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Nursing home workers warned government about safety violations before Covid-19 outbreaks and deaths

Nursing home | CNN | Blake Ellis and Melanie Hicken | May 14, 2020

“(CNN) A flu shot will protect you from coronavirus, a worker reported being told by supervisors at a Rhode Island nursing home, where at least 60 residents were diagnosed with Covid-19 and at least one died.

Keep working, an employee who was vomiting and running a temperature at an Ohio long-term care facility was instructed, according to another worker complaint.

No need to tell authorities, a worker reported being told about the Covid-19 related deaths of colleagues at a Missouri nursing home.

These employee accounts were drawn from more than 500 complaints filed in recent months with the federal government’s Occupational Safety and Health Administration (OSHA) and state worker safety programs approved by the agency.

A CNN review of these records, along with reports made to other government officials and interviews with employees, show that long-term care workers across the country feel their own lives are at risk as they work on the frontlines in facilities that have become hotbeds for Covid-19 — with more than 10,000 deaths nationwide.

Like hospitals, nursing homes have faced severe supply shortages during the pandemic and have been urgently seeking assistance from the government. Worker complaints allege dangerous conditions in which staff members are deprived of basic protective gear and have been told to use coffee filters as masks and wear garbage bags or rain ponchos as medical gowns. The employees say they have been kept in the dark about outbreaks in their own facilities as they care for elderly and frail residents who are particularly susceptible to the disease.

Some of the employees’ grievances, CNN found, were made just days or weeks before Covid-19 outbreaks and deaths were announced at the same facilities. Other complaints were lodged after management was allegedly well aware the virus was spreading throughout their facilities.

Warning notices were posted on a door at an entrance to the Cedar Mountain Post Acute nursing facility in Yucaipa, Calif. There have been 21 resident deaths there — the highest number of Covid-19 deaths in any facility in San Bernardino County.

In New Jersey, for example, the 10 facilities where CNN identified complaints to OSHA have all had coronavirus deaths. In total, these locations reported around 500 cases and nearly 150 deaths.

OSHA, which is charged with enforcing workplace safety laws, has faced criticism for its slow response to complaints related to Covid-19. A spokesperson told CNN the agency investigates all complaints and “has been acting to protect America’s workers” — saying it is paying “particular attention to protections for health care workers, emergency responders, and others with a heightened exposure to coronavirus.”

The same day CNN published its story, OSHA issued an alert with guidance for long-term care employers, providing safety tips to reduce coronavirus exposure in the workplace which included sending sick workers home and regularly monitoring supplies of PPE.

Yet, the records show that OSHA has closed many complaints after operators denied the claims or promised to address alleged issues. On-site inspections, which the agency says it launches to investigate the most serious allegations, were rare.

In the worst examples, employees reported that managers hid positive cases from staff, meaning caregivers had no way of knowing for sure whether they were treating a patient with the disease. They expressed concerns over a lack of preparation, training and supplies to prevent them from contracting and spreading the virus. Employees have also reported staff being forced to work while symptomatic for Covid-19.

“Management is not telling the staff what’s really happening nor are they taking the correct steps to prevent the illnesses,” an employee claimed in March about a Michigan facility, which declined to comment on the complaint. Even though residents were “non-stop coughing” and “very sick with temperatures and upper respiratory issues” — and some had died — the complaint said staff were told they couldn’t wear masks and that hand sanitizer was being hidden from employees.

Warnings to the government

Under federal regulations, employers are supposed to protect workers from hazardous conditions. During the pandemic, that includes requiring the use of gloves and respiratory protection “when job hazards warrant it” and ensuring workplaces are “free from recognized hazards that are causing or are likely to cause death or serious physical harm,” according to OSHA’s website.

The more than 500 complaints identified by CNN come from employees working for long-term care facilities, such as nursing homes and assisted living centers, as well as hospice and home health care companies. They were filed with OSHA, as well as states with OSHA-approved worker safety programs, and date from early March to early May.

OSHA was continuing to investigate more than 300 open complaints, according to the most recent data posted on the agency’s website. More than 200 long-term care complaints had already been closed, meaning OSHA reviewed responses from employers and determined that further action was not warranted. OSHA officials can close complaints if there is “information indicating the employer is aware of the hazard and is correcting it,” according to guidance on its website, meaning that just because a complaint has been closed does not mean it was found to be invalid.

Officials at the nursing home accused of not reporting worker deaths, for example, said in their written response to OSHA that they didn’t report one employee’s death because they had only later learned it may have been related to Covid-19, and that the autopsy results were still pending. Representatives of the facilities where employees complained of wearing rain ponchos, being told to work while sick, or that a flu shot would protect workers from Covid-19, denied the accusations in statements to CNN.

