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Nursing Home Worker: “Everything About This Is Designed for Disaster”

Shelly Hughes
Susie Young

Some of the first US cases of coronavirus came from Washington nursing homes. We spoke to a nursing home worker and in-home care worker in the state about what it’s like providing care in the midst of a pandemic, and the brutal low-wage working conditions, worker shortages, and lack of decent health care that can only worsen the crisis.

A patient has his vitals taken at the International Community Health Services on March 20, 2020 in Seattle, Washington. Karen Ducey / Getty

Interview by
Andrej Markovčič

As the COVID-19 pandemic continues to spread, the inability of our privatized and fragmented health care system to respond has been laid terrifyingly bare. While nearly every part of the country is now affected, Americans first started hearing about outbreaks in Washington State nursing homes.

Much like other private health care providers, nursing homes and longterm care generally have been both underfunded by the public and cruelly exploited for profit by corporations for years. This treatment of some of the most vulnerable people in society normally flies under the radar, but the explosion of COVID-19 drew attention to how we care for the elderly in the United States.

Last week, as most of us were only starting to grasp the scale of the pandemic, Andrej Markovcic spoke with Shelly Hughes, a nursing home worker in Bellingham, WA, and Susie Young, an in-home care agency worker in Spokane, WA. Both are members of SEIU Local 775. We discussed the state of longterm care and what made it not only possible but predictable an outbreak like this could happen in nursing homes.


AM

What are the principal worries of workers in your nursing home right now?

SH

There’s a lot of concern among the workers in my facility. What if we do get sick or we do start showing symptoms? They won’t let us go back to work. People may be in situations where they are losing income. Some of us have PTO we can draw from. Some of us even have short-term disability. But very few of the lower-wage workers in my facility have access to affordable health care.

AM

Does your facility have a plan for staff who may need to stay home to take care of children or who get sick themselves?

SH

My employer is going to try and find agency workers if our staff starts getting sick. They’re going to try to find affordable childcare for workers with children so that they don’t miss work. So they’ve given us a lot of promises to try, and a lot of those came after they found out that I’ve been doing interviews and I just didn’t have a lot to say about what the building’s management had really been doing other than checking everybody’s temperature and asking a few questions when we get to work.

I feel like they’re in damage control mode right now. They desperately need to do or say whatever they can to get people to continue to show up to work. Because the fact is agency workers that are willing to work in nursing homes, there just aren’t any up here.

AM

Susie, what are you encountering as an agency worker in your area?

SY

It’s very uneven.

We have serious problems in in-home care, because if a worker doesn’t show up this is very impactful for a client. We are there to cook their meals, we’re there to help give them a bath. Could some of them wing it for a day without having nobody there? Yes. But some of them that have really high medical needs, they need that worker every day. If you get workers that are going to be sick, I don’t know what’s going to happen to these people.

AM

It sounds like there is not a lot of backup in this system as it is right now.

SY

No.

SH

None.

SY

We do not have enough workers. My client came home and they’re hoping that she could have service seven days a week, and my agency said we do not have staff for that. We do not have staff. That’s kind of scary.

SH

My facility was short-staffed before all of this started. There is a massive shortage of certified nursing aids willing to do this job, and this isn’t going to make it any easier.

SY

Two of the three major hospitals in Spokane were already diverting ambulances when I called 911 for this client. I’ve never heard of such a thing. The hospitals are already so full that they’re not taking ambulances. When COVID-19 really hits Spokane, what do we do? It is pretty scary.

AM

So, whether or not people are coming in with COVID-19, the hospitals are just inaccessible?

SY

Right, because there’s already a flu epidemic that’s going around. The regular flu.

SH

I’m getting over influenza myself. I missed a few days of work and used up almost the last of my sick time. One of the things that my managers have decided to do is to ask people that work in multiple homes and facilities to basically pick one so that we’re not sharing staff. The assumption is the reason that the disease spread so fast in the nursing homes further south is because they all share workers. There’s no way for a caregiver to be able to afford rent anywhere near Seattle without multiple jobs.

There needs to be a plan to compensate people for their loss of income. You have people who are being asked to cut their income in half.

I honestly believe that the disease is being spread faster by all these workers who don’t have access to affordable health care and a strong culture in nursing homes that encourage you to come in even when you’re not feeling well.

You have to practically be dying on the floor before they’ll let you go home. Then you better not be gone for more than three days or you’ll have to come with a doctor’s note. If you don’t have health insurance, that’s a huge bill on top of already missing work.

Everything about this is designed for disaster, it doesn’t make any sense. The blood of these people who passed away are on the hands of these nursing home offices.

AM

Does it feel like this outbreak in the nursing homes could have been avoided with different priorities and policies in place?

SH

Absolutely. First of all, as far as short staffing goes, it is endemic, it is baked into our nursing home system. It’s about numbers, it’s about money. When it comes to these Medicaid nursing homes, the reimbursement rate is criminally low. We have one of the lowest reimbursement rates for people on Medicaid staying in nursing homes in the entire country.

So if you’re a nursing home with a lot of Medicaid residents, you have to pinch those pennies somewhere. You’re probably not offering the best quality food; you have the tightest grip imaginable on your staff.

The nursing home that’s been in the news lately is run by an infamously anti-union company. I know a lot of people that do my same job there that I’ve talked to see if there’s anybody that would come out and speak about what it’s like to work there right now. But they’re afraid. They’re terrified. They would be fired instantly. They might even be or sued for trying to say anything.

