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The Illinois nursing home where Chris Brown works was frequently short-staffed even before the coronavirus crisis hit. But now it’s chaotic. “It’s been drastic,” he said. “It’s been very hectic.” At first it felt like no one had a real plan for how to handle the virus, he said. “The rules changed every five minutes.” This led to an atmosphere that “was very tense all the time,” with people arguing with each other. It’s a little calmer now, but employees are still scared. There’s an entire floor in his building devoted to residents with Covid-19; it’s now completely full, and they’ve had to start putting infected patients on a second floor.
Personal protective equipment was already in short supply before the pandemic. “Now we don’t really have any PPE,” Brown, a certified nursing assistant (CNA), said. He has a hard time finding masks, especially because managers are rationing them. The ones he can find aren’t the N95 masks that are the most protective; instead, employees are given surgical masks. The gowns he gets, he says, are cheap and still don’t keep his clothes from getting wet. The gloves are so flimsy that they frequently break while he’s working with residents. They’re out of face shields.
“Of course I’m exposed to it,” he said of Covid-19. “At this point I believe that everybody in the building has already had it.” He thinks he’s had it too, since he lost his sense of taste and smell for 16 days, even though he hasn’t been able to get tested. He’s worried he may have brought it home to his mother, who has been staying with him off and on as they try to get her into a home, and that he’ll experience long-lasting effects from having had it. But he can’t afford to stay home from work. He has bills and rent that need to be paid. He still hasn’t gotten his stimulus check, either. “If we had the luxury to not be here…I’d have done it,” he said. “I feel helpless in a lot of ways.”
But Brown didn’t stay helpless. Along with employees at 64 facilities across the state who are members of SEIU Healthcare Illinois, he prepared to go on strike to prod management to act and protect both residents and employees. They garnered support from residents’ families, who staged a protest ahead of the strike to underscore their demands.
Their demands included that employees be given more personal protective equipment, that more stringent safety protocols be put in place, and that employees receive hazard pay and better base compensation. They demanded a one-year contract with a wage floor of $16 an hour for CNAs and $15 for everyone else, plus a 50 percent hazard pay bonus for anyone who works during the coronavirus crisis. They wanted 80 hours of paid sick leave for anyone who gets Covid-19, as well as a guarantee from owners that workers who have to take leave to protect their own or their families’ health will still get health insurance. They also wanted owners to be more transparent about the Covid-19 cases at their facilities and to ensure that staffing levels are adequate to offer quality care.
The solidarity between employees and residents paid off. On Thursday, the union and the nursing home facilities announced a tentative agreement with concessions that the union called “significant” and will avert the strike if approved by a majority of members. The two-year contract, which will cover over 10,000 union members, includes a $15 baseline wage for all workers; $2 per hour hazard pay for all employees for the duration of the crisis; more paid sick days for Covid testing, illness, or quarantine; and provisions to ensure that workers get adequate PPE that follows regulatory guidelines.
The pay increase is “the largest wage hike in our history for our employees,” Bob Monitor, CEO of the Alden Network and member of the Illinois Association of Health Care Facilities, said in a statement. “We are grateful a walkout was avoided, and that our heroic staff members will continue caring for our vulnerable seniors as we fight this battle together.”
These gains “will help safeguard the health and safety of workers and the residents for which they care—at a time when both are vulnerable to the risks associated with COVID-19,” an SEIU press release stated. They “are a testament to the courage and commitment of workers who were poised to strike.”
But this crisis didn’t start with the coronavirus. Wages have been low and benefits minimal throughout Brown’s employment. He started out earning just $9 an hour and got a raise to $13 only after Illinois nursing home workers nearly went on strike back in 2017. He now makes $13.90. His brother, who works at a grocery store, makes more than he does. He gets his health insurance through the union. “For the most part we don’t really have any benefits,” he said.
Wages at nursing homes have long been low. Across the country, nursing assistants who work at nursing care facilities can expect to earn less than $28,000 a year. Those who keep the buildings and sheets clean make even less.
Laverne Johnson makes just $14.10 an hour in the laundry room after working for her Chicago nursing home for 10 years. At 65, she would like to be able to retire soon. “I don’t want to be working at 70 years old,” she said. But “I can’t retire because I’m not making enough money.” She often has to prioritize which bills she’ll pay in a given month. “You got to pinch here, pinch here, pinch here. That’s not fair we got to do that.”
