Diary Of A Pandemic: The Caregivers
Nurses have carried the weight of 16 months of pandemic care in nursing homes and assisted living facilities. Photo by Shutterstock
In Texas, at least 10,500 people died in nursing homes and assisted living facilities during the worst of the pandemic. Through it all, nurses have had to fight the virus twice as hard - on the job and among their families at home.
Editor’s Note: This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The John A. Hartford Foundation.
Through the worst days of the COVID-19 pandemic, many nurses in Texas assisted living facilities, hospitals and nursing homes were diligent in taking care of elderly residents and patients, even as their own relatives were battling the virus at home.
Yes, vaccinations have recently helped stem the unprecedented health crisis in these facilities, where Latinos are a significant portion of the frontline workers. But it will be some time before these essential workers can overcome the emotional toll of the experience.
Texas Health and Human Services Commission data shows that between April 2020 and April 2021, nearly 9,000 Texans died in nursing homes -- a rate of 175 per week. Another 1,550 died in assisted living facilities. These figures account for roughly one of every five COVID-19 deaths reported in Texas.
Nationwide, such centers have long reported problems. The Center for Health and Community at the University of California, San Francisco, found that in the last 20 years, nursing homes have had serious problems with patient care. Even before the virus, 75% had shortages in staffing registered nurses. And 63% were found with infection control violations.
“Nurses are part of high-risk (for COVID) minority groups due to lack of tests, face masks, gowns or personal protection equipment (PPE),” said Charlene Harrington, emeritus professor of nursing and sociology at UCSF and the study’s leader. “Since some receive low salaries and hold several jobs, they cannot stay home if they are sick.”
Experts recommend minimum staffing of one nursing assistant for every seven residents. Some facilities employed one nursing assistant for every 10 or even 15 residents during the pandemic, Harrington said. “This was emotionally hard for everyone as they couldn’t bring outside help.”
“Nurses are part of high-risk (for COVID) minority groups due to lack of tests, face masks, gowns or personal protection equipment. Since some receive low salaries and hold several jobs, they cannot stay home if they are sick.”
With the vaccine rollout, Texas lawmakers unanimously approved Senate Bill 25 to allow residents in nursing homes to add an "essential caregiver" -- anyone who can spend at least two hours a day with them in registered facilities.
The initiative followed recent Texas Health and Human Services Commission recommendations to expand visitation statewide in nursing facilities and other long-term care settings.
“The forced isolation was particularly hard on residents with dementia and their families,” said state Sen. Lois Kolkhorst, the bill’s author.
Groups like Texas Caregivers for Compromise pushed for the legislation and are now anxious to see it implemented. “The reopening is not optional,” said Mary Nichols, one of the group’s advocates. “While we should be cooperative as facilities get implementation of the guidelines in place, they should be able to give relatives some specifics about when they will comply.”
palabra. spoke with many Latinos on the front lines, in care facilities and COVID units, during the pandemic. While performing essential work, many were also caring for elderly relatives at home, helping them through COVID infections, quarantines, isolation and depression.
We’re highlighting here the personal accounts of a few who speak for many:
“I was afraid the virus would clot my blood or clog my lungs and I would die”
-Rosario Passmore
Rosario Passmore
Until three months ago I was working at the Windcrest Nursing & Rehabilitation Center in Fredericksburg, TX. It is a town where my neighbors are mostly Germans and Hispanics.
Before the pandemic, I worked an 8-hour shift taking care of up to 25 patients. Since I always worked in cardiovascular units or intensive care, I liked working with the elderly in adult daycare, mainly with those who had overcome heart attacks.
But with the arrival of COVID my shifts grew to 12 hours. I was assigned to the COVID unit and I could no longer move freely to other parts of the nursing home. I got a raise of $3 an hour, although in other COVID units such as the ones in hospitals, nurses like me were paid double. But the admissions were closed at my facility and there was no money. There was room for 120 people, but we had only about 60.
There were many COVID-positive cases and those infected spent at least 10 days in isolation. They closed the entire nursing home. No one could come in. Family members who wanted to see patients did so from the windows. I often brought a tablet (computer) so they could chat with relatives. But when someone was dying there was no possibility of saying goodbye.
