Brian E. McGarry is an assistant professor in the Department of Medicine at the University of Rochester. Lori Porter is the co-founder and chief executive officer of the National Association of Health Care Assistants. David C. Grabowski is a professor of health-care policy at Harvard Medical School.

As covid-19 has ravaged nursing homes, it has also made working in these facilities the most dangerous job in America. Since the start of the pandemic, facilities have reported 760 covid-19-related deaths among their staff.

If deaths continue at this pace over a full year, it will equate to more than 200 fatalities per 100,000 workers. This would more than double the rate of previous years’ deadliest occupations, such as logging and commercial fishing.

Nursing home workers, including nurses, nursing assistants and support staff, have quietly become the heroes of this pandemic. Under normal circumstances, they perform a physically and emotionally demanding job, providing an intimate level of care for some of our most vulnerable citizens often for low wages and limited benefits. The presence of covid-19 in more than half of the roughly 15,000 U.S. nursing homes, combined with the heartbreakingly inadequate response from federal and state governments, has made going to work an act of bravery and selflessness.

As a nation, we should be recognizing these individuals, much in the same way we lauded hospital workers in recent months and first responders in the aftermath of the 9/11 attacks. National hazard pay for nursing home workers is a clear and tangible way to acknowledge the exceptional nature of their work during these unprecedented times.

Congress has increased unemployment benefits to an extra $600 a week for individuals who lost their jobs due to covid-19. Certified nursing assistants working in nursing homes make on average $590 a week. Being out of work should not be more lucrative than being on the front lines of the pandemic.

But this is about more than just pay. We must also respect the value of these workers and the care they provide by ensuring that every nursing home has the resources it needs to allow staff to safely and effectively care for their residents.

Critical among these resources are basic personal protective equipment and testing. Direct care staff need full access to all equipment recommended by the Centers for Disease Control and Prevention, including N95 masks, eye protection and gowns, which are critical to preventing virus transmission to health-care workers. A recent survey found that many nursing homes have a severe shortage of supplies, and in some cases, federally provided supplies have been so low-quality that they are not usable.

With severe shortages of protective equipment, nurses and other workers are having to choose between helping others and ensuring their own safety. (The Washington Post)

Nursing home staff also need free access to coronavirus testing. Because the virus can be spread when carriers have no symptoms, frequent testing with timely results is the only way to ensure that staff are not bringing the virus into facilities. Testing is not cheap, and nursing home workers have often been caught in the middle of arguments among insurers, nursing homes and the government over who should foot the bill. The federal government recently announced that antigen testing would be made available for staff and residents at every nursing home in the country, but it is unclear how quickly this testing will be implemented and who will pay for the testing supplies for staff.

Finally, workers should be able to make safe choices regarding when to go to work and when to stay home if symptoms develop. For many direct care workers without paid leave, sick days mean lost income. This remains true even after the passage of the Families First Coronavirus Response Act as nursing home workers were typically exempt from its emergency sick-leave provisions. We should extend non-punitive sick leave to all nursing home workers.

Likewise, facilities need sufficient staff to meet the needs of their residents, including backup staff that can fill in when other workers stay home. The same bravery, compassion and loyalty to patients that have driven nursing home employees to keep working in the face of danger may also encourage them to ignore early covid-19 warning signs for fear of understaffing.

For the past four months, we have implicitly asked nursing home workers to risk their lives to care for our loved ones in nursing homes without acknowledging the gravity of this request. We failed to provide nursing home workers with the basic tools to do their jobs safely or even financially compensate them for the risks they are taking. This lack of support is a national source of shame that has directly contributed to the sobering death totals among both nursing home staff and residents.

As covid-19 cases continue to rise, we must correct these mistakes. Federal action to implement the reforms outlined here would do much to mitigate the risks facing nursing home workers while recognizing the incredible value they provide to society.

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