gown if it’s hard to read the name or they were in a rush. And I find that really disturbing.

From the state and officials we’re hearing about all this PPE flowing in and things are getting better.

It’s really disturbing PPE is so scarce at our facility because now that we are a COVID-positive facility, we are admitting new patients that are recovering from the coronavirus from the hospital to begin their rehabilitation. We’ve already had an extensive outbreak. So it’s really concerning they would make that decision to increase the amount of exposure staff has if the protective equipment isn’t actually in place.

I do think it’s important to give people a place to get stronger before they go home and a place to be quarantined, and, you know, improve their health before they go out into the community, and I would be proud to be part of that if I felt like my safety was being valued and our facility was actually prepared to do that.

One thing I’ve been thinking about as we’ve been talking is — why haven’t you quit? What’s stopped you from walking out the door? Is it money? A desire to help people? A mix?

Honestly, I’m wrestling with that myself, because if I were to look at it objectively, probably the most financially responsible decision would be to walk away. Because if I get infected and have to go to the hospital — they don’t give us really good insurance. It’s something like an $8,000 deductible for my own plan. And they’re not covering the cost of being out of work. There’s no additional sick time for contracting the virus at the facility. You have to use your own accrued paid time off, which a combination of sick time and vacation time.

But I think part of it is the fear that it’s going to take a long time for things to recover. There’s a strong fear that if you leave work now, you’ll be out of work for six months or longer.

But at the same time, you feel a responsibility to stay and help, because a lot of people have quit. And you know the staffing ratios are really delicate and they’ve always been on a tightrope because they like to work people as hard as they can, they like to cut costs as much as they can. So it doesn’t take very many people quitting to know that inadequate care is going to be delivered. And honestly, it is being delivered. People are not getting taken care of to the degree they deserve to be. But that was true before the pandemic. But now it’s just exacerbated.

Were they doing anything at the facility for staff to try to keep morale up?

Yeah, they gave us T-shirts that said we were heroes and they’re giving us gift cards or bonuses and calling it hero pay. But they’re not asking us what we need and what we want and what would make us comfortable. Once or twice a week, they’ll provide lunch. We had a barbecue. It boosts morale for some but there’s others looking at it like me, and I just see a bunch of people standing too close together not practicing social distancing.

We hear the word hero thrown around a lot, especially by the administrator when they’re trying to boost morale. But it is really frustrating and it does something strange to your psychological wellbeing to be called a hero but at the same time sort of be disregarded and not be provided with safety and protection — that’s financial protection or physical protection. There’s something really kind of disturbing about that. It’s almost like a guilt trip that gets put on you. To be a hero and to not complain and to not speak out — it’s almost as if, heroes don’t speak out.

When we were talking earlier about doing this interview, you said one of the reasons you wanted to talk to me about what you were witnessing was that there was a disconnect between what patients’ families are being told, what the public is being told and what was really happening. Can you walk me though that disconnect? What is happening that you think the public and family members need to know about?

There were really large missteps in how things were handled. I think nursing homes operate as a bit of microcosm of what we’ve seen in the country with concerns being minimized and minimized and minimized until the truth is glaringly obvious and then all of the reactions were simply that. They were reactions. There was very little done that I would say was proactive.

A lot of the changes that were made, policies that were designed to minimize infections, were carried out extremely poorly and were carried out in a way that didn’t adequately value the health and safety of the residents or the employees.

What’s an example of that, something where it was kind of obvious what was needed to everyone on the ground and it didn’t happen?

There was always a lot of pressure to come into work if you had a sore throat or a cough. Really, they focused almost exclusively on having a fever, which we know is not the only telling symptom and, at the point you have a fever, may be too late.

How did that pressure to come in if you had, say, a sore throat, manifest itself? What did that look like?

If you called out for like mild cold symptoms, you would be looked down on as wanting to shirk your duties, of not being a team player. It didn’t seem like caution was valued.

Do you think any of the deaths so far in the facility were preventable? 

