As Covid continues its deadly rampage, nursing homes and other long-term senior care facilities continue to be the hardest hit, accounting for approximately 36 percent of U.S. deaths from Covid-19, according to the New York Times.
The virus is known to be particularly lethal to adults over 60 who have underlying medical conditions, and it spreads most readily among large crowds in indoor spaces. This is practically the definition of a nursing-home population.
The staff working with these elderly residents are at high risk, as well. Many of them have tested positive for Covid, and many across the country have died. Yet they go to work, day after day, taking care of this most vulnerable population. For most, it’s more than a job; it’s a calling.
J. reached out to the San Francisco Campus for Jewish Living, which is experiencing an outbreak of Covid among staff and residents, and interviewed four staff members about their jobs, their concerns, and their reasons for doing what they do. Here are their stories, in their own words.
CNA (certified nursing assistant)
Vanessa has been a CNA for five years, always at the Campus for Jewish Living. She is a senior at Cal State East Bay, majoring in psychology, and works full time to support herself. She starts her shift at 6:45 a.m. by clocking in, then has just over an hour to get her six to eight patients up and ready for breakfast. CNAs, also called nurse’s aides, perform the bulk of hands-on care for the residents. It takes about 20 minutes to get each one ready: put on their clothes, brush their teeth and hair, put in their dentures. With the dining room closed during Covid, breakfast trays are delivered to the rooms; Vanessa passes them out, gets the residents in their chairs, helps them as needed (opening their milk and yogurt, for example) and feeds those who can’t feed themselves. From 9 to 10 a.m. she cleans up, helps them to the toilet, changes the incontinent ones and makes sure they’re busy until lunch, when the entire process repeats. After lunch, she has rounds, going from room to room to make sure everyone is dry, positioned correctly in their chair, and has something to do or is taking a nap. She’s off at 3 p.m. Like all staff members who work with patients, Vanessa is wearing full personal protective equipment (PPE): gloves, mask and a plastic face shield, plus protective body gear over her scrubs. As she leaves each resident’s room, she throws the body gear and gloves into the trash, dons a complete new set and enters the next room.
Going into geriatric care was never something strange or uncomfortable to me. I love the concept of helping — older people especially. My parents are Mexican, from Guadalajara, and in my culture you respect your elders. You don’t talk back, you don’t question them. Growing up, I was so attached to my grandparents, and I still am, even though I only have one grandmother left. I was always told, these are your grandparents, and when we’re not here, these are the ones you listen to and check in with. My grandparents were my life.
The relationships with my patients, it’s more than caregiving. It starts to become very personal, because you’re all they have. They don’t have visitors. You become their world. They’re so interested in what I do. When I tell my patients, “Oh yeah, I have a big final tomorrow,” the next day they ask, “How did your final go?” It’s really a personal, intimate relationship with them, and that I wouldn’t take away for the world.
The way I see it, they have no one else. The least I can do is come in for eight hours and help them out, make them feel good for my shift. It’s always about them. This is someone’s life. This is someone who’s lived three or four times as long as I have.
They share so many stories with me. I was raised for five years by these wise people. I’m supposed to be taking care of them, but they teach me so much. One patient, he collects clocks. He doesn’t care about the time; he just loves clocks. His collection in his room is from all the places he’s been in his entire life. I have patients who survived World War II. I never ask about anything. I just accept whatever they open up to me about. I just take it in, whatever they decide to share.
I do care for patients who have Covid. Am I scared of contracting it? No. I trust myself and my co-workers to wear proper PPE while we give care. If I’m scared, who’s going to do it? Who’s going to come in and change them and bring them their tray? A lot of our patients deal with depression as it is. It’s normal. If they contract Covid, it’s already bad for them, dealing with this alone and no family or loved ones able to visit or give physical support. If I act like I’m so scared to be around this person, how are they going to feel?
We know the drill. We know what to do to keep ourselves and them safe. It’s really them I worry about. If I get sick, God forbid, hopefully I’ll be able to handle it. But one of my patients? That’s a whole different ballgame.
