Nursing Aides Plagued by PTSD After ‘Nightmare’ Covid Conditions, With Little Help

It was in mid May when nursing assistant, Debra Ragoonanan’s sight dimmed while she was at work in a state funded Massachusetts veterans home. With all this happening her head was spinning as she said, she immediately called her husband. He took her to the emergency room, after he had sore her and the doctors concluded that she had a brain aneurysm.

It was the latest in a string of health problems she links to the first months of 2020 after dozens of veterans died at Soldiers’ Home in Holyoke amid one of the deadliest covid-19 outbreaks at a nursing home in the United States. Ragoonanan has worked in the home for about thirty years. Now, she said, the sights, sounds, and smells there linked with trauma memories hit her. In her list of conditions ranging from minor to major, she mentioned panic attacks, brain fog, and other signs of post-traumatic stress disorder, which is associated with high risks of developing aneurysms and even strokes.

Close examination of the outbreak forced the state to rename the facility to the Massachusetts Veterans Home at Holyoke, fire its leadership, fund a $480 million renovation of the facility and accept to pay $56 million to veterans and families. However, the front-line caregivers of patients have not been given any respite as they try to endure the impact of this outbreak.

“I am retraumatized all the time,” Ragoonanan said, resting at her back porch before going to her night shift. Whenever I read this, I wonder: “What do I have to do next?”

Covid took approximately 3600 American healthcare employees’ lives in their initial year of the outbreak. It gave physical and mental ailments to so many more — and an equally devastating feeling of being stranded.

What has happened to the workers has been captured through state investigations, and surveys among the nurses, among other published research studies. These found that many health care workers weren’t given masks in 2020. Many contracted covid and still some reported working while they were still struggling with it. Several cases in more than a dozen of lawsuits for residents and workers of nursing facilities describe such experiences. Some of the others claim that their employers failed to provide reasonable accommodations when the workers developed depression or PTSD arising from the pandemic functions. There has been some litigation that has been thrown out of court and there are those that are still alive.

Unions and health care employees also stated that they informed state and federal agencies of these conditions. But the federal Occupational Safety and Health Administration had fewer inspectors in 2020 to investigate complaints than at any point in a half-century. Of the 22 formal complaints concerning covid it followed up, it conducted probes into roughly 20%; Of over 16 000 other complaints received by phone or email, only 0.4% was acted upon.

Dental hygienists, nursing assistants and other health aides and other employees earning below median wages experienced severe effects during waves and still do. Women constitute roughly 80 percent of the low-wage workers in LTCHs, and these workers are increasingly immigrants, people of color, and living below the poverty line than doctors and nurses.

Among them, the following factors extended a person’s covid risk. They also help explain why such workers were confined to exercising little control over minimizing or reporting risky environments, according to Eric Frumin, the former safety and health director, and the Strategic Organizing Center, a group of labor unions.

He also pointed out that with a declining number of people joining unions, theseorganizations seek better wages and safer working conditions. In the 1950s, one-third of America’s workforce belonged to a union; the current strength is around 10%.

Like essential workers in meatpacking plants and warehouses, nursing assistants were at risk because of their status, Frumin said: In this country, workers have no power, this means they can be thrown to the curb as if they are worthless.

Speaking to KFF Health News, essential workers in different sectors said they were let down by a system that expected them to give their lives for the country at its time of vulnerability but cannot protect those who have been injured while serving.

“The state doesn’t care. The justice system could not give a damn. No one is interested,” Ragoonanan added. “Now we all have to go right back to the work place where this began so that’s a two fold blow.”

‘A War Zone’

The issue concerning healthcare employees is an issue for the United States as the population continues to age as well as when thinking of future pandemics. The surgeon general Vivek Murthy described their exhaustion as a ‘public health crisis’ that decreased patient care outcomes. In addition to the lower-wage health care workforce shortage, which Mercer consulting firm expects to be more than 3.2 million by 2026.

A case study of the ability of labor conditions to compromise the health of the workers is evidenced by the features in the Holyoke veterans home. The facility is of no distinction, but its circumstances have been painted in pictures in a state investigative report and in a report by a joint oversight committee of the Massachusetts Legislature.

It was in March 2020 that The Boston Globe received information of refrigerator trucks full of corpses of the departed veterans, from the Soldiers’ Home. A little over 100 residents passed on within a few months.