The elderly were very desperate. They missed the outside world. Sometimes we let them go for a walk for just half an hour.
At first, the relatives brought food packages and we waited 24 hours before touching or distributing them. But we stopped receiving things from outside for fear of risking a transmission.
Disposable surgical gowns, shoe covers, and N95 masks that we ordered … began to arrive around April. Everything had to be insulated. We looked like astronauts.
I had only one Latina patient who suffered from Alzheimer's and lived with great anxiety. She only found calm when walking in the garden. But when she had COVID, her activities came down to eating in the room and conversations on a tablet with her three children. I was the one helping them to connect. After a few days off, I returned and learned she was gone. Her relatives thanked me for being with her for so long, dressing her and feeding her.
The Health Department made constant inspections and took weekly COVID tests. They were very annoying for my nose but I got used to it.
When I got home I would undress in a room furthest away from everyone, put my clothes in the washing machine, go in and out through the back door. I would eat in the kitchen.
I live with my 30-year-old son, the oldest of two, who graduated as an electrician in San Antonio. He eventually ended up taking care of me when I got infected. He would leave my food outside the bedroom door.
That was in December. Despite the strict mask policy, some nurse aides and drivers bringing supplies lowered their guard. They no longer kept their distances. A relative of one of them tested positive, and after three days I began to feel the symptoms.
I saw that COVID affected my patients’ lungs. So I kept quarantined but I did breathing exercises. I was afraid that, like it happened to other nurses, the virus would clot my blood or clog my lungs and I would die. COVID was tough: I didn’t want to eat. I still have back pain, a stomach ache that feels like an ulcer.
My brother passed away at that time. Although his test came back negative, he was diagnosed with pneumonia and treated with antibiotics and inhalants. After leaving the hospital, he went missing for two days and we found him dead. We are still waiting for the autopsy results to find out what happened.
A cousin in El Paso also got infected. He died four months ago, but my aunt never received his corpse. The funeral homes there were full, even up to a month ago.
My mother is 81 years old. She was born in Mexico, in Ciudad Juárez and lives in El Paso. She used to visit me for a month every year, but during the pandemic her doctor would not allow her to come because I am a frontline worker.
I was offered a higher-paying job at a nursing home in Kerrville, Texas, where there are fewer patients and everyone is already vaccinated. There is still a COVID unit here and we are admitting people, but the elderly who come from hospitals are quarantined for 10 days or until they test negative.
I got the Johnson and Johnson shot but I am still wearing PPE.
In June, I'm going to Los Cabos, a trip that I had to cancel last year. I can't wait to spend more time with my family, having a BBQ or going out for a drink with my friends. We Latinos are all about family and hugs. I'm sick of this mask.
“Even though some residents tested positive, they were in denial”
- Lupe Weaks
Lupe Weaks
After 20 years of working in nursing homes, I recently decided to join a nursing travel agency. I learned there was a shortage of nurses in San Antonio, and moved there. Since then, I have been helping in the COVID unit of an assisted living facility. I grew up Catholic in a Latino family from Guadalajara, Mexico. My parents always told me: if there are people you can help, don't turn your back on them.
At the beginning of the pandemic I was working at River Hills Health & Rehabilitation Center at Kerrville. It was a 12 hour-shift, three days a week. Then I had four days to relax at home. The lockdown was strict, not allowing any visitors, and testing of all of our employees. The relatives of our residents constantly called late at night saying: “I tested negative, let me in.” There was a lot of explaining, but we were very cautious and held strictly to our rules.
Residents were allowed to watch TV. We encouraged them to learn more about COVID in official COVID sites online, to explain how serious it was, because some believed in conspiracy theories.
Even though some tested positive, they seemed to still be in denial. They suffered from depression and anxiety. They said: “I know I don't have it, I don’t have diarrhea. For keeping me here I am gonna get it.” We were constantly talking to families on the cellphone, explaining the need for quarantine. Connecting them on FaceTime with loved ones cheered them up a lot.
I told them: “Stay in your room, you are safe. Practice breathing, drink water, be grateful now, until you are tested again.”
