“At every moment of the epidemic, both health care workers and nursing home workers […] have always been provided with all the protective equipment that was reasonably needed. This was stated by Miklós Kásler, Minister of Human Capacities, in an interview at the end of May. This came as response by Kásler to criticisms from the opposition parties. They complained that there was not enough protective equipment for those working in nursing homes. According to the Minister, whoever said that, was simply not telling the truth.
However, dozens of sources we have talked to over the past few weeks, see the situation differently. They gave us insights into what the epidemic control looked like inside state-run institutions, including homes for people with disabilities and psychiatric patients.
Nurses and care givers working in institutions in different cities of the country spoke of their experiences only on the condition that their names be withheld because they fear losing their jobs.
Contrary to the Minister’s claim, they told Direkt36 that it mostly depended on their own initiative and creativity whether there was enough protective equipment in their institutions. Employees in several nursing homes have complained that they mostly either received face masks from donations or had to sew masks for themselves. Additionaly, patients also helped sew masks for their own caregivers in some institutions.
Sources also complained that the epidemic control measures imposed by the government are difficult to enforce in nursing homes. Quarantine rooms had to be set up everywhere, which resulted in overcrowding, as in most nursing homes there were already too many people cohabitating in tight, poor conditions.
By now, it has also become clear that while health care workers are set to receive a HUF 500,000 reward in early July