The state investigation put the blame into the home’s administration involving superintendents, starting from Bennett Walsh. “Mr. Walsh and his team made almost everything perfect in order to facilitate the spread of covid 19,” the report read. He resigned due to pressure at the end of that year 2020.

At least 80 staff members of the facility contracted covid, in part because of the ‘lack of provision and enforcement of appropriate personal protective gear,’ including masks. They ranged from a disciplinary letter written to a one nursing assistant who wore a mask as the man cared for sick veteran at night in March. “Your actions are disruptive, extremely inappropriate,” it said.

In an effort to hire more caretakers, the home leadership placing infected and non-infected veterans in the same unit to increase staffing levels, the report said propagated the virus. It claimed vets failed to get enough water/flavors in their final hours, or enough painkiller medication; several workers interviewed said the scene is best described as total ‘chaos,’ ‘a hell or ‘war.’

Walsh only stayed out of the care units during this period because his wife was immunocompromised, his lawyer said in a deposition to KFF Health News. “More importantly, he never observed the merged unit,” it said.

But nursing assistants interviewed by KFF Health News said they did overtime, including with covid, assating that they would lose their jobs if they did not go alongside their colleagues. “I kept telling my supervisor, I am very, very sick,” said Sophia Darkowaa, a nursing assistant who said she now suffers from PTSD and symptoms of long covid. “I like lost four people while in hospitaldead on my arms while I was sick.”

: Certified Nursing Assistants described how flooded and traumatized they were by a high mortality rate of veterans they used to take care of for years — for years of dressing, shaving, and showering with them, or listening to the stories of the war.

“They were in pain. They were hollering. They were even praying to God,” Ragoonanan added. “They were vomiting, the only thing showing was their teeth. They’re defecating on themselves, defecating on your shoes.”

Speaking to the paper, nursing assistant, Kwesi Ablordeppey described them as being like family to him. “I recall transferring five of such men into body bags one night,” he said. “I’m sure I will remember that, or rather I won’t be able to forget it.”

He said that he has had difficulties with sleeping even four years after the event and is often found crying in his bedroom after coming from work. “For them, I just pull a tissue to my eyes to avoid them realizing that indeed I was crying.”

High Demands, Low Autonomy

Surveys of 24,000 HCWs from January 2020 till May 2022 found that about one-third of them had developed PTSD like symptoms due to the pandemic. The disorder makes people prone to dementia and Alzheimer’s disease. This in turn can result in substance dependency and acts of self destruction among young persons.

Since covid started, the director of the Trauma Stewardship Institute, Laura van Dernoot Lipsky, said she receive hundreds of unsolicited emails from members in health care systems who were seriously contemplating suicide. “I received response than I have ever received in my career,” she said. They are as vociferous as ever, she said, because trauma does not simply recede when the immediate crisis is over.

A second reason why these workers are traumatized is what clinicians call the ‘moral injury’ notion that originates from soldiers who feel guilty after acting in manners that their conscience deemed wrong – due to their training. This was the-case of most of the health care workers in the pandemic who were not provided with the necessary resources to work.

“Otto-health workers who earn less than the amount they receive in the health care industry work under high job demands and low decision making authority at workplace; conditions, which increase their job stress,” added Hoopsick, a public health researcher from the University of Illinois, Urbana-Champaign. “They also have less with which to deal with that stress,” she added.

Mental health treatment is scarce and available mainly to those in lower income category. Also, the employees in the health care system with lower educational attainment or those who have low income cannot afford to take time off work, to change jobs so as to move to a different region, or give up their occupations to commence over to prevent exposure to their trauma.

This means that a certain type of memories which can be as powerful as the event itself may occur. ‘If there is no shift in the conditions, it can be bitterly, bitterly, bitterly difficult for the brain and nervous system to rekey,’ van Dernoot Lipsky said. She does not limit herself to advocating for self-care empowering herself to push for policies on staffing in the health facilities and provisions for mental illnesses.

In 2021, the Massachusetts legislatures were well aware of the plight of the Soldiers’ Home residents and staff when stating in a joint committee report that the events “will affect their health for many years.”

But compensation has been given only to veterans. “Their sacrifices for our freedom should never be forgotten or taken for granted,” the state’s veterans services director Jon Santiago said during an event to announce a memorial for veterans at the Soldiers’ Home who died in the COVID outbreak. The state signed a $56 million settlement earlier this year after about 80 veterans contracted covid, and an equal number of families of veterans who died because of the virus filed a class-action lawsuit.

