One evening in May, nursing assistant Debra Ragoonanan\u2019s vision blurred during her shift at a state-run Massachusetts veterans home. As her head spun, she said, she called her husband. He picked her up and drove her to the emergency room, where she was diagnosed with a brain aneurysm.<\/p>\n
It was the latest in a drumbeat of health issues that she traces to the first months of 2020, when dozens of veterans died at the Soldiers\u2019 Home in Holyoke, in one of the country\u2019s deadliest covid-19 outbreaks<\/a> at a long-term nursing facility. Ragoonanan has worked at the home for nearly 30 years. Now, she said, the sights, sounds, and smells there trigger her trauma. Among her ailments, she lists panic attacks, brain fog, and other symptoms of post-traumatic stress disorder, a condition linked to aneurysms and strokes<\/a>.<\/p>\n Scrutiny of the outbreak prompted the state to change the facility\u2019s name to the Massachusetts Veterans Home at Holyoke<\/a>, replace its leadership, sponsor a $480 million renovation<\/a> of the premises, and agree to a $56 million settlement for veterans and families. But the front-line caregivers have received little relief as they grapple with the outbreak\u2019s toll.<\/p>\n \u201cI am retraumatized all the time,\u201d Ragoonanan said, sitting on her back porch before her evening shift. \u201cHow am I supposed to move forward?\u201d<\/p>\n Covid killed more than 3,600 U.S. health care workers<\/a> in the first year of the pandemic. It left many more with physical and mental illnesses \u2014 and a gutting sense of abandonment.<\/p>\n What workers experienced has been detailed in state investigations, surveys of nurses, and published studies. These found that many health care workers weren\u2019t given masks in 2020. Many got covid and worked while sick. More than a dozen lawsuits filed on behalf of residents or workers at nursing facilities detail such experiences. And others allege that accommodations weren\u2019t made for workers facing depression and PTSD triggered by their pandemic duties. Some of the lawsuits have been dismissed, and others are pending.<\/p>\n Health care workers and unions reported risky conditions to state and federal agencies. But the federal Occupational Safety and Health Administration had fewer inspectors in 2020 to investigate complaints than at any point in a half-century. It investigated only about 1 in 5 covid-related complaints<\/a> that were filed officially, and just 4% of more than 16,000 informal reports made by phone or email.<\/p>\n Nursing assistants, health aides, and other lower-wage health care workers were particularly vulnerable during outbreaks, and many remain burdened now. About 80% of lower-wage workers who provide long-term care<\/a> are women, and these workers are more likely to be immigrants, to be people of color, and to live in poverty than doctors or nurses.<\/p>\n Some of these factors increased<\/a> a person\u2019s covid risk. They also help explain why these workers had limited power to avoid or protest hazardous conditions, said Eric Frumin, formerly the safety and health director for the Strategic Organizing Center, a coalition of labor unions.<\/p>\n He also cited decreasing membership in unions, which negotiate for higher wages and safer workplaces. One-third of the U.S. labor force was unionized in the 1950s<\/a>, but the level has fallen to 10% in recent years.<\/p>\n Like essential workers in meatpacking plants and warehouses, nursing assistants were at risk because of their status, Frumin said: \u201cThe powerlessness of workers in this country condemns them to be treated as disposable.\u201d<\/p>\n In interviews, essential workers in various industries told KFF Health News they felt duped by a system that asked them to risk their lives in the nation\u2019s moment of need but that now offers little assistance for harm incurred in the line of duty.<\/p>\n \u201cThe state doesn\u2019t care. The justice system doesn\u2019t care. Nobody cares,\u201d Ragoonanan said. \u201cAll of us have to go right back to work where this started, so that\u2019s a double whammy.\u201d<\/p>\n \u2018A War Zone\u2019<\/strong><\/p>\n The plight of health care workers is a problem for the United States as the population ages and the threat of future pandemics looms. Surgeon General Vivek Murthy<\/a> called their burnout \u201can urgent public health issue\u201d leading to diminished care for patients. That\u2019s on top of a predicted shortage of more than 3.2 million lower-wage health care workers by 2026, according to the Mercer consulting firm<\/a>.<\/p>\n The veterans home in Holyoke illustrates how labor conditions can jeopardize the health of employees. The facility is not unique, but its situation has been vividly described in a state investigative report and in a report from a joint oversight committee of the Massachusetts Legislature.<\/p>\n The Soldiers\u2019 Home made headlines in March 2020 when The Boston Globe<\/a> got a tip about refrigerator trucks packed with the bodies of dead veterans outside the facility. About 80 residents died within a few months.<\/p>\n The state investigation<\/a> placed blame on the home\u2019s leadership, starting with Superintendent Bennett Walsh. \u201cMr. Walsh and his team created close to an optimal environment for the spread of COVID-19,\u201d the report said. He resigned under pressure at the end of 2020.