Bonnie Seifried used to sit outside her husband’s window every day.
The nursing home where Frank Seifried lived, the Woodlands of Arnold, stopped allowing in-person visits in March — so every morning, she set up a folding chair and a polka dot umbrella under a tree outside.
Seifried sat with her husband for hours, separated by a thick layer of glass, writing out messages to him on a little whiteboard and sharing updates about their kids and grandkids.
Sometimes, she noticed, the staff wouldn’t check on him for hours at a time.
“He’d have to go to the bathroom, and I’d get up and start pacing,” Seifried said. “Every time I'd see somebody walk by in the hall, I'd bang on the window. It would be nothing to put on the call light and have to wait for an hour or two or three.”
But the situation deteriorated after the coronavirus arrived at the Woodlands of Arnold, sickening 141 residents, including Frank Seifried.
Bonnie Seifried watched from the window as her husband struggled to breathe, his face flushed “fire red.” She called the front desk repeatedly, asking that someone give him his prescribed breathing treatments and take his temperature, but she said the nursing staff was completely overwhelmed.
Nursing homes across the U.S. have long struggled with staff shortages, but families and workers in St. Louis say the crisis has worsened in recent months, as the pandemic has pushed some facilities to a breaking point. Faced with the possibility of contracting the coronavirus themselves, nursing home staff — often women of color earning a low hourly wage — have had to weigh whether the paycheck is worth the risk.
For Shunda Whitfield, caring for residents at Estates of Spanish Lake in north St. Louis County is satisfying and, at times, exhausting.
Most mornings, Whitfield plays gospel music to calm the 20 residents on her floor, many of whom have dementia. As she moves from room to room, she takes each person to the bathroom, then helps them eat breakfast and take a shower.
On a good day, Whitfield has help from a second nursing assistant. But if a coworker calls in sick or doesn’t show up, she’ll sometimes work up to 16 hours a day by herself.
“We lost a lot of staff during the pandemic, so we’re pretty short in the building,” Whitfield said. “A lot of people was just scared. Some people left voluntarily, some left from health issues, and some people contracted the COVID and didn’t come back.”
At least six staff members at Estates of Spanish Lake had confirmed cases of COVID-19 as of June 28, the most recent data provided to the Centers for Medicare and Medicaid Services.
Whitfield herself became seriously ill with COVID-19 in April and isolated herself in a bedroom at home, worried that her family might catch the coronavirus. “My husband would talk to me through the door when my anxiety would get high,” she remembered. “I’d start crying and panicking like, ‘I can’t hardly breathe.’”
After Whitfield recovered, more than a month later, her doctor warned that it might not be safe for her to go back to her job at the nursing home. She has lupus, an autoimmune disease, and she’s at a higher risk of complications if she contracts the virus again.
But without a stable income, Whitfield worried that she wouldn’t be able to support her family or cover the cost of her medication. So she returned to work.
“The ‘what if’ is on my mind every time I come to work,” she said. “What if I take a chance and contract it again? What if it'd be worse this time?”
‘It scared me so bad’
About 1 in 4 long-term care workers in the U.S. are Black, compared to about 12% of all workers nationwide. Overall, these workers are disproportionately lower-wage earners, with 58% making less than $30,000 in 2018.
Michael Howard, a nursing assistant at Grand Manor Nursing & Rehabilitation in St. Louis, said he personally knows workers who have decided the pay is too low to put their lives on the line.
His friend and coworker, Cynthia Whitfield, died of COVID-19 in late April. The medication technician, of no relation to Shunda Whitfield, was reportedly denied paid sick leave after she contracted the coronavirus.
“It scared me so bad, because she was younger than me,” said Howard, 62. “We all came together, we prayed, and we cried it out. Then we pulled up our bootstraps and kept going.”
But as more workers have quit or fallen ill, he added, the remaining staff has had to work double shifts to make sure the residents are cared for. “When you’re short staffed, you become vulnerable because you get tired,” Howard said. “You'd be woke, but your body is not there with you like it should be.”
Mersades Shobe, director of operations at Grand Manor, said that it can be difficult to recruit staff at nursing homes in St. Louis because facilities in St. Louis County can often pay a higher rate. But she added that Grand Manor currently doesn’t have a staff shortage.
“It’s challenging at times, but things are getting better,” Shobe said, adding that there is sometimes a “revolving door” of staff.
But some fear this intense pressure could have lasting consequences on workers. A federal report issued in September warned the “Herculean effort” demanded of nursing home staff during the pandemic will likely “exacerbate turnover and staff shortages in the long term.”
Throughout the U.S., nursing home residents make up a disproportionate share of COVID-19 cases and deaths.
At least 6,416 people have tested positive for the coronavirus in long-term care facilities in Missouri, and 1,029 have died as of Sept. 20. The actual number of cases and deaths is likely higher, given that the federal government only began collecting data from nursing homes in mid-May.
In St. Louis County alone, 2,320 residents contracted the virus across 98 long-term care facilities as of Aug. 28 — and 494 died from COVID-19, accounting for two-thirds of all deaths in the county.
Edna Mukelabai, resident care director at Parc Provence in Creve Coeur, remembered an evening when three residents died in the span of an hour.
“That night, I went home at 1:30 a.m. and I sat in the car and cried,” Mukelabai recounted during a recent virtual seminar organized by the Washington University Institute for Public Health. “That's the first time I broke down and realized that this was very, very very serious.”
Though rates of new infections in St. Louis County nursing homes have slowed in recent months, some families say basic care is still lacking — and that makes it harder for residents to thrive.
“When you talk about quality of care, it goes beyond they didn't die last night,” said Michelle Gralnick, whose parents live at Delmar Gardens West. “It's easy for people to say, ‘Well, they're getting food, and they're getting clothed, right?’ Yeah, but when they moved into a nursing home, the emphasis was supposed to be on home.”
In February, Gralnick cofounded the Delmar Gardens West Family Council, a group of about two dozen who advocate for their relatives at the Chesterfield facility.
Her mom has multiple sclerosis and has been hospitalized several times for infected bed sores. Under Missouri mandate, the 81-year-old should be repositioned every two hours, but sometimes she’s been left in bed all day, Gralnick said.
“In general, basic needs are not being met because the staff that is there are either pulled in too many directions, or the seasoned staff that had relationships with the residents are no longer there,” she added.
Delmar Gardens West did not respond to a request for comment.
‘Overworked, underpaid, dead tired’
Bonnie Seifried no longer sits by her husband’s window.
The 89-year-old retired dentist contracted the coronavirus twice, first in May and again in July. He died of COVID-19 on July 24. St. Louis Public Radio contacted the Woodlands of Arnold, but the facility did not respond to a request for comment.
Seifried doesn’t blame the employees at the facility, who she said are “overworked, underpaid and dead tired.” She spent years at the nursing home, first as a volunteer when her mother was a resident and later as an employee for nearly eight years in their administration and accounting departments. And she says that’s why it’s been difficult for her to watch the extraordinary pressures put on its staff.
“This is not an indictment of any one person or any facility,” Seifried explained. “This is a system that’s terribly broken.”
Still, the image of her husband’s last hours haunts her. She remembers the fear in his eyes as he lay alone in his room and regrets that she wasn’t there to hold his hand.
In her apartment, she keeps a stack of handmade signs that she taped to his window, reading “We all love you,” and “There is flu, I can’t come in.”
Eventually, she said, she’ll try to let them go.
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