Staffing issues still plague Soldiers’ Home in Holyoke despite National Guard presence and state assurances

Nurses say the crisis has deepened despite the efforts of the National Guard.Suzanne Kreiter/Globe staff

For a week, caregivers at the Soldiers’ Home in Holyoke battled the fast-moving contagion, unprotected and severely outmanned. But last Monday, when state officials learned of the deadly outbreak and took control of the elder care facility, help finally arrived.

Droves of National Guard soldiers unloaded boxes of face shields and surgical gowns and began to administer tests for the coronavirus that had swept through the state-run home, killing nearly a dozen veterans and infecting scores more.

But a week later, the situation remains bleak, workers at the home say. Nurses still report dire staff shortages and quarantine violations. At least 68 staffers have tested positive for the virus, straining the already thin ranks of qualified caregivers. Remarkably, infected staff who are not exhibiting symptoms are still being required to report for work, risking an even wider outbreak, according to several workers.

“Oh there is still plenty of chaos there,” said Andrea Fox of the Massachusetts Nurses Association, which represents 40 registered nurses at the 250-bed facility.

State officials said they did not learn about the severity of the outbreak until five days after the first casualty on March 24, when an anonymous tipster and the union raised alarm. Governor Charlie Baker immediately placed the facility’s superintendent, Bennett Walsh, on paid administrative leave and hired former prosecutor Mark Pearlstein to investigate the home, the events that led to the outbreak, and why the home failed to notify public health officials as conditions worsened.

Baker appointed Val Liptak, chief executive of Western Massachusetts Hospital, as interim superintendent of the facility and deployed a National Guard contingent to expedite coronavirus testing, distribute personal protective equipment, and relieve overburdened nurses.

Despite the leadership overhaul and an influx of aid, the crisis has deepened. Twenty-seven veterans have now died, at least 20 due to the coronavirus, and 62 others, many with preexisting conditions that make them highly vulnerable to the disease, have tested positive. Eighteen others are being retested.

Union leaders and workers have said managers exacerbated the outbreak by combining units to conserve staff and putting residents with symptoms in close proximity with the healthy.

Such lapses have continued in recent days, nurses said. In at least one unit, uninfected residents share a three-stall bathroom with residents who have tested positive. A spokeswoman for the Executive Office of Health and Human Services said Monday that “clinical command is enforcing quarantine zones for COVID-19-positive residents,” but declined to respond directly to reports of the shared bathroom.

With staffing levels critically low, caregivers who have tested positive continue to work in units with veterans who have managed to stay infection-free, according to three employees and two union officials.

In an internal e-mail sent Friday, Debra Foley, communications director of the facility, told all staff who had tested positive but were asymptomatic to continue showing up for work, despite studies that have shown asymptomatic people can still transmit the virus and cause severe cases in those they infect.

On Wednesday, the Executive Office of Health and Human Services acknowledged that the return-to-work chart Foley had sent out neglected to say that positive but asymptomatic staffers should wait seven days after testing to return to the facility. A new e-mail making that clear was sent out Wednesday.

The office said the policy was based on Centers for Disease Control and Prevention guidelines that permit asymptomatic health care professionals to return to work if “options to improve staffing have been exhausted.” The office also said staffers who meet that criterion will only work with COVID-19 patients.

Yet three nursing staffers familiar with the situation said at least one infected but asymptomatic staffer is assigned to a floor with uninfected patients. The caregivers spoke on the condition of anonymity because they feared retribution at work.

While the National Guard deployment has helped stabilize the situation to a degree, some members lack the medical expertise and background knowledge of patients to have a meaningful impact, caregivers said. One nighttime caregiver said she asked soldiers to collect patients’ vital signs and they returned with just a temperature. During a 12-hour shift earlier this week, the nurse scrambled to look after 23 veterans, including one who slowly succumbed to the infection through the night. Around 3:30 a.m., she broke into tears, overwhelmed by sadness and stress.

“This is not the care I give or the care these men deserve,” she said.

The caregiver didn’t get a chance to go to the bathroom until after she clocked out that morning because she was the only nursing professional in her unit, she said.

Staffing has long been an issue at the home. The Globe reported last week that union representatives and nurses had warned state leaders for years that chronic staffing shortages could lead to wrongful deaths and inadequate patient care. But their pleas for help went mostly ignored and the worst-case scenario they warned of came to fruition when the virus arrived.

The staffing shortages have also led to a breakdown in communication between the facility and the families of the veteran residents, who haven’t been able to visit since March 14 and were kept in the dark as fatalities mounted. Nurses buzz through the home to the ceaseless sound of ringing telephones as family members try desperately to reach their loved ones.

“Our phones, they don’t stop ringing,” said the nighttime nurse, echoing the reports of two other nurses on different units. “But there is just so much going on.”

Susan Regensburger was one of those callers. Last Thursday, her family had plans for a Zoom call with her 99-year-old father, John MacKay, a World War II veteran who has tested positive. They waited for a half-hour, but he never joined. The staffer who had set up the call had fallen ill. On Sunday, Regensburger couldn’t reach anyone. Finally, on Tuesday, she received a callback. Her father’s oxygen level had dropped from a cautiously safe 94 to the dangerous territory of 89.

“I think I’ve aged myself 10 years in a week,” she said. Her family had plans to celebrate MacKay’s 100th birthday on May 15. His life has included an Air Force tour in Burma, a career as a social studies teacher and guidance counselor, and time spent cleaning up after five daughters like “a janitor in a sorority house.” Now Regensburger doubts MacKay will make it to May.

Meanwhile, the remaining staff who have tested negative for the virus so far worry that their luck will soon run out.

“Each morning you basically go, ‘I’m gonna get it,’ ” one nurse said. “It’s just a question of how bad.”

A nursing assistant from the facility is currently on a ventilator in a nearby hospital’s intensive care unit from complications of COVID-19, according to Cory Bombredi of Service Employees International Union Local 888, which represents the home’s employees.

The Executive Office of Health and Human Services said Monday that additional nursing staff will be receiving training in infection control developed by the UMass Nursing School Faculty before going to the home. The state is working on an “enhanced staffing pattern” that will include hiring contractors and per-diem staff.

“We continue to pursue reforms in respect to care, isolation, and infectious disease control [at the Soldiers’ Home],” Baker said during a press conference Wednesday.

But many wish the reinforcements and reforms had come weeks earlier.

“You have to wonder, is it too little too late," said one nurse, holding back tears. “We have so many more that we’re going to lose.”