The state’s attorney general also filed criminal charges against Walsh and the home’s former medical director, David Clinton, for their management of the crisis. Two of them, at least, avoided a trial and, thereby, the possibility of going to jail this March by doing what they did not do before: changing their Not Guilty pleas to the fact that the more than sufficient facts of the case were enough to warrant a Guilty conclusion.

KFF Health News questions posed to an attorney that represents both Walsh and Clinton, Michael Jennings, were not answered. He instead cited proceedings in March where Jennings said that “many nursing homes were found wanting in the initial phases of the pandemic” and that “the process of blaming will only lead to more disaster.”

Nursing assistants also joined this company’s leadership in a lawsuit. The lawsuit said that, apart from their long covid symptoms, what the aides saw “traumatized them and they are still diagnosed with post-traumatic stress disorder.”

It never got to trial and several courts found that the caretakers could have quit their jobs. ”Plaintiff could have resigned his employment at any time,” wrote, judge Mark Mastroianni noting Ablordeppey’s, the nursing assistants’ representative, in the case.

Instead, the decision was never that black and white, according to Erica Brody, the attorney who argued the case on behalf of the nursing assistants. ‘What makes this so heartbreaking is that they couldn’t have quit, because they squarely needed the job to feed their families.’

‘Help Us To Retire’

The author did not have information about any cases of staff of long-term nursing facilities ensuring their employers were held responsible for labor situations in covid situations that led to mental and physical impairments. Attempts to find such cases were undertaken through KFF Health News analyzing lawsuits filed and making phone calls to about a dozen of lawyers but none of the workers emerged winners in these cases.

Indeed, SEIU Local 888 which is a chapter of the Service Employees International Union in Massachusetts is seeking an assistance outside the judicial system. It has advocated for a bill — a bill of last session by Democratic state representative Judith García — to provide for early retirement of workers at the state veterans home in Holyoke andSanta Cruz affiliated in Chelsea with additional five to 10 years of retirement benefits. The bill will be passed in December.

Massachusetts state employee pension plans provide pensions equivalent to eighty percent of an individual’s wages. Application of workers qualify at different times for different jobs keeps on varying. For police officers, it is taken at the age of 55 years. Nursing assistants can qualify once the total amount of time for serving at the government facility and the age are equal to one hundred years. The state stops the clock if these workers use more than their allowed days off for sickness or vacation.

Many of the nursing assistants at the Holyoke veterans home went over their monthly data limits because of covid-related lingering symptoms and long covid, post-traumatic stress, and Ragoonanan had a brain aneurysm. She has pointed out that even five years would make the difference, although, at 56 years, Ragoonanan feels she is, in effect, losing her life. “Help us retire,” she uttered under her breathe looking at her left slippered feet swollen due to diabetes. “We have bad PTSD. We are dying, coming to committing suicide.”

There are professions that people associate with shorter life expectancy rates. Similarly, in USA researchers using production function approach have demonstrated that people with low income on average die earlier as compared to their counterparts with high income. Approximately 593,000 of about 1 million direct care employees in long-term care not in structural categories earn less than $30,000 or roughly $15 an hour in 2018, Department of Health and Human Services analyses and KFF, a health policy research, polling, and news organization that contains KFF Health News found out.

This means that pay that is reasonable was among the measures mentioned in the surgeon general’s report on burnout. Another was ‘hazard compensation during public health emergencies’'.

For those few employers who provide disability benefits, that is usually accompanied by a reduction in wages. Employees in Holyoke who worked as nursing assistants noted that the state was willing to cut its wages by more than half and they could not bear that loss.

“Low wage workers are in a very, very bad situation because they are barely making it through their full wages,” said John Magner, the legal director of SEIU Local 888.

Despite some intermittent acts of appreciation for frontline health care workers at the beginning of the pandemic, essential workers have not been compensated in the same manner as have veterans or the emergency responders that perished while saving countless lives in the aftermath of September 11. For instance, comedian turned talk show host Jon Stewart has advocated for this group for more than ten years, and compelled Congress into ensuring that the group is paid for their sacrifices.

“Basically, people need to grasp how it is that things have gotten this bad,” van Dernoot Lipsky said. “It’s so important that society doesn’t put this on individual workers and then abandon the responsibility.”