Assisted living resident companion Michelle Dencklau utilizes hand sanitizer in this April 8 photo from Friendship Haven, a senior living community in Fort Dodge, Iowa. (Photo courtesy of the Ogden Newspapers COVID-19 Reporting Team)

MARIETTA, Ohio — With residents among the most susceptible to complications and deaths due to COVID-19, nursing homes and assisted living facilities can become battlegrounds in the fight against the novel coronavirus.

There have been nearly 27,000 deaths from COVID-19 nationwide in long-term care facilities, according to an ongoing count by the Associated Press. A life lost can be devastating to a family, and not just those meeting the traditional definition of what most believe a family to be.

“Losing patients and residents is extremely difficult, especially those who have been in our care for a long time,” said Julie Beckert, associate vice president of marketing and communications for HCR ManorCare, the non-profit owner of Heartland of Marietta in Washington County, Ohio. “They are like family to our employees.”

In an effort to protect residents, long-term care facilities have prohibited most visitation, with the exception of end-of-life situations.

“Right now, we are not only the caregivers, but the family members, and we take those roles very seriously,” Beckert said.

Located just outside Marietta, Ohio, in Devola, Heartland has had more than three dozen confirmed positive cases of COVID-19, with 34 patients in isolation in-house and 11 having already recovered, Beckert said. Although she did not provide a number, she said there have been deaths related to COVID-19 at the facility.

According to statistics from the Ohio Department of Health, there have been six staff cases of COVID-19 at Heartland.

“Employees who tested positive, were exposed or have tests out, are not in the center and are quarantined at home and cannot return until cleared,” Beckert said.

Many communities are rallying around health care providers during the pandemic as the situation highlights ongoing struggles of the industry and debate continues over how much protection to give facilities from potential lawsuits.

Dr. Matthew McNabney, associate professor of medicine in the Johns Hopkins University Division of Geriatric Medicine and Gerontology, said he’s spoken with long-term care facility employees who are “feeling discouraged about how their work is being interpreted.”

“They’re doing the best they can with the most vulnerable people in our society,” he said.

McNabney said it’s important for families of long-term care residents to maintain positive relations with staff members. Keeping their morale up will ultimately benefit the patients as well, he said.

At Heartland, there’s an employee assistance program in place to provide counseling, financial education and more through third-party experts, Beckert said. Hospice chaplains are also available to support workers, she said.

“We appreciate the support we have had from our families and the community,” Beckert said. “We realize it is very difficult for families because they cannot come into the facility and visit their loved ones.”

HCR ManorCare offers additional employee compensation packages as well that vary by market and facility, she said.

Fredonia Place in Fredonia, New York, has 58 assisted-living apartments and 26 memory care suites. So far, they have not had a resident or staff member test positive for the virus, but knowing the virus is out there and working to help residents – many of whom are used to coming and going as they please – can be stressful to employees, said Mike Ferguson, regional director of sales, marketing and culture development for the facility.

“It’s also a little stressful to staff and residents to know New York is going to be one of the last places to reopen,” he said.

Fredonia Place is about seven hours from New York City, but it’s much closer to Buffalo, which has recently become another “hot spot” in the state, Ferguson said.

Every other week, the facility has been able to add to workers’ paychecks, he said. Fredonia Place has also moved from 12- and 14-hour shifts to eight-hour shifts, which increases the staff rotation and gives workers more time at home.

“Cutting those hours down has been taking a little bit of the stress off of them,” Ferguson said.

The staff has seen an outpouring of support from community members making hundreds of handmade masks, with the recommended N95 masks in short supply, he said.

Friendship Haven in Fort Dodge, Iowa, meanwhile, cares for 350 residents in independent and assisted living and skilled nursing settings. No positive COVID-19 tests have been reported, but that doesn’t allow the 380 full- and part-time employees to let their guard down, said Julie Thorson, chief executive officer of the home.

“There’s still a battle going on,” she said.

Membership in a closed Facebook group for Friendship Haven employees has increased during the pandemic. Thorson posts daily updates, chaplains share encouraging messages and the PPE inventory is shared weekly.

“We really tried to create a forum for employees to stay connected, get clarifications, ask questions,” she said.

Employees must be careful not to expose themselves to the virus while off the clock too, Thorson said, lest they risk bringing it back to the residents.

“In this field, we have an added responsibility to behave in a certain way outside of the work hours,” she said. “That’s asking a lot of them.”

That’s one reason the not-for-profit entity increased wages by 10 percent in late March for employees working directly with residents.

“We’ll increase it more if COVID does come into the building,” Thorson said.

Like many places around the country, Webster County, Iowa, where Friendship Haven is located, is beginning to open up more businesses and activities. Thorson said she asked employees to be careful as opportunities to get out and about present themselves.

The response from one worker?

“Julie, we care too much about our residents” not to be, Thorson said.