RN, director of nursing and clinical operations
Peggy decided on a career in nursing during her junior year of college. The Chicago native has been in the field for four decades, working as an ICU nurse, a med-surg nurse, an educator and a director of nursing at other facilities. She has been at SFCJL for 2½ years, her first time working in a senior care facility. She manages a staff of 290 nurses and nurse’s aides. She gets to work around 8 a.m., and tries to leave by 7 or 7:30 p.m. Since Covid hit, her days are much longer, filled with meetings with health departments and internal meetings to review policies and assess an ever-changing situation. Although her age puts her in the at-risk category, she says she will only get vaccinated after all her nurses get theirs first, because they are the hands-on front-line workers.
I took this position because I was so captivated by the people who work here. I’ve worked at many different places, and when I came here I was overwhelmed by the attitude of staff toward the residents. The kindness and caring I saw, to me, it was dramatic. The staff were singing with the residents, dancing with them, doing artwork with them, knowing them so well. A nurse’s aide once said to me at lunchtime, “Peggy, she likes her sandwich cut on a triangle, not horizontal.” That’s the level of detail they know about residents. I was really struck by it.
Covid put a huge damper on all the fun activities we could do. I find that I so miss that. Friday afternoon was community Shabbat in the big lobby area, people singing songs, the rabbi doing prayers. It was wonderful. Every month we had birthday lunches for everyone whose birthday was that month. We’d all sit in a nice room together, with tablecloths, just to do something special for people.
While we’re still trying to do what we can to make things special for residents, it’s not the same communal feeling, because we just can’t. Health and safety have to come first.
Nursing is so high-touch. It’s such a normal thing to pat someone on the back, on the shoulder, give them a little hand massage, or a back rub. It’s a normal part of what you would do during the day. Now we have to wear gloves. It’s just not the same. Suddenly we’re talking through masks and face shields, we’re wearing gloves, we’re wearing gowns over our clothes. For our residents with impaired vision, many of them don’t know who they’re talking to as well anymore. And yet their safety and health has to come first.
All the residents, even those who are minimally cognitively impaired, they are a little bit mystified, I think, by what we do. Even though we explain it, it’s like, “I don’t understand why.” Many of them miss their families, and the families really miss them. It’s really hard on families.
Our social workers are the primary contact with the families, but I certainly contact some. The anxiety level is so high now, understandably. When you can’t be here, you don’t know what’s going on. Families react differently. I can’t tell you how many positive comments and emails I’ve had from families, thanking the staff, really understanding that we’re all struggling through this. Then there are other families that don’t quite understand that we’re not trying to punish them, or the residents. It’s the hardest thing for me, when families accuse us of not looking out for the safety and welfare of the residents.
If I didn’t love it, I wouldn’t do it. I don’t love Covid; I love being here, working with the leadership team, from [CEO] Daniel Ruth to our team of nurse managers. Everybody has stretched themselves beyond what they ever dreamed they could do. You never hear, “That’s not my job.” It’s always, “Let me help you with that.” That’s the mantra.
I’m definitely in the at-risk population, as are many of our caregivers. I have staff older than me. They are here every single day, and I’m so proud of them.
Oh, my family would like me to stay home! My husband of many years [and] my younger son live at home; my older son came home from school in Boston for a few weeks last March, and he’s still living in the top bunk bed. They would all like me to stay home. They are totally quarantined. They are not interacting with anyone else. I do the grocery shopping and come to work every day.
Part of my job is comforting staff. I’ve had several who have been very fearful of interacting with Covid residents. They’re terrified by it. It’s something we work through: “What are your fears? What can we put in place to make you feel more comfortable? These are the safety cautions we have in place.” At the beginning, there was a lot of concern. Certain departments were much more reluctant, almost shaking in fear. It took a lot of talking, and explaining, and circling back to do it again, trying to answer questions. I think people got a lot of pressure from their families at home: “Oh, don’t go near those people!” These are people who need our care. These are people who need us, and we want to be here to take care of them. It does take a lot of talking, and repeating yourself, and listening. Listening, listening, listening and hearing what’s the foundation of their fears.