Now she fears she’s putting her health at risk. She has to take city buses to work. Although her facility originally offered extra hazard pay only to people assigned to work the Covid floor, other staff members have to go to the floor as well; Johnson delivers linens, and the dietary staff delivers meals. And while the Covid patients’ laundry isn’t supposed to be sent down the general chute, it often gets mixed in, so she’s never sure what she’s getting exposed to. The facility has been waiting two or three days to tell staff when someone tests positive. “I don’t know if I’m working with somebody that has it,” she said.
Because she’s unsure if she’s been exposed, she hasn’t visited her 91-year-old mother, whom she used to see once or twice a week, in two months. “I talk to her on the phone everyday, but that’s not the same,” she said.
When the nurses and nursing assistants are overwhelmed at her facility because of a lack of staff, Johnson often pitches in, serving the residents their lunches and taking them outside for smoke breaks. Employees are stretched even more thinly than usual with the coronavirus. This past Sunday “was just chaos,” Johnson said. “They were so short-handed.”
“We’re just overworked and underpaid,” she added.
For-profit nursing homes often keep staffing levels low in order to increase profits, putting a heavier burden on the remaining employees, who have to care for more patients. Seventy percent of the country’s 15,400 facilities are for-profit.
That’s been true at the facility where Brown works, where the situation before the pandemic was much the same as during it. “We were dealing with these things way before Covid,” he said. His facility was frequently short-staffed, leaving CNAs like him to care for 15 to 20 residents per shift. It’s not just backbreaking work—it’s also time-intensive. Brown gets residents out of bed, bathes them, grooms them, dresses them, changes their diapers or helps them go to the bathroom, rotates them so they don’t get bed sores, feeds them, and brings them into common areas for meals or activities. It typically takes him an hour or two to complete everything a resident needs.
His eight-hour shift doesn’t leave him enough time to care for everyone. Residents are “not receiving the care that they’re supposed to get,” he said. “We’re trying to do the best we can, but we’re understaffed and overworked.” It’s hard on him. He got into this line of work after caring for his grandfather, who was suffering from cancer; watching his grandfather die in his arms cemented his passion for caregiving. “I want to be there for somebody else’s family,” he said.
Supplies at the facility already ran low even before having enough equipment became a matter of life and death. Brown often couldn’t find enough towels or soap for every resident. He sometimes receives just one bariatric diaper, even though he has multiple residents who need them. So despite his low pay, he often buys things out of his own pocket.
Nursing home owners run on thin margins in part because Medicaid and other government programs provide low reimbursement rates, which owners say have not kept up with the cost of care. Many nursing homes are owned by Wall Street investment firms, private equity shops, or real estate investment trusts, which typically make the facilities rent their properties from the investors. The contracts usually mandate rent increases every year, creating lucrative profits for investors but saddling facilities with extra costs that are fixed even in the middle of a recession or, now, a pandemic.
These underlying economics meant that many residents already lived in low-quality settings before Covid hit. More than half a million people lived in facilities that were rated below average, according to The New York Times. The lowest-rated ones are disproportionately for-profit.
Now, the disinvestment in nursing homes is creating deadly conditions. Nursing homes across the country have been ravaged by Covid-19 outbreaks. As of April 28, more than 2,700 nursing homes, or more than one in six facilities nationwide, had reported cases among residents or staff, according to a Washington Post analysis. As of April 21, more than 36,500 residents and staff had contracted Covid-19. Some states haven’t even released this information yet. The death count so far is staggering: More than 7,000 residents and staff have died.
In Illinois, where the workers had planned to strike, nursing homes account for 44 percent of the state’s total deaths. But at some of the facilities, employees didn’t find out that coworkers had died from Covid-19 until they heard about it on the evening news.
For weeks, nursing home employees sent management dozens of letters and made public appeals asking for better protections and pay. But when they got no answer, they voted to go on strike and gave management a notice on April 27. Brown was prepared to strike in hopes of securing the basics: “Better pay, better PPE, better benefits,” he explained. “I do what I do because I love it. And I’ll continue to do what I do because I love it. But I just want to be appreciated.”
“I’m putting my life on the line,” he added. “You talk about heroes… Superheroes are appreciated. But not in health care. In health care, superheroes just get sick.”