Absolutely. I think if better education was provided about infection control practices — because one thing we know is people going in and out of rooms without using gloves, without washing their hands. When they’re taking blood pressure and monitoring vitals. Without sanitizing the equipment between uses. Not washing hands between caring for roommates. So, a lot of the spread started out between roommates, which would make sense — they’re in close proximity. But I do think some of these deaths were preventable.

We’ve had a few deaths in the facility from respiratory failure, but because they were never tested, we’ll never know.

So I do think some of these deaths could have been prevented, absolutely.

It’s kind of hard for me to wrap my head around — the country is talking almost exclusively about COVID-19 at this point — and this facility filled with vulnerable people, they were not doing things like washing hands between seeing patients and other things that just sound super basic?

Yeah. Or like, gloves being stocked in rooms. And soap dispensers being stocked. And hand sanitizers being stocked. You had to walk down multiple hallways to find the things you need. And sometimes, you’re left in a position where you have to decide if you’re going to jeopardize somebody’s health or jeopardize your own.

Because it’s a long-term care facility there are people with varying stages of dementia who might be engaged in various unsafe behaviors. You might catch them doing something, and technically you have the capacity to intervene. But I found myself in many situations where I don’t have gloves in the room to help someone to the bathroom and they’re going regardless of it being safe or not. I don’t have a contact gown available. I have to walk down multiple hallways and request one. So in time sensitive situations, you’re put in this really difficult situation where you just have to decide whose safety is most important here. And factored into that is everyone else you see after that person and all of your coworkers.

Is there a defining image or experience that’s going to stick with you from this?

Yeah. Seeing this woman who normally took very good care of herself and took a lot of pride in her appearance just looking so haggard and pale and sweating — like sweating from the corners of her eyes, reaching up from her hospital bed, almost like clawing for air. Just gasping for air. Just seeing that — I can’t get that out of my head.

Was she OK?

She was hospitalized but she did come back to the facility. And I would say that, I don’t know how it’s happened, but there are people that are recovering that, I’m just like, amazed that they made it out OK. People that I thought never would be able to survive this are coming back from the hospital. Whatever the hospital is doing, it’s working.

That might be kind of a segue to what I was going to try to end on, and it’s cheesy, I know, but is there anything in all of this that’s given you hope or you’re kind of feeling encouraged about?

I am actually really feeling encouraged by the number of survivors. I would have thought that out of 43 people — and that’s a very low estimate, but of the 43 confirmed positive cases, (fewer than 10) died. That’s lower than I would have expected considering the age and the health problems that they had.

When this thing started, anytime I saw a name pop up under the list of people testing positive, I’d think, “Oh man there’s no way they’re going to make it.” But a lot of people are a lot tougher than I thought they would be.

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After the Mercury provided a detailed account of the allegations and concerns expressed by the employee to the facility, an administrator emailed the following statement:

The health, safety and wellbeing of our residents and employees remains our top priority during these unprecedented times as we continue to battle the COVID-19 pandemic. …  As part of those ongoing efforts, we recently had inspectors from the Department of Health and the state surveyors visit the center to inspect our current policies and procedures related to Covid-19 and they applauded our proactive and aggressive efforts on behalf of our residents and employees. Additionally, we received zero deficiencies in their findings upon completion of their visit. They confirmed that we are following all proper infection control practices and are adhering to the CDC guidelines. We will continue implementing all proactive safety precautions according to all health care recommendations and regulations.

Nursing homes around the state have struggled to obtain protective equipment, according to data recently compiled by the Virginia Hospital & Healthcare Association, with 21 reporting difficulty obtaining isolation gowns and 12 reporting difficulty obtaining N95 masks.

Gov. Ralph Northam expressed concern when asked this week about the indefinite reuse of disposable N95 masks described by employees.

“Absolutely it’s not acceptable,” he said.

He said administrators should approach the state for help if they’re facing shortages. “Tell them you heard from the governor today,” he said. “And that we have PPE and please request it and we’ll do our best to get our supply to them.”