Deborah Berkowitz, director of the worker health and safety program at the National Employment Law Project, criticized the lack of thorough oversight by OSHA in connection to Covid-19.

“All the employer needs to tell OSHA is we are trying,” said Berkowitz, who previously served as chief of staff and then a senior policy adviser for OSHA.

OSHA provided data to CNN showing that it had opened more than 40 Covid-19 related inspections into nursing facilities. The majority of these were triggered by employee deaths or hospitalizations, and only two were opened at facilities where there were worker complaints, according to the data available. Only three states with their own OSHA-approved worker safety programs had opened any inspections at nursing facilities related to complaints, according to OSHA.

While details about open complaints and inspections are not publicly available, the allegations made by workers in the closed complaints provide a window into the kinds of concerns nursing home workers are expressing to the government.

At Opis Coquina Center, a Florida nursing home where the state says 16 residents have died and at least 11 workers have contracted the virus, an employee told OSHA in early April that leaders allegedly waited days to tell staff about a resident who tested positive for Covid-19. The center’s corporate owner said it could not comment on the specific information in the complaint, but noted that it had been closed without any action against the facility.

Also last month, a worker at the Cardigan Nursing & Rehabilitation Center in Massachusetts reported that residents weren’t being tested for Covid-19, and that the facility was reporting them as negative when there was evidence they were positive. The local health department was not being informed of the “assumed positive” cases either, the complaint alleged.

The state has not released information about where the more than 3,000 long-term care deaths have occurred in Massachusetts, but publishes a list of all facilities with two or more cases. An administrator at Cardigan, which is not on that list, declined to say whether there had been any deaths — only stating that Cardigan does not fall into the category of two or more positive Covid-19 cases. She denied the allegations in the complaint and noted that it had been closed.

The most common problem threatening long-term care employees was a lack of personal protective equipment, or PPE, which includes face masks, gloves and gowns. Some workers said they weren’t provided with protective gear because of facility shortages, while others said their facilities didn’t allow them to wear masks even if they had them.

“Long-term care providers are facing an unprecedented situation that has left them begging for testing, personal protective equipment (PPE) and staffing resources,” said Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, a trade organization representing long-term care facilities. “Just like hospitals, we have called for help. In our case, nobody has listened.”

Many employees reported not being provided masks while working with residents who had tested positive for Covid-19 or were symptomatic. In some cases, the facilities accused of improper safety measures subsequently reported that coronavirus had infiltrated their facilities.

That was the case at Cedar Mountain Post Acute Rehabilitation in California. Five days after an employee filed a complaint about a shortage of masks there, county officials learned there was Covid-19 in the facility. Cedar Mountain has now reported that 77 residents have tested positive, as well as 36 staff members. There have been 21 resident deaths — the highest number of Covid-19 deaths in any facility in San Bernardino County, according to state data.

A facility spokesperson told CNN that Cedar Mountain “was never short on PPE” and that the facility’s proper PPE usage and inventory had been verified by the county and state health departments, as well as the US Centers for Disease Control and Prevention.

The first positive case of coronavirus at Stafford Hill Assisted Living, in Massachusetts, was reported to the town nearly two weeks after a complaint was made to OSHA. The employee said the facility had not developed or communicated a plan to reduce employees’ risk of Covid-19 and that supervisors weren’t allowing staff to wear masks, even when they brought their own.

A spokeswoman for the facility acknowledged that an employee was told not to wear a homemade mask to work even though medical grade masks were unavailable and said the facility was following CDC guidance at the time. She said that when the complaint was made, Stafford Hill was days away from securing medical masks and emphasized that when the employee requested to wear the homemade mask, there had been no positive cases. Since then, however, 14 staff members have tested positive, and 20 residents, according to the facility. There have been three deaths — all residents.

Four days after Avista Healthcare in New Jersey reported a Covid-19 outbreak to the county, a worker worried about the virus spreading to staff. The worker told OSHA that employees caring for a suspected Covid-19 resident were not given proper PPE and that the same resident was being allowed into common areas. State data shows there have been 60 positive cases at the facility and 18 deaths. The facility did not respond to a request for comment.

In a May letter reviewed by CNN, a Camden County official told the state health department that the county had been “diligently assessing the facilities and educating the staff on infection control measures” and had “very serious concerns” about Avista and other facilities. He asked the state health department, which said the letter is under review, to immediately install a state monitor to keep tabs on the facility — an action typically only taken when there is a situation that places the health and safety of residents in potential jeopardy.