<\/p>\n Investigators said that \u201cat least 80 staff members\u201d tested positive for covid, citing \u201cat least in part\u201d the management\u2019s \u201cfailure to provide and require the use of proper protective equipment,\u201d even restricting the use of masks. They included a disciplinary letter sent to one nursing assistant who had donned a mask as he cared for a sick veteran overnight in March. \u201cYour actions are disruptive, extremely inappropriate,\u201d it said.<\/p>\n To avoid hiring more caretakers, the home\u2019s leadership combined infected and uninfected veterans in the same unit, fueling the spread of the virus, the report found. It said veterans didn\u2019t receive sufficient hydration or pain-relief drugs as they approached death, and it included testimonies from employees who described the situation as \u201ctotal pandemonium,\u201d \u201ca nightmare,\u201d and \u201ca war zone.\u201d<\/p>\n Because his wife was immunocompromised, Walsh didn\u2019t enter the care units during this period, according to his lawyer\u2019s statement in a deposition obtained by KFF Health News. \u201cHe never observed the merged unit,\u201d it said.<\/p>\n In contrast, nursing assistants told KFF Health News that they worked overtime, even with covid, because they were afraid of being fired if they stayed home. \u201cI kept telling my supervisor, \u2018I am very, very sick,\u2019\u201d said Sophia Darkowaa, a nursing assistant who said she now suffers from PTSD and symptoms of long covid. \u201cI had like four people die in my arms while I was sick.\u201d<\/p>\n Nursing assistants recounted how overwhelmed and devasted they felt by the pace of death among veterans whom they had known for years \u2014 years of helping them dress, shave, and shower, and of listening to their memories of war.<\/p>\n \u201cThey were in pain. They were hollering. They were calling on God for help,\u201d Ragoonanan said. \u201cThey were vomiting, their teeth showing. They\u2019re pooping on themselves, pooping on your shoes.\u201d<\/p>\n Nursing assistant Kwesi Ablordeppey said the veterans were like family to him. \u201cOne night I put five of them in body bags,\u201d he said. \u201cThat will never leave my mind.\u201d<\/p>\n Four years have passed, but he said he still has trouble sleeping and sometimes cries in his bedroom after work. \u201cI wipe the tears away so that my kids don\u2019t know.\u201d<\/p>\n High Demands, Low Autonomy<\/strong><\/p>\n A third of health care workers reported symptoms of PTSD related to the pandemic, according to surveys between January 2020 and May 2022<\/a> covering 24,000 workers worldwide. The disorder predisposes people to dementia and Alzheimer\u2019s. It can lead to substance use and self-harm.<\/p>\n Since covid began, Laura van Dernoot Lipsky, director of the Trauma Stewardship Institute, has been inundated by emails from health care workers considering suicide. \u201cMore than I have ever received in my career,\u201d she said. Their cries for help have not diminished, she said, because trauma often creeps up long after the acute emergency has quieted.<\/p>\n Another factor contributing to these workers\u2019 trauma is \u201cmoral injury,\u201d a term first applied to soldiers who experienced intense guilt after carrying out orders that betrayed their values. It became common among health care workers<\/a> in the pandemic who weren\u2019t given ample resources to provide care.<\/p>\n \u201cFolks who don\u2019t make as much money in health care deal with high job demands and low autonomy at work, both of which make their positions even more stressful,\u201d said Rachel Hoopsick, a public health researcher at the University of Illinois at Urbana-Champaign. \u201cThey also have fewer resources to cope with that stress,\u201d she added.<\/p>\n People in lower income brackets have less access<\/a> to mental health treatment. And health care workers with less education and financial security are less able to take extended time off, to relocate for jobs elsewhere, or to shift careers to avoid retriggering their traumas.<\/p>\n Such memories can feel as intense as the original event. \u201cIf there\u2019s not a change in circumstances, it can be really, really, really hard for the brain and nervous system to recalibrate,\u201d van Dernoot Lipsky said. Rather than focusing on self-care alone, she pushes for policies to ensure adequate staffing at health facilities and accommodations for mental health issues.<\/p>\n In 2021, Massachusetts legislators acknowledged the plight of the Soldiers\u2019 Home residents and staff in a joint committee report<\/a> saying the events would \u201cimpact their well-being for many years.\u201d<\/p>\n But only veterans have received compensation. \u201cTheir sacrifices for our freedom should never be forgotten or taken for granted,\u201d the state\u2019s veterans services director, Jon Santiago, said at an event announcing a memorial for veterans who died in the Soldiers\u2019 Home outbreak. The state\u2019s $56 million settlement followed a class-action lawsuit brought by about 80 veterans who were sickened by covid and a roughly equal number of families of veterans who died.