It’s been three months since Wilder Jean, a 50-year-old supervisor in a local nursing home, got sick with COVID-19, was hooked up to a ventilator at Boston’s Brigham and Women’s Hospital, and put into a medically induced coma.
As he grabbed a folding chair from his garage in South Easton one afternoon in July, Jean still gripped a cane in his right hand.
“I was very complicated. I ended up with acute renal failure (and) a lot of infections,” he said. “The hard thing is, you wake up every day, you don't know what it's gonna be. Is it going be a swollen foot? I just still have times when you're so fatigued, you don't want to get up.”
Jean is one of more than 7,000 long-term care workers in Massachusetts who got COVID. At least 26 of those workers died, according to federal and state data obtained by WGBH News. Nationwide, the number of long-term care worker deaths from COVID tops 700 — on pace to make caregiving the nation's deadliest occupation, more dangerous than logging or commercial fishing, according to research released last month by experts at Harvard and the University of Rochester.
“I didn’t know if I was going to make it. My doctors eventually said my condition was one they did not see before,” said Jean, who spent 24 days on a ventilator with no visits from his family.
It wasn’t until he came out of the coma that Jean learned his wife had also gotten COVID. He said he felt awful knowing he must have infected her. She recovered at home, quarantining in the basement while their two college-age daughters shopped, cooked and cared for their mother.
COVID deaths among residents in long-term care facilities in Massachusetts have fallen significantly for several weeks, but workers are still getting infected — about 1,000 confirmed and probable cases in Massachusetts since June, according to Medicare data.
Like Jean, who is Black and Haitian-American, the majority of frontline workers getting sick in long-term care homes are people of color, many of them immigrants. In Framingham, Lawrence and Worcester, more than 70 percent of the nursing home workers testing positive for COVID are Black, Hispanic or Asian, according to records obtained by WGBH News. The state does not track the race and ethnicity of workers who got COVID.
Geralde Gabeau, the director of the Immigrant Family Services Institute in Boston, works with the Haitian community and said their reliance on nursing homes for employment has created a cascade of trauma — as they put their own lives at risk to do this work.
“One nurse described it like a war zone where they were not equipped to fight back,” Gabeau said. “They put their lives in danger, but at [the] same time, they are witnessing people dying in front of their eyes and they're not able to help them.”
Because the workers come from a culture that holds elders in such high regard, Gabeau said, they treat their patients like their own family and experience the deaths on a very personal level.
“It’s like they are losing their mom or their dad. It takes a huge toll on them,” she said.
Nirva — a 48-year-old nursing aide in a rehab facility in Boston — is still worried for her own health and the safety of her family members. WGBH News is not using her last name because she is fearful talking to media will endanger her job. Nirva lives with her two sons, who are in their 20s. She has not hugged them once since the pandemic.
“I didn’t want [my children] to get infected. Of course, it's hard for me because we always hugged each other,” she said, explaining how she also changes shoes in her car before she enters her home.
While workers are scared of bringing COVID home, advocates and experts said long-term care staff also likely helped transmit the virus to elders in their care. One reason is the lack of protective equipment, even now, after outbreaks in nursing homes became national headlines. More than 60 nursing homes in Massachusetts reported in July they did not have enough N-95 masks to last more than a week.
Robyn Stone, the head researcher with Leading Age, a national association of nonprofit elder service providers, said many states didn’t prioritize personal protective equipment for long-term care homes.
“When a nursing home would put in a request to the state for equipment, they were not top priority,” Stone said. “This was a serious failure of our public health system to recognize early on the hot spots.”
Massachusetts health officials said they have distributed more than 2.5 million pieces of PPE to elder care homes since the pandemic began.
Stone also pointed out that the workforce in nursing homes is often from communities facing the broadest COVID infection rates. These workers are dealing with sick people at work all day and may be exposed to sick people in their communities, she said.