We needed to check temperature, oxygen and vital signs twice in a shift. We changed uniforms in an isolation room and threw away biohazard uniforms. I had 10 patients on my charge. They got tested once a week.
When the peak of the disease was more intense, I was covered head to toe. I wore my N95 super tight on my face, put on gloves and wore the big paper suit hoodie (PPE). Some patients appeared to be afraid because they couldn’t recognize us.
We constantly wiped down everything with Lysol -- the doorknobs, the surfaces.
When I would get home from an overnight shift, I undressed right outside my door. Entered in panties and bra and put everything in the washer, and ran to the shower. This was all to protect my husband. I got tested twice a week.
I think the measures in both places I’ve worked were above and beyond. If someone showed signs of respiratory distress, I called 911 immediately and the patient was sent out to an ICU. When they were safe they came back here or went with their families. Some lost their lives because they had underlying conditions like high blood pressure or heart conditions.
I was vaccinated with Johnson & Johnson and so was my husband. Despite that, I am still regularly COVID tested. It doesn't matter, the care continues.
Now that visits are allowed again, we just received two visitors. But they can't stay in the same area. They must wear masks. And they can only see one family member at a time.
Some patients are allowed to walk out of their room, but not to visit other patients in other rooms.
Even though more people are now vaccinated, we will probably go one more year with the mask rules. We check for side effects of the vaccines and tell residents to drink a lot of fluids and if they have symptoms, they have to isolate themselves in their rooms again. So far, they complain about their muscles being sore, and that’s it.
As for my family, I lost my mom to a heart attack. She was from Guadalajara and my dad from San Diego, where I was born. My family lives in California, and nobody contracted COVID. I checked on them constantly and they told me the rate of infection was a lot higher because people from Tijuana come to work and travel back and forth. I just said to them: be careful, right now try not to travel and always wash your hands.
“It was devastating to see how one person dies after another. I had to seek therapy”
-Fabiola Merlin
Fabiola Merlin
I have been a nurse for five years. During the pandemic I was working at the University Medical Center in El Paso, the largest hospital in a 250-mile radius in the county. We admit people from El Paso, Ciudad Juárez, in Mexico, from New Mexico, and from around the entire state of Texas.
I was driving up from Juárez to work. At first, I was afraid of not being able to cross the border, but since I was an essential employee, I was allowed to cross daily. The entire hospital ended up being a COVID unit. In March, when everything exploded, nurses and doctors were very scared, always in fear of exposing ourselves and our families.
We did not know how to handle the situation. We lacked PPE. We did not have enough gowns, and the N95 masks were also insufficient. There was a cleaning process we came up with to reuse them five times. It was very uncomfortable because after cleaning the masks, they smelled pretty bad. When we started to receive N95 masks donations, things got better.
We brought in quite a few portable oxygen and BIPAP machines (to push air into the lungs). But we didn't know how to use them, so respiratory therapists had to come teach us.
When patients lack oxygen they start to get confused because their lungs become too saturated and they need to be oriented. I had to tell them: this is what you need to be alive, if you take off your mask, you can die.
It was easy to become too close to them, getting to know their family through video calls. There is a close relationship with the patient when you see what COVID is doing to their bodies. It is strong and sad. One hopes that something good comes out of all the care you did, but it is not like that.
There was a Code Blue for emergency situations every minute, and it was out of control. The hospital had to order more black bags for the deceased. Several times, after I got home, all I could do was cry. I didn't know how to get that pain out. It was devastating to see one person die right after another. I had to seek therapy.
The unit I was working at had 29 rooms with single beds. But with the COVID wave, the hospital became saturated and we had to double the capacity.
My patients were between 30 and 80 years old, and mostly Hispanic. I think the risk factor in our community is that we have bad diets and bad habits are predominant. Young people have hypertension or chronic diabetes.
I am an only child. My dad passed away many years ago and my mom is 70. I avoided seeing her as much as possible, but I ran errands for her and left fruits and veggies at her door.
I spent so much time with my fellow nurses that it would have been irresponsible to actually visit my mom. I never saw her, and that was very difficult. As Hispanics, we are very tied to family.
