When state health officials recently asked Aileen Tinney what she needed to keep her Baltimore nursing home residents and staff safe from the coronavirus, she eagerly responded — requesting 20 cases of gloves, five cases of gowns, five cases of medical-grade masks and five cases of disinfectant wipes.
On Thursday, at a secret stockpile location off Pulaski Highway, her staff members were instead given one box — not case — of gloves, two boxes of gowns, four boxes of N95 masks and zero disinfectant wipes. They also got 24 face shields, which they hadn’t requested but happily took.
The supply was a fraction of what the Catholic Charities administrator had requested as she hustles to meet a new mandate from the governor that nursing home staff members must wear gloves, gowns and masks in most interactions with residents. It made clear to Tinney what she has sensed for weeks.
The government could not save them.
“You realized no one’s going to come and make sure you have everything you need," said Tinney, who oversees more than 200 staff members at St. Elizabeth Rehabilitation and Nursing Center and the Caritas House Assisted Living facilities in Southwest Baltimore. “We’re in charge of this facility. We have to make sure we get what we need."
[ Maryland health care workers: Share your stories with The Baltimore Sun ]
Amid the global coronavirus pandemic, this is the ground-level reality on the front lines of care, in the hard-hit and vulnerable nursing home industry, in an emerging regional hotspot in the nation with the heaviest caseload.
Much as states have had to fend for themselves, scrounging for life-saving medical gear and protective equipment on the open market, nursing homes hoping to avoid becoming the next deadly cluster have needed to stretch their resourcefulness and creativity to meet Gov. Larry Hogan’s mandates and keep their communities safe — in the face of a staggering threat.
While Tinney’s facilities hadn’t identified any infections as of Friday, at least 90 of Maryland’s roughly 220 nursing homes had. At Pleasant View Nursing Home in Mount Airy, 18 residents are dead, with dozens more infected. State officials won’t specify how many of the state’s 206 dead were nursing home residents, but many have been elderly.
[ How national testing shortage helped lead to Maryland’s deadliest coronavirus cluster ]
State officials won’t name the facilities with infections, or say what they are doing to ensure that staff members who work at multiple facilities aren’t carrying the virus around with them. They also won’t describe how or whether they are conducting “contact tracing” — checking back on the movement of the infected —to see how the virus may be spreading outward from the facilities into the community.
While acknowledging the threat with increasingly grim assessments over the past week, Hogan has offered reassurances that his administration is doing everything in its power to halt the viral spread, prepare the state’s health system for a surge of patients and reduce the human toll. The Republican governor has issued a slew of executive orders to hedge against the worst-case scenario of overwhelmed medical wards and bodies piling up. He has specifically sought to intervene against the light-speed spread of the virus through nursing homes, which have been hard-hit nationwide.
His actions have brought him accolades from across the country, and in some parts of the state and local health care systems. Some residents have welcomed his blunt realism in the face of equivocation from leaders at the federal level, and his stepping in with resources as deaths rose.
But in interviews with relatives of nursing home residents, industry representatives, and nursing home administrators and staff, many said they still feel overwhelmed by the threat and frustrated at the way it has played out in Maryland.
“I understand that this virus can spread, and I understand that nursing homes are susceptible to this, but for it to happen to this many people?” said Robert Holmberg, whose father, Gary, is among the 18 dead and more than 100 infected at Pleasant View. “It didn’t have to happen like this.”
[ Federal stocks of protective equipment nearly depleted, officials say ]
State officials acknowledge that they were slow out of the gate to respond, in part because of federal failures to provide adequate testing for the virus, which left them blind for some time to potential clusters. To this day, they say there are not enough tests available to test all staff at nursing homes — even though it’s clear to them that the virus has entered the facilities via infected staff who display no symptoms.
But they say they are doing their best to recover from the delayed response and continued lack of resources, and to adapt to new lessons about how to prevent spread of the virus.
Some stakeholders say they understand the failures at the federal level, but still question why the state didn’t intervene sooner to protect nursing homes — long known as infection hot spots — or why nursing homes hadn’t proactively implemented some of the measures they’re now being forced to adhere to by the state.
By March 30, when Hogan gave a statewide stay-at-home order to stem the spread of the virus, two residents at Pleasant View were dead, including Gary Holmberg, a retired District of Columbia firefighter who had died the day before. By April 3, when Hogan ordered more expansive measures, including the mandate that nursing home staff wear various forms of protective gear, six residents were dead and additional cases had been identified in 60 other senior facilities statewide.
By April 7, when Hogan announced special health care and logistics “strike teams” would begin responding to the worst-hit nursing homes, the virus was in 90 senior facilities in the state, and 17 were dead at Pleasant View.
Officials believe the virus likely arrived there via asymptomatic Pleasant View staff and then spread with stunning efficiency, making the limited testing of staffers with symptoms insufficient. In the days since, the family-owned nursing home in the Carroll County town has been a scene of devastation — and upheaval, as the Maryland National Guard swept in to stabilize things.