“They are at high risk in their work (and) high risk in their communities,” Stone said. “And that causes more stress, which causes higher potential for actually being susceptible to the virus. They’re at the vortex of it all.”
The workers are at the vortex, but they’re not valued, said policy experts and workers themselves. Both said low wages and punitive sick leave policies for long-term care workers mean many workers try to hold down jobs in multiple facilities or keep working even if they feel sick — fueling transmission of the virus.
Stephen Campbell at PHI, a nonprofit group that advocates for direct care workers, said racism plays a role in the low rates at which Medicaid and Medicare reimburse nursing homes for services. That leads to low wages and benefits for workers, he said.
“That lack of support for compensation (is) reflecting the societally racist perceptions of this work,” Campbell said. “It's undervalued because it is often performed by people of color, and Black or African-American workers in particular.”
What makes the work so dangerous and risky for this largely minority workforce is all the close contact required.
“Assisting residents with activities of daily living, like bathing and dressing and toileting. You can't do this from the other side of the room. You have to do this up close,” said David Grabowski, a health care policy expert at Harvard Medical School.
Grabowski said the high-touch work creates a simple equation: If there’s coronavirus in the communities where workers live and work, they are going to get infected and bring it to the elders in nursing homes, rehabilitation facilities and assisted living homes. Or they will bring it from work to their families.
“They're putting their lives at risk,” Grabowski said. “Anything we can do to support this workforce in terms of hazard pay, bumping up their wages, offering them non-punitive sick leave — if they become sick, they should be able to stay home, not infect residents, other staff.”
Mass Senior Care, the trade association for most of the state’s long-term care providers, said operators still face staff shortages. But they say they are nevertheless routinely screening workers for signs of COVID and telling them to stay home.
It is less clear whether those sidelined workers will get paid.
Wilder Jean, the nursing supervisor, said when he first felt sick in April, his boss still urged him to come to work.
“They only care about you coming in and do the job. But … you're telling them, ‘This is my health. This is my body. I know my body is telling me something else,’” he said. “It was something else.”
Even for workers who do have paid sick leave, it often does not extend long enough to recover from COVID. Emmanuel Owusu, the head of the African Bridge Network in Boston, works with many immigrants who hold jobs in long-term care facilities. He said recovering from COVID often brings financial hardship.
“They have to stay home way much longer than any financial assistance afforded to them,” Owusu said. “While they are trying to recover, now they are worried about their bills.”
State lawmakers are pushing for an emergency sick leave law and a $55 million fund during the pandemic to help workers faced with the bad choice Jean confronted last spring. Workers could get up to $850 a week and a promise from employers that their jobs are secure if they take the sick leave.
And nursing homes still need more PPE. Nationwide, one in five elder care homes report a shortage, and in Massachusetts, 14 percent of these homes said they are short of masks and gowns.
“That's a scary number to think about,” said Grabowski at Harvard. “I think the true number is probably even larger. And if we see once again a huge spike in cases here in Massachusetts, nursing homes need abundant amounts of PPE.”
Elder homes still need more workers. To address chronic staffing shortages, state health officials tried to entice workers last spring with signing bonuses of between $500 and $1,000 for new workers. About 30 workers took advantage.
Caroline Rowe, at the International Institute of New England in Lowell, said some immigrants are still eager to work in nursing homes despite the risks because the pandemic ended other jobs they once relied on. One example was the Southwick clothing factory in Haverhill that just shut down, laying off more than 400 workers.
The institute has a class to train nursing assistants and it is now filled to capacity.
“Health care is a scary industry to get into right now, but I think it is making sure that they understand the risk and know how to protect themselves,” Rowe said.
Protecting themselves will be the challenge. Some communities in Massachusetts are again seeing an uptick in COVID cases. Public health experts agree that if another wave of coronavirus is coming, it is these workers — and the elders they care for — who will once again be at highest risk.
Ashley Belanger, an intern with the WGBH News Center for Investigative Reporting, contributed to this story.