Life and death on the ‘COVID floor’

  • On July 17, Ricardo Santiesteban stands outside the hotel he stays at in Manchester while working. GEOFF FORESTER / Monitor staff

  • Ricardo Santiesteban outside the hotel he stays in Manchester at while working on Friday, July 17, 2020. GEOFF FORESTER—Monitor staff

  • Ricardo Santiesteban outside the hotel he stays in Manchester at while working on Friday, July 17, 2020. GEOFF FORESTER—Monitor staff

Monitor staff
Published: 7/29/2020 12:50:21 PM

The outbreak of COVID-19 at Hillsborough County Nursing Home in Goffstown started on the Saturday of Mother’s Day weekend.

David Ross, a nursing administrator at the home, had just driven home from his shift when he got a call from a staff member – another resident had tested positive. The nursing home already had a couple of isolated positive tests, but this time it was different.

Three residents who all lived near each other started showing symptoms of COVID-19, which indicated the virus might be spreading within the facility instead of coming from an outside source.

Ross rushed back to the nursing home and by the evening, another positive case was confirmed. Immediately, the entire floor was tested for COVID and staff started moving the infected residents into a five-bed infirmary in the corner of the rehab department. Nurses and administrators stayed until 3 a.m, moving the residents’ belongings and disinfecting everything – the housekeeping supervisor stayed late to teach nurses what products to use.

At the end of the night, residents had been grouped by positive tests, negative tests, and test results that had not come back yet. Things seemed under control when Ross went home to cook his wife a Mother’s Day dinner.

“As soon as put my fork down I got a call that there were more positives,” he said.

Thirty more residents and 17 staff members tested positive. The home needed to be reorganized and cleaned all over again.

The nurses who took the weekend off came back to one of the hardest-hit long-term care facilities in New Hampshire – all in all, a little more than half of the 300-bed facility contracted COVID-19. A long 12 weeks later, which many staff describes as a lifetime, the facility is finally down to their last positive resident.

When the outbreak first started, 30 staff members quit almost immediately, worried about their pre-existing health conditions, or that they might infect their families.

For Kevin Poulin, a nurse at Hillsborough, quitting didn’t even cross his mind. Hillsborough County Nursing Home felt like home to him in a lot of ways. Most obviously, his mom, fiancee and cousins work there, which isn’t unusual at the home. He also felt very close with the residents, some of whom he had known for 12 years from the day he started working there in high school, making beds and carting laundry.

The home slid into a staffing crisis.

Anthony Santiesteban had the thankless job of trying to fill the empty shifts on the day’s chart. Even before the pandemic, Hillsborough was frequently short-staffed for the 3 p.m to 11 p.m shift, he said.

The pandemic amplified the problem even more – in addition to the staff that quit, there were those who tested positive for COVID and needed to stay home from work for 2 weeks, at a minimum.

Anthony started his shift by running around the building, asking staff if they’d be willing to work extra hours. If he couldn’t fill the spots that way, he started calling the staff from other shifts one by one, even offering incentives like gift cards to Hannaford. He learned to bargain with staff – if they came in for a shift today, they could cancel their shift next week. This created a seemingly endless cycle of desperately trying to fill empty shifts.

As a last resort, he called nursing agencies to see if they could spare any staff.

Still, after doing all of that, sometimes he still could not find anyone to take the open shifts.

“There were many times when it was just falling apart,” he said.

That’s when the head nurses or administration volunteered to fill spots. Physical therapists in the home volunteered to work as nursing assistants and administrators stayed late to help fold laundry or work in the kitchen. David Ross even took an 8-hour certification class so he would be able to help out on the floor with patients.

The COVID floor, which used to be known as B2, was the hardest to staff. Ross had to ask several nurses to work with the infected patients, which a couple nervously agreed to. As he helped staff into their protective gowns before they entered onto the floor, he sometimes noticed them trembling.

B2 used to be one of the most active floors in the nursing home. Many of the residents had lived there for years and thought of their neighbors and staff as family. Framed puzzles completed by the residents donned the walls and recliners lined the common areas.

Now, the hallways, which used to be bustling with residents playing games in the common areas or shuffling down the halls, were eerily quiet. The doors were covered in a layer of plastic and the rooms were bare. Residents’ belongings, aside from clothes and personal care items, were stored in labeled boxes in a conference room.

“It could not have possibly changed to a more polar opposite place,” Ross said.

Working on the COVID floor was physically exhausting.

Staff wore booties over their shoes, a protective gown, a hairnet, an N95 mask, a surgical mask, and a face shield for hours at a time. Sometimes, they were worn for more than 8 hours, as many nurses on B2 worked overtime to compensate for short staff. Ricky Santiesteban, a licensed nursing assistant on the COVID floor and Anthony’s brother, had 30 hours of overtime during one pay period.

“I would take off my gloves after I left for a break and sweat would just be dripping out,” he said.

The mental toll of working on B2 was even worse.

Ricky said one of the most important parts of his job was keeping the residents positive. If a resident started crying because they missed their old room, he leaped into action.

“You got this!” he said. “I’ll make sure everything is fine.”

He stayed with the resident, joking and talking next to their bed until they smiled.

But being a bubbly, upbeat presence on a floor filled with illness and death took a toll on Ricky. When he got back to his hotel room (which he has stayed in during the pandemic to protect his family), he didn’t have the energy to call his friends. He usually sat in silence or read to recharge for the next day.

Then, there was the sheer amount of deaths nurses witnessed – about 40 in all.

Usually, nursing assistants witnessed one or two deaths a month that happened slowly as the patient declined in hospice. In the COVID unit, residents frequently declined quickly and without warning.

Anthony, who started working on B2 after recovering from COVID, started getting nervous every time he went into a patient’s room.

“Every time I opened one of the doors, it’s like who is this going to be now?” he said. “What did the virus do to them?”

Ricky said once this is all over he is going to take a break from nursing.

Despite the hardships, the staff has become closer than ever.

Even on the hardest and busiest days, they make sure to cheer and clap as the staff on the COVID floor entered for their shift. When a day is particularly hard on B2, Poulin said the staff had a small ritual which made things better.

He would make eye contact with the other staff members as they frantically passed each other in the hallway.

“Are you doing great?” Poulin would ask sarcastically.

“Yeah, we’re doing great,” the staff member would respond.


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