DES MOINES — Long-term care facilities were among the hardest-hit during COVID-19’s first surge of the pandemic this summer.

Now, with the virus spreading through Iowa, those facilities are once again bearing the brunt of the pandemic.

So severe has the situation become that the state public health department has given its blessing — as a last resort in emergency situations — for long-term care workers with a confirmed COVID-19 infection to provide care to patients without the virus.

As of Friday night, there were COVID-19 outbreaks — defined as three or more confirmed cases in a facility — at more than one-fourth of Iowa’s roughly 440 long-term care facilities. And nearly 1,000 Iowans had died at long-term care facilities.

And many nursing homes throughout the state say they are facing critical shortages of available workers and the personal protective equipment that protects those workers from the virus, such as gloves, protective eye wear, gowns and medical-grade face masks.

As of mid-October, 38% of Iowa nursing homes reported having less than a one-week supply of personal protective equipment, or PPE; and 43% of state nursing homes reported being short on staff, according to survey responses nursing homes send periodically to the federal Centers for Medicare and Medicaid Services.

While long-term care facilities across the country have been hit hard by COVID-19, Iowa is higher than the national average for nursing home resident cases and deaths per capita, and nursing home staff cases per capita, according to federal data compiled by AARP. The state also is worse than the national average in the percentage of nursing homes that say they are short on staff and personal protective equipment for that staff.

“It is serious,” said Di Findley, executive director of Iowa CareGivers, a nonprofit that works to address shortages among direct care workers like certified nurse aides and home care aides. “The people who work in these jobs, the nurse aides, social distancing isn’t really an option. You can’t give somebody a bath or assist somebody to the toilet or help them with oral hygiene from 6 feet apart. Because of that, (those workers) are a little higher risk of contracting and spreading the virus.

“So they live in fear. They love their jobs, but they still live and work in fear now.”

Findley said direct care workers had been working in difficult conditions for years, before the pandemic hit in March. She said the positions were high turnover and low-paying: she said the median salary for a direct care worker in Iowa was $13.80 per hour.

“They’re putting their lives on the line for $13.80 per hour,” Findley said. “Things were not good before, so you can imagine now, in the midst of a pandemic, how challenging it is for those folks on the front line, and their employers.”

Anthony Carroll, advocacy director for the Iowa chapter of AARP, said the 38% of nursing homes with less than a one-week supply of PPE was “troublingly high,” particularly at the pandemic’s eight-month point.

“We’re halfway through November, and that is troubling,” Carroll said.

The state has a PPE stockpile, and Gov. Kim Reynolds this week urged nursing homes facing shortages to request equipment from the stockpile.

Reynolds’ spokesman later clarified that a facility must be dealing with an outbreak before in can request PPE from the state stockpile. The spokesman said facilities not experiencing an outbreak might be considered eligible to receive PPE from the state stockpile, but those will be evaluated on a case-by-case basis.

Carroll said the state should do what it can to make it easier for facilities to get the PPE they need.

“Iowa should streamline this process to make it easier to get PPE in the hands of long-term care facility staff and residents,” Carroll said. “For the sake of residents, families and staff, Iowa needs to do whatever it takes to ensure that we no longer have over 38% of Iowa nursing homes reporting that they don’t have a one week’s supply of PPE.”

Reynolds this week also announced she is dedicating $14 million in federal funding designated for COVID-19 response efforts to help long-term care facilities with staffing and testing. When asked if the funding can also be used to purchase PPE, Reynolds referred to the state stockpile.

Reynolds also noted her office and the state public health department had worked on guidance for long-term care staffing. One of the new guidelines, published in the state public health department’s November update says workers with a confirmed COVID-19 infection may provide direct care to patients with a suspected infection, and “as a last resort in emergency staffing situations,” workers with a confirmed COVID-19 infection may provide direct care to patients without an infection.

Reynolds also said this week she expected to announce an initiative next week to recruit more nurses and other critical health-care workers to come to Iowa to help bolster the state’s strained workforce. The governor’s spokesman said a plan to bring more health care resources to Iowa was being developed, but details would not be available until next week.

“Like our hospitals, it’s important that we also provide assistance to long-term care facilities at this time, and that every Iowan continues to do their part to protect the most vulnerable of our health care workforce,” Reynolds said.

Carroll and Findley both suggested Reynolds should consider deploying the Iowa National Guard to help with Iowa’s overwhelmed health care workers, and both proposed a state registry for direct care workers, which could be used by employers to more easily find workers when faced with staffing shortages. Legislation to create a state direct care worker registry was proposed during the 2020 session of the Iowa Legislature and was being considered before the pandemic hit and derailed the session.

Findley said she would like to see some of the federal pandemic response funding to be put toward hazard pay and other financial issues like increased child care needs for direct care workers.

“You hear a lot about doctors and nurses, and they are very, very important. But let’s not forget about these people (direct care workers),” Findley said. “They’re on the front line and they are an important piece of our ability to mitigate and fight this virus. And they need our support, too.”

Rod Boshart of the Gazette in Cedar Rapids contributed.