At night, it’s perfectly normal for me to have twenty different human beings to look after to make sure that they stay safe. The level of infection control goes out the window when staffing is not where it should be. People are scrambling around and probably not washing their hands as much as they should. They’re putting themselves and their residents at risk when there aren’t enough people around.

Having more people on the floor means more eyes, it means more people paying attention to somebody who’s not feeling well, it means an extra temperature check that might have caught somebody who was sick before they died.

AM

I assume that unless someone has significantly more financial security than the average American, this is the kind of facility they’re likely to end up in. Is that accurate?

SH

Yeah, most people who are in these nursing homes, their stay is being paid by Medicaid. Either they didn’t have anything to begin with or maybe they ran through all of their Medicare and they’ve sold their house and they don’t have anything left.

SY

In home care, our union has really done a very good job increasing our wages and benefits by 40 percent over the years since 2002, because we have the strength and numbers. But we only have a few nursing homes that are part of the union. We need more nursing homes to come on board so we have more strength and can improve wages and staffing. Otherwise who’s gonna sign up for this job?

The population is aging. How can you continue to have an aging population and you want to cut Medicaid dollars? Sixty-five percent of the Medicaid dollars in this state go towards long-term care. That means nursing homes, home care, assisted living. There are more children that are on Medicaid, but most of the dollars are in long-term care.

If the federal government wants to cut those Medicaid dollars, what happens to these elderly people? I’ve said to workers over and over again: part of your job is to advocate for your clients. You are their voices and you can tell their story. It’s terrible what we do to seniors in this state. Again, it comes down to these Medicaid dollars. We can’t cut them.

SH

Yeah, Washington State refuses to collect income tax, so every year they’re looking at what they can cut. They can cut here because there’s not enough public awareness around long-term care. Maybe there will be now because people are asking “why did this spread so fast in nursing homes?” It’s the one possible silver lining around this horrible deadly cloud. Maybe out of all of this we can get some dollars and some love into these nursing homes.

AM

Other than these questions about whether you’ve been to China, which doesn’t really tell us anything, are your employers taking any concrete steps to protect you and the residents? Are you being provided with any protective equipment? The N95 masks, gloves, things like that?

SH

Definitely not, nobody has those. We have these flimsy little paper masks —

SY

They’re a joke.

SH

They’re used to keep you from infecting other people. They have zero effectiveness at protecting you from somebody else who is sick. My facility and others around the country are actually trying to enact policies just to keep people out of the facility.

I definitely get the sense not necessarily that they don’t know what they’re doing, but that there’s just very little that we can do. I worry because we have so many people that are working extra hours, which makes you much more susceptible to illness. Being exhausted because you’re working sixteen hours a day every single day. When people start dropping, there’s no one to replace them. Then who’s going to take care of the eighty residents in our building?

AM

What would it take to get these facilities staffed up to safe levels?

SH

The most important thing is you need people who are willing to do it, and that is not going to happen unless the wages increase.

You can go make more money working at Target or Taco Bell or McDonald’s. You can go get easier jobs that don’t involve the constant presence of death for fourteen bucks an hour. Getting these companies to increase wages is the hardest endeavor of my life.

This is not an easy job. It requires a clean background track check. This is a job that requires a couple of months to get through the class, then you have to take a skills test that most people fail. It’s a job with a very steep learning curve. Most of the people who get through all of that and make it onto the floor don’t last for more than nine months.

It isn’t necessarily that they’re leaving the profession entirely. It’s that they got a little experience under their belt and they can now go make more money somewhere else.

SY

They can leave the nursing homes and come to in-home care, and we pay more money.

SH

A better bet than trying to get new people who’ve never done this before is to seek out people who have done this before but have left to go do something else. There are a ton of people on Washington State’s registry that have my certification but no longer work [for nursing homes]. If you were willing to offer people more money and some bonuses and some health care, for the love of God, we could help out the nursing homes.

AM

Do you see a difference in the unionized nursing homes compared to nonunionized?

SH

My facility is one of the more prepared for what’s going on, and a lot of that has to do with the presence of trade union advocates that are willing to call out bullshit when we see it. We don’t allow our workers to be taken advantage of, we don’t allow them to be blamed for things that aren’t their fault.

AM

Why is it that the companies that own these care facilities have gotten away with paying these kinds of wages and allowing these kinds of conditions?

SH

It’s because evil grows in darkness. If people are not aware of what’s going on, they can’t be angry about it, they can’t be upset by it.

Frankly, nursing homes are very far outside your average person’s day-to-day life. It’s not something people like to think about. Unless it’s in their face and it directly affects them, say because there’s an epidemic that started spreading in a nursing home, most people aren’t even gonna ask questions.

There’s not enough general knowledge out there about the conditions in nursing homes. And the nursing home industry has a powerful lobby. They spend a lot of money on their lobbyists and paint themselves as being saints. Instead of going off and making more money somewhere else they are deigning to take care of the elderly.

It preys on the good nature of nurses and caregivers. They feel so guilty for not working extra, and it’s designed that way. That’s the way that this system is able to still function. It absolutely takes advantage of their workers, because if you choose to go work in the nursing home, you choose to take care of people, you’ve got a big heart, you care, and you’re easy to manipulate.

SY

But you burn out fast.

SH

I’ve seen so many people leave who love the work but just can’t stand how sad it makes them when they know they’re not taking good enough care of the people around them they’ve come to know and love. They flame out on the floor and never come back.

SY

But Shelly and I are not giving up the fight.

SH

In my building, we’re all gonna work until we can’t anymore. Then we don’t know what’s going to happen.