Written by Matt Stevens
At the Pennsylvania long-term care facility where Tisheia Frazier works, the coronavirus was a terror. During the most harrowing weeks of the pandemic in April and May, she said, four residents died in a matter of hours, and 70 people in an 180-bed unit died in less than a month.
Another caregiver, Ellen Glunt, recalled watching an older couple celebrate their 80th wedding anniversary. The wife held a wedding photo up to the glass window, as her ailing husband remained on the other side.
And then there is Bob Lohoefer, a nursing director in Philadelphia with almost 40 years of experience who has had flashbacks to the trauma rooms he worked in decades ago. At the height of the pandemic, he sat at his desk, a shield over his face, so frustrated by the government’s handling of the virus and his own organization’s bureaucracy that he thought to himself: “I don’t want to do this.”
Few groups have witnessed more of the virus’ horrors than caregivers — front-line workers who have grappled with the public health crisis while trying to help older people at risk of isolation, distress and, in some cases, death. The deaths of almost 40% of all Americans killed by the coronavirus have been linked to nursing homes and similar facilities — indoor spaces crowded with vulnerable adults. The share is even higher in Pennsylvania, where deaths in nursing and personal-care facilities account for close to two-thirds of coronavirus deaths statewide.
In interviews ahead of the election with more than a dozen caregivers in Pennsylvania, one of the country’s most important battleground states, they described how their experiences are shaping their political outlooks. It has hardened some convictions and transformed some caretakers, otherwise apolitical, into activists. It has forced others to reassess their beliefs about American exceptionalism, the role of government in their lives and their industry, and their decision about whom to vote for in November.
“Nine months ago, I would have told you that I was 100% behind Trump,” Lohoefer, a lifelong Republican, said of the president. “But as a result of COVID, I’m not 100%sure where I stand now.”
The problems Pennsylvania has encountered are emblematic of the nation as a whole: There were struggles to procure personal protective equipment, difficulties with rapid testing, staffing shortages, disagreements between local, state and federal government agencies and new rules piled onto an already heavily regulated industry.
And although several health care executives maintained that most of Pennsylvania’s senior care communities have relatively few confirmed COVID-19 cases, and that their staff members have performed heroically, stakeholders in every corner of caregiving agree that the pandemic exposed the country’s overburdened health care system, testing the mental, emotional and physical limits of all of the people who work in it.
“If you don’t see it, you really don’t understand how difficult it is,” said Louise Santee, a longtime caregiver who brought a curling iron to work to calm a resident who could not understand why she could no longer go to the hairdresser. “It is truly heart-wrenching when you see what this has done to our people.”
In interviews, caregivers as well as patient advocates, medical professionals, facility managers and residents themselves said they had never experienced anything like the first six months of the pandemic.
Maintenance workers were sent to hardware stores to buy disposable paint tarps that could be fashioned into gowns. Nurses pleaded with their bosses to let them lower their masks just so residents could recognize them; some forced their family members to go stay with relatives, terrified that they would bring the virus into their home. And some residents could not understand why they were suddenly cut off from their families and the world.
The chaos was so pervasive that it was nearly impossible, everyone said, to separate what was happening from the politics at play. As caretakers endured day after exhausting day, state officials set forth new regulations to govern how nursing homes should work. And President Donald Trump delivered a drumbeat of dangerous claims — mocking masks, praising unproven treatments, speculating about bleach and about the virus disappearing.
Some residents became so dismayed by Trump’s conduct that they set up voter registration drives on their campuses; others held miniprotests near major roads, holding signs and soliciting honks from passing vehicles. A few front line workers began phone banking at home and writing to their state legislators.
And top officials at care facilities voiced deep frustration about how the virus response rapidly devolved from a public health issue to a partisan fight. They insisted that faster, clearer and better-coordinated government intervention could have saved lives.
“When you work in our business, you become accustomed to a certain level of bumbling,” said Jim Bernardo, the president of Presbyterian Senior Living, which cares for thousands of older people in Pennsylvania and beyond. “This rose to an entirely different level.”
Surveys of Pennsylvania voters show that Trump’s standing has been damaged in recent months by his administration’s handling of the coronavirus. At the end of February, around the time one of the first known virus deaths in the United States was reported, polling averages had Trump and his opponent, Joe Biden, separated by roughly 3 percentage points in Pennsylvania. Those polling averages now show Biden ahead of Trump by a wider margin. A New York Times/Siena College survey released Sunday showed Biden up by 6 points in the state, which Trump won narrowly in 2016.
Four years later, with its 20 electoral votes, Pennsylvania looms as one of the most important swing states in the election. Many of Trump’s remaining paths to victory require him to win the Keystone State, and to do that, he needs voters like Lohoefer, the nursing director, in his camp.
Lohoefer voted for Trump in 2016. But he has been pushed to his limits. He recalled with derision how the government and his corporate office would send sudden, often conflicting mandates during the early days of the pandemic.
It was eyewear that sent Lohoefer over the edge. At one point, he said, he was told every worker needed goggles, so he ordered $1,100 worth of fitted goggles only to be told four days later that goggles should be replaced with face shields.
“We even went to the point where we bought colorful ones so people choose their color,” he vented six months after the episode.
Lohoefer’s views are complicated. He is a Republican who believes all Americans should be guaranteed good health care. He is a medical worker of a mixed mind on masks. He is deeply skeptical about the effectiveness of Plexiglas barriers — and even more suspicious of the policymaking logic that made them so pervasive.
Overall, he thinks the reaction to the virus was “overkill,” but he also thinks Trump was wrong to suggest it was “nothing to worry about.”
“He did a terrible job,” Lohoefer said of Trump’s handling of the pandemic. “But everybody did a terrible job.”
As the virus spread across her facility, Frazier, the caretaker who witnessed dozens of deaths, said she would see Trump on television without a mask and grow frustrated. And although she has voted for Republicans and had been a fan of Trump’s when he was on reality television, she began to blame his cavalier response for her worsening situation at work.
Americans, she came to believe, would not act until the virus affected them personally.
“If we want to make America great again, then we need to change the political face of our country,” she said, noting that she has made a point of discussing her view of Trump with Republican friends. Frazier said she would vote for Biden somewhat begrudgingly, mostly as a vote against Trump.
“I can’t even tell this story without having a tear coming down my face,” she added. “How can you, as the leader of our country, stand in front of our thousands and not show emotion?”
Frazier began to cry as she recalled her final moments in April with a resident with whom she had built a rapport over several years.
During better times, the woman assumed the role of floor matriarch. She was “sassy,” and would tell you “exactly what she felt,” Frazier said. Sometimes, when she had a spare moment during her shift, Frazier would pop by and say “Hey, beautiful!” — and the woman would beam.
But as Frazier put it, the virus “took her smile away.” Restrictions kept the woman’s family away. She lost weight — almost “half her body size,” Frazier said. A grim thought crossed her mind: She might be one of the last people the woman would see before she died.
Eventually, hearing her friend’s cries for care became too much. Frazier couldn’t help herself. She broke the rules.
“I took my gloves off and held her hand without the gloves,” Frazier said. “I knew she would pass then, and I did not want her to pass without having human touch.”
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