‘This is healthcare providers crying out for help’

Nursing home employees have also turned to elected officials for help — desperate for someone to intervene and echoing many of the concerns detailed in the OSHA complaints filed about other facilities.

“For many weeks we have been working extremely short staffed!” an employee at the Life Care Center of Nashoba Valley wrote to officials in Littleton, Massachusetts, according to records obtained by CNN. “Instead of managers stepping up and helping us that are struggling to keep patients safe they’re in [their] offices. The Friday our first patient tested positive we were wearing masks and were told we couldn’t do that cause (we) were contaminating the floor.”

Littleton documents show that town officials received at least 12 calls and messages from employees as deaths mounted there in April — eventually becoming the site of 14 deaths and more than 80 positive cases among residents and staff. One employee reported testing positive for the virus but received no response after calling the facility in an attempt to let management know. A spokesman acknowledged that calls may have gone unanswered because family members, town officials and the media had been overwhelming the phone lines and staff was “prioritizing patient care.”

As of April 13, the most recent data provided by Life Care, more than 30 employees at Life Care Center of Nashoba Valley had tested positive for the virus or were presumed to have contracted it because they showed symptoms.
Another staff member was one of the first employees sent home with a fever, according to a message given to town officials, but hadn’t been told of any cases at the facility so didn’t get tested. Then the employee learned a colleague was in the hospital.

“My dear friend and nurse is fighting for her life in the ICU sedated on a ventilator,” the worker told town officials, according to records containing summaries and in some cases the full text of calls and messages they received from family members and workers. “Never knew what was going on in the facility.”

The nurse this employee was concerned about later died, and after her death, a caller told the town that there were two more nurses in the ICU.

A spokesman for Life Care Centers of America, the corporate owner of Nashoba Valley, told CNN that management immediately notified all staff of the first positive case at the end of March and that “it is simply not true that we knew information related to the outbreak and didn’t communicate this to our staff.” He said that a state health department survey found the facility was in compliance with infection control regulations and preparation for Covid-19 — including the proper use of protective equipment. Regarding the two additional nurses an employee claimed had gone to the ICU, he said one recovered and the other was a certified nursing assistant who went to the hospital but “to our knowledge was never in the ICU.”

As of April 13, the most recent data provided by Life Care, more than 30 employees had tested positive for the virus or were presumed to have contracted it because they showed symptoms.

Even more recently, a Pennsylvania state senator, Katie Muth, has been inundated with text messages and calls from employees at a state-run veterans home where her office said there had been around 50 deaths since April 1 — though not all had been definitively linked to Covid-19. The state did not provide figures for the Southeast Veterans’ Center, but said its system of six veterans homes had reported 101 resident cases, 47 staff cases and 39 confirmed or probable Covid-19 deaths.

Muth said workers at the Southeast Veterans’ Center reported that supervisors were putting pressure on them to erase signs of the disease from medical charts and records and to come to work even after testing positive for Covid-19.

“This is healthcare providers crying out for help,” Muth said in a statement. The senator, along with the county coroner, has called for an investigation into the facility’s handling of the outbreak.

A spokesperson for the Pennsylvania Department of Military and Veterans Affairs, which operates the facility, said that it takes all concerns from its staff very seriously and has been following CDC guidelines of when it is appropriate to bring employees back to work. She said the department has an officer who is responsible “for ensuring that all employee inquiries are addressed and appropriately resolved” — noting that the veterans home had recently passed state and county inspections and these had found that the facility was using the correct protocols.

One employee at the veterans home, who asked to remain anonymous out of fear of losing her job, told CNN that what has become a desperate situation all began when the facility banned staff from wearing PPE up until the first week of April. Management, she complained, said wearing masks might “scare or insult” residents. A colleague was even disciplined for wearing his own mask to work, she said.

She said employees undoubtedly spread the virus throughout the facility as they delivered meals, and that even though certain residents were clearly displaying symptoms of Covid-19, she heard supervisors telling staff they weren’t sick. Supervisors have also called and “bullied” workers who tested positive, she said, telling them to come to work or not get paid. The state said it could not comment on employee-related matters.

Even as scrutiny on the veterans home has intensified, she said her bosses were putting pressure on employees to stay quiet about just how bad the situation has become.

She would have quit by now, but she views the veterans at the facility as her “adopted family.” Each morning, she said she cringes as she logs into the facility’s system to see whose name is the latest to pop up on her screen as “expired.””


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