<\/p>\n The state\u2019s attorney general also brought criminal charges against Walsh and the home\u2019s former medical director, David Clinton, in connection with their handling of the crisis. The two averted a trial and possible jail time this March by changing their not-guilty pleas, instead acknowledging that the facts of the case were sufficient to warrant a guilty finding.<\/p>\n An attorney representing Walsh and Clinton, Michael Jennings, declined to comment on queries from KFF Health News. He instead referred to legal proceedings in March, in which Jennings argued that \u201cmany nursing homes proved inadequate in the nascent days of the pandemic\u201d and that \u201ccriminalizing blame will do nothing to prevent further tragedy.\u201d<\/p>\n Nursing assistants sued the home\u2019s leadership, too. The lawsuit alleged that, in addition to their symptoms of long covid, what the aides witnessed \u201cleft them emotionally traumatized, and they continue to suffer from post-traumatic stress disorder.\u201d<\/p>\n The case was dismissed before trial, with courts ruling that the caretakers could have simply left their jobs. \u201cPlaintiff could have resigned his employment at any time,\u201d Judge Mark Mastroianni wrote, referring to Ablordeppey, the nursing assistants\u2019 named representative in the case.<\/p>\n But the choice was never that simple, said Erica Brody, a lawyer who represented the nursing assistants. \u201cWhat makes this so heartbreaking is that they couldn\u2019t have quit, because they needed this job to provide for their families.\u201d<\/p>\n \u2018Help Us To Retire\u2019<\/strong><\/p>\n Brody didn\u2019t know of any cases in which staff at long-term nursing facilities successfully held their employers accountable for labor conditions in covid outbreaks that left them with mental and physical ailments. KFF Health News pored through lawsuits and called about a dozen lawyers but could not identify any such cases in which workers prevailed.<\/p>\n A Massachusetts chapter of the Service Employees International Union, SEIU Local 888, is looking outside the justice system for help. It has pushed for a bill \u2014 proposed last year by Judith Garc\u00eda, a Democratic state representative \u2014 to allow workers at the state veterans home in Holyoke, along with its sister facility in Chelsea, to receive their retirement benefits five to 10 years earlier than usual. The bill\u2019s fate will be decided in December.<\/p>\n Retirement benefits for Massachusetts state employees amount to 80% of a person\u2019s salary. Workers qualify at different times, depending on the job. Police officers get theirs at age 55. Nursing assistants qualify once the sum of their time working at a government facility and their age comes to around 100 years. The state stalls the clock if these workers take off more than their allotted days for sickness or vacation.<\/p>\n Several nursing assistants at the Holyoke veterans home exceeded their allotments because of long-lasting covid symptoms, post-traumatic stress, and, in Ragoonanan\u2019s case, a brain aneurysm. Even five years would make a difference, Ragoonanan said, because, at age 56, she fears her life is being shortened. \u201cHelp us to retire,\u201d she said, staring at the slippers covering her swollen feet. \u201cWe have bad PTSD. We\u2019re crying, contemplating suicide.\u201d<\/p>\n I got my funeral dress out because the way everybody was dying, I knew I was going to die.<\/p>\n Debra Ragoonanan<\/p>\n Certain careers are linked with shorter life spans. Similarly, economists have shown that, on average, people with lower incomes in the United States die earlier<\/a> than those with more. Nearly 60% of long-term care workers are among the bottom earners in the country, paid less than $30,000 \u2014 or about $15 per hour \u2014 in 2018, according to analyses by the Department of Health and Human Services<\/a> and KFF<\/a>, a health policy research, polling, and news organization that includes KFF Health News.<\/p>\n Fair pay was among the solutions listed in the surgeon general\u2019s report on burnout. Another was \u201chazard compensation during public health emergencies.\u201d<\/p>\n If employers offer disability benefits, that generally entails a pay cut. Nursing assistants at the Holyoke veterans home said it would halve their wages, a loss they couldn\u2019t afford.<\/p>\n \u201cLow-wage workers are in an impossible position, because they\u2019re scraping by with their full salaries,\u201d said John Magner, SEIU Local 888\u2019s legal director.<\/p>\n Despite some public displays of gratitude for health care workers early in the pandemic, essential workers haven\u2019t received the financial support given to veterans or to emergency personnel who risked their lives to save others in the aftermath of 9\/11. Talk show host Jon Stewart, for example, has lobbied for this group for over a decade, successfully pushing Congress to compensate them for their sacrifices.<\/p>\n \u201cPeople need to understand how high the stakes are,\u201d van Dernoot Lipsky said. \u201cIt\u2019s so important that society doesn\u2019t put this on individual workers and then walk away.\u201d<\/p>\n Healthbeat is a nonprofit newsroom covering public health published by Civic News Company<\/a> and KFF Health News<\/a>. Sign up for its newsletters here<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n