SMITHFIELD, R.I. (WPRI) – In nursing homes across Rhode Island, health care providers are trying to reassure residents confined to their rooms that they will be safe from a public health crisis that’s killing them more than any other segment of the population.

But in the hallways – away from residents – the conversations are less comforting.

“We have to put on a brave face and tell them not to worry, even though we are terrified ourselves,” said Amanda Collins, a registered nurse at a long-term care facility in Smithfield. “We are literally in the face of people who can die of this illness and kill us in the process.”

States across the country are grappling with high rates of death in nursing homes, as vulnerable populations in congregate care settings are highly susceptible to dying from the disease. But the crisis is particularly bad in Rhode Island.

As of Friday, 94 Rhode Island nursing home residents had died from the disease, representing 80% of the state’s entire death toll of 118.

In Massachusetts, 702 of the 1,404 deaths reported as of Friday – or 50% – were at long-term care facilities, according to the Massachusetts Department of Public Health. In Connecticut, 375 nursing home residents had died as of Thursday, accounting for about 39% of the 971 total deaths, according to data from WPRI 12’s sister station WTNH 8 and the state website.

A New York Times investigation Friday showed at least 6,900 people living in nursing homes have died nationally, representing about 18% of total deaths reported.

Looked at as a share of the overall nursing population, based on 2017 numbers from the Kaiser Family Foundation, Massachusetts stands out with deaths accounting for 3.6% of total nursing home population. Rhode Island and Connecticut, meanwhile, look similar at 1.2% and 1.6%, respectively.

R.I. Health Department Director Dr. Nicole Alexander-Scott claims the state has been aggressively addressing the outbreak at nursing homes in Rhode Island, and announced new plans Friday to try and stop the sickness from spreading and killing more residents.

But whether those increased efforts have come quickly enough is up for debate, as the disease has already wreaked havoc in nursing homes across the state.

“Many of our unfortunate deaths have occurred in our senior populations and in our congregate care settings – in particular, nursing homes,” Alexander-Scott said.

Wrought with disease

The toll has been greatest at Golden Crest Nursing Centre in North Providence, where 24 residents had died after contracting COVID-19 as of Thursday, representing about 20% of the nursing home’s total population.

Eighteen residents had died at Oak Hill in Pawtucket, and seven more nursing homes across the state had reported at least one death. More have been affected, as the locations of the 10 new nursing home deaths were not immediately disclosed.

Collins, who spoke during a virtual press conference to try and raise awareness about nursing home conditions, said the lack of personal protective equipment in nursing homes has forced many health care providers to wear the same mask when treating residents who are suspected of having the disease and those who do not.

Nursing home residents — already highly susceptible to infection — mostly interact with caregivers who move from room to room, making the need for clean gear all the more important, Collins added.

Gov. Gina Raimondo said Friday more PPE has been secured and much more is on the way, and promised nursing home workers will be prioritized. But Collins said the fight so far has been frightening for both her — whose partner is at home with ALS — and her staff.

“I’m sick of apologizing to my staff for the lack of supplies,” Collins said.

The high rate of nursing home deaths has contributed to Rhode Island having a relatively high rate of deaths per capita. As of Thursday, the state ranked No. 8 in the country with the most deaths per capita, and the coordinator of the White House coronavirus task force, Dr. Deborah Birx, this week expressed concern about Rhode Island’s geographic position contributing to the pandemic.

“First, they had increasing cases from the New York City area and now they have new increasing cases from the Boston area,” Birx said during a White House news briefing. “They are caught between two incredible hot spots in the country.”

Raimondo and Alexander-Scott have said it’s particularly challenging to fight coronavirus in a state that’s so densely populated and has a high percentage of older adults. (Rhode Island ranks first in the country for the share of the population age 85 or older.)

“Rhode Island is facing extremely difficult challenges in our nursing homes,” Alexander-Scott said. “Every day you hear the evidence.”

On Friday, Alexander-Scott unveiled a new plan to establish so-called “strike teams” to respond to the needs of nursing homes, and said there’s a plan to test and retest people more often to quickly identify where the disease is spreading in the future.

On Thursday, she announced one facility – Oak Hill – would become a specialty treatment center where residents discharged from the hospital could recover without infecting others.

The state has licensed 960 new people to work at congregate care settings, and is trying to attract more from other states by fast-tracking the licensing process. Alexander-Scott said the state has waived training requirements for certified nursing assistants whose licenses may have lapsed in the last two years.

Still, advocates for nursing home workers have been sharply critical of the industry’s long-standing tradition of understaffing the facilities — fueled in part by a decline in government money steered toward long-term care facilities.

The problem now is worsening as caregivers are beginning to quit over fears that they too will become sick, according to a new report by Raise the Bar on Resident Care, a coalition of unions, religious groups and other nonprofits.

“Even before the coronavirus hit, short staffing was a problem at my facility with CNAs responsible for 10 residents each,” Aletha Browne, a ward clerk at Pawtucket Skilled Nursing and Rehab, said in a statement. “Now, because caregivers are afraid and are leaving, two-to-three CNAs can be responsible for 39 residents for the whole day.”

‘Fewer corners cut’

State Sen. Sam Bell, D-Providence, blames the rising COVID-19 death toll on years of Medicaid cuts proposed by Raimondo and approved by his colleagues in the General Assembly.

Bell said the loss of funding forced several nursing homes to close their doors, creating crowded conditions at the remaining facilities. He echoed Collins’ concerns about a lack of staff and lower wages impacting morale and the desire for health care workers to “put their lives on the line” during the crisis.

“When you have that much consolidation, you wind up with overcrowding and you cannot handle the social distancing needed,” Bell said. “More money would mean fewer corners were cut. The facilities might have been able to stockpile personal protective equipment.”

Three decades ago, the majority of Medicaid spending on long-term care nationwide – about 90% — went toward nursing homes. Last year, the number fell to less than 50%, according to a report by Truven Health Analytics and the AARP.

When Raimondo first entered office in 2015 she formed a working group to “reinvent Medicaid,” which included a plan to save $13.3 million by improving care and reducing long-term stays at nursing homes. The state at the time had been funneling about 80% of its long-term care dollars toward nursing homes.

The working group aimed “to increase the use of home- and community-based services as alternatives to nursing facilities, where appropriate,” according to a document at the time.

The industry has complained of repeated cuts in the years since and Raimondo in January proposed to divert another $400,000 from nursing homes, consistent with the working group’s original plan back in 2015. That proposal was made before the current pandemic.

The shift in funding has had supporters, coming at the same time that more people are choosing to live at home later into their lives, and as in-home nursing services become more popular.

But nursing homes are still needed — especially for older adults reliant on Medicaid — and less money has translated into staff reductions, since long-term care facilities spend roughly three of every four dollars on personnel costs.

Staffing shortages have contributed to the public health crisis, as the coalition report shows the spread of infection is typically higher in nursing homes with staffing problems.

“Infection control is always a serious challenge in nursing homes, but it is exacerbated even further by short staffing,” wrote members of the collation. “Asking a front-line worker to take care of 13 to 15 residents per shift is a crisis in normal times – but in a pandemic, it can be the difference between life and death.”  

Looking forward, state leaders hope the decision to focus more on nursing homes could help curb the high rate of deaths and spread of sickness.

Collins’ outlook is not as hopeful.

“Imagine being a CNA, making $12 to $14 an hour, and going to work in an environment that could potentially kill you and your whole family,” Collins said. “We haven’t even hit the peak.”

This story’s original broadcast version misstated the percentage of nursing home deaths in Rhode Island.