For family physician Dr. Daniel Aukerman, who stepped in to provide Pleasant View residents care when few others would, the first order of business some mornings — along with checking his own temperature and gearing up — has been signing death certificates.
"The people were very much in need of help,” Aukerman said.
Rick Mantheiy, whose father, Paul, and aunt, Donna, lived at Pleasant View and are now fighting the coronavirus, said with four residents to a room, they weren’t even six feet apart — recommended for “social distancing” — when sleeping. He thinks Pleasant View could have done far more to protect its residents, but also wonders if Carroll County health officials should have done more, and if Hogan’s mandates could have come sooner. He questions whether the mandates are being followed even now.
Mantheiy’s wife, Ashley, who works at a hospital herself, said the nursing home could have done far more to mitigate against the threat posed by the virus, but by the time it arrived, “they were just on fire ... and there was no help.”
In recent days, Pleasant View has seen a surge in support and care. But other facilities say they’re still going unsupported in critical ways.
Leaders of nursing home industry groups say they have repeatedly asked for the state’s full list of facilities with infections, given that it is up to nursing home administrators to determine if any of their staff are being exposed to the virus at second nursing home jobs. But state officials told them releasing it would compromise patients’ right to confidentiality. They have not responded to requests for the list from The Baltimore Sun.
Tinney, of Catholic Charities, said she is continuing to gather information about where 220 of her nursing home employees might also work, believing the information could help reduce risk of further exposure to residents.
“It’s a huge issue,” Tinney said. “We’ve been clear since the beginning: It’s us that will bring this into the facility.”
Marc Romanych, whose mother lives in an assisted-living facility in Baltimore County, said he and his wife, Jackie Scott, went looking for the list of facilities with infections on the state health department’s website after learning of the outbreak at Pleasant View, and were surprised they couldn’t find it.
“I care because I worry about my 95-year-old mother, but I worry about the larger picture,” Romanych said, suggesting nursing home administrators are due the data. “If they don’t have the information they need to make rational decisions … there’s a problem there."
There are also other problems.
Already, Hogan’s order last weekend mandating that all nursing home workers wear personal protective equipment is stretching stores of masks and gowns that were already in short supply, and stressing the resourcefulness and creativity of nursing home administrators to meet those needs and keep people safe, they said.
Employees at Forest Haven Nursing and Rehabilitation Center in Catonsville said managers recently gave geriatric nursing assistants two items each: a plastic rain poncho and a nylon hair bonnet. In reply, workers who recently voted to unionize with the 1199 SEIU health care workers union delivered a petition demanding better supplies.
“It’s unacceptable to hand a nursing home worker a rain poncho and call it PPE," or personal protective equipment, said Donta Marshall, 1199 SEIU vice president of long-term care in Maryland and the District of Columbia.
Forest Haven administrators did not respond to a request for comment.
Donna Johnson, a cook at Forest Haven, said she is staying in the facility’s kitchen as much as possible over concerns her employer isn’t doing enough to disinfect other areas of the nursing home. Her manager gave her a mask to wear, but she worries that doorknobs, elevator buttons and common spaces aren’t being disinfected.
She fears being exposed to the coronavirus at work and bringing it home to her family in West Baltimore, and wishes her employer would do more to keep employees safe.
“As essential as I am to them, I’m more essential to my family,” Johnson said. “That’s what’s most important to me.”
Tinney said she has been filling in gaps in protective equipment supplies with orders from Amazon, hoping they’ll arrive on time. Community members at Open Works, a “maker space” in the city, donated plastic face shields. Neighboring Saint Agnes Hospital kicked in some gowns, and when the Catholic Charities division that oversees homeless shelters came across a stock of 75 more, that meant enough for one more shift.
McKesson Corp., a regular supplier, came through early with a delivery including more masks and gowns. And one of her own employees donated another 150 washable gowns, which can be laundered in house, Tinney said.
“We’re getting by," she said, “because everyone’s working together.”
Breaking News Alerts
LifeSpan Network, the Health Facilities Association of Maryland and Leading Age Maryland, all associations that represent senior care providers, expect to begin distributing a new stockpile of supplies to their members starting late next week. The groups put in a $200,000 order with Owings Mills company Strategic Factory when, based on surveys of facilities across the state, they learned just how stretched for supplies many nursing homes are or could be soon.
Holmberg, whose father died at Pleasant View, said he thinks all the orders Hogan has issued to increase safety protocols and reduce the spread of the virus within nursing homes are good. He thinks more equipment is obviously needed.
“But someone has to hold them accountable,” he said.
State officials have provided no framework for how they will monitor compliance with the new mandates.
Ashley Mantheiy said her young sons have struggled to come to grips with the fact that their “Paw Paw” is sick.
While she has nuanced concerns with how things played out, and what could have been done differently, she said, they just know that now, they can’t visit their grandfather.
“That’s the hardest part," she said.