I lived with my boyfriend, but in the first months of the pandemic, we began to sleep in separate rooms. I constantly disinfected the house, the doorknobs, and the shower.
Recently, on my days off, I worked registering vaccinated patients on the Texas official website. They were very organized at the beginning vaccinating health personnel, but the doses began to get scarce and many older adults with chronic diseases such as diabetes, hypertension or immunological problems had to postpone their appointments.
My mom already received the second dose of AstraZeneca a month ago in Juarez, but they are very slow in Juarez covering all the elder population.
Now I work in another hospital and although our challenges continue, I think the biggest lesson I learned was to enjoy life. Being healthy is something I value a lot now.
“No one knows how difficult it is to care for a frail relative, much less if she is depressed.”
-Vicky Morales
Vicky Morales
For eight years I have been seeing my family every Sunday for lunch or to play the lottery. But when COVID hit, my interaction with my parents was limited to running errands for them and seeing them sporadically, always wearing masks.
My father Espiridion, born in Mexico, in Nuevo Laredo, turned 84 and my mother Juanita, from Zacatecas, is 76. My father complained: “take off that mask, we want to see you. You are not going to get infected and you are not going to infect us.” We then decided we would just call them on the phone. They were suffering a lot of anxiety and depression.
A tumor was detected in one of my mother’s kidneys and she had surgery to remove it. I had to quarantine myself before going to take care of her for almost two months.
Her recovery was complex. But perhaps the most difficult thing was taking care of someone who had never had to ask for help with anything. My mom has always been very independent and strong. She always cooked for everyone and was always on the go. In recent years, her knees and heels hurt a lot from a surgery on her foot, but except for taking a little more time to rest, she never needed our care.
My sister Irma and my brother Martin came from Fort Worth to visit mom in Laredo. We were in the second wave of COVID and because of New Years celebrations, we anticipated more cases. Our family did not have dinners or anything. We were taking great care of ourselves. We don't know how, but at the beginning of the year my mother tested positive.
My dad tested negative, fortunately, they had been sleeping in separate rooms. My dad would leave her food and things at the door, so not seeing anybody caused her even more depression.
At first she could not breathe and they gave her infusions, but two days later her pressure rose a lot and I had to call 911. They sent some (emergency medical technicians) to check her and as her heartbeat was out of control. I followed the ambulance to Laredo Medical Center, but it was very distressing. They didn't let me in.
They kept her there for about three days in intensive care because there were no more beds available in the COVID unit. She was alone in a room but when she left she was very upset because no one had come to see her.
When she was discharged, the nurse told her that she must feel very blessed: Of the seven people who came on the day she did, nobody else went home.
Of the six siblings in our family, I was the only one who could work remotely, so I moved to my parent’s house to take care of mom. Watching my parents lose their routines was very difficult. My dad would go out every morning to have coffee with his friends, run errands home or pay bills. My mom used to hang out at an adult health center where she liked to make coffee for others and play the lottery. With the shutdown, she lost that social life. On top of that, one of her friends died of COVID. That depressed her even more, enough so we had to medicate her. I think she recovered easier from kidney surgery than from COVID.
My 58-year-old brother, our only brother, was infected in winter, at the same time as my mother. He was hospitalized in Fort Worth for two months, and we were not allowed to see him either. The doctors told us to make rosaries because he had fibrosis in his lungs and they couldn't do more for him. But, miraculously, he recovered. He recently got out of the hospital. Finally, in spring, he was able to walk again.
My dad is a Korean War veteran and has received assistance from volunteers at food pantries during COVID. But other than that, I don't think any government agency did anything, even contact tracing, for them.
My father has already received the two doses of the vaccine, Moderna, and my mother just got the OK from her doctor to be vaccinated.
I think this strong experience, which has not ended, made me admire nurses more. No one knows how difficult it is to care for a frail relative, much less to deal with their depression, and much less in a pandemic.
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Jenny Manrique has covered human rights in Latin America and the United States for two decades. She wrote about immigration for the Dallas Morning News and national politics for Univision. Her work has been published, in English and Spanish, in The New York Times, The Boston Globe and CNN, among others.