If Covid has taught us anything, it’s that it really takes a strong team to get through it all. The whole team, from the administrator to housekeepers to dietary staff to nursing staff, everybody working together. One person can’t take care of this.
Maryanne “Mac” Cunanan
Mac grew up in the Philippines and came to California six years ago with her mother. They live together seven blocks from the SFCJL, so she rides her bike to work. Her shifts start at around 8 a.m; Wednesday and Thursday are her normal days off. She started as a housekeeper, cleaning rooms and mopping the floors. She was promoted last February and now supervises a housekeeping staff of 72 with two other managers. Her duties involve assigning staff to every room each morning, to do a thorough cleaning and make sure everything is sanitized and ready for the residents.
When Covid hit in March, we had to do a lot of in-service, tell the staff how to don and remove their PPE. Was I afraid? A little bit. It’s the first time we have experienced these kinds of difficulties. We have no shortage of PPE supplies, and our employers are doing everything they can to educate us. My mom is scared for me, though. Every day she says, “Please stay safe. Take care of yourself.” She also goes to work, so I say the same things to her!
The saddest part for me is that in the Filipino culture, when you come home you put the back of your parent’s hand on your forehead [for respect]. Since the pandemic came, I can’t do that. Even at home with my mom, we practice social distancing, because we both go out to work. We stay in our own rooms, we don’t eat together.
I love to see the residents having fun. But no more. Now they have to stay in their rooms. I would like to tell God, “Please, make the pandemic end.” I really miss seeing everybody, especially our residents. This is an abnormal life for them. I want to see them happy, because this is their home. We are here only because of them.
RN, nurse manager
Teri has been a nurse for six years. She is married with six children, the youngest 8 months old. She works the daytime shift Monday to Friday. She drives to San Francisco for work, sometimes with her husband, a social worker. As a registered nurse, she mainly handles medical care for the residents, including clinical assessments. The CNAs provide most of the hands-on patient care, helping them with bathing, feeding and other activities of daily living.
I went out on maternity leave last April, and returned in September, when I became the manager on a short-term rehab unit for a while. As the pandemic grew, we needed to protect ourselves and the residents more, so we needed to wear more PPE. At the beginning of the pandemic, we weren’t even sure about masks. Now it’s full PPE. That definitely changes the way we provide care, and the time it takes to do things. That impacts staffing. It’s very time-consuming to change PPE between every room.
There is no “typical day” now at work. Every day changes. There was much more consistency before Covid; now, we take it as it comes. First thing in the morning, we have a huddle to check in with all the nurses about the status of the patients. Do any of them need special help? If so, those are the ones I visit. Sometimes they are Covid-positive, sometimes not. Most of the residents on my floor are Russian-speaking. We have translators, and some of the staff are Russian speakers. It was a “green zone” (Covid-free), but some tested positive, so now it’s a “red zone.” We decided not to move the positive residents to a new area, with new caregivers; it would be too hard for them.
We’ve been in isolation here a long time. We used to have Russian-speaking “sitters” that would come to take them out for walks, or just to talk with them. Of course, we can’t do that now.
We get a lot of support at work. We talk to each other and remind each other this will end eventually. The work is exhausting, emotionally and physically. Sometimes we are short of staff, and one of my biggest roles is supporting my staff as well as myself and the residents. Everyone is eager to get their vaccines and have it be over!
When I get home after work, sometimes I talk to my husband about work, but sometimes I don’t want to think about Covid at all. I just want to be with my kids. My husband is a social worker at the YMCA. We both enjoy our jobs. We enjoy helping people. We work for good organizations, and we protect ourselves.
When we think about going out to work, it’s never a question of should we be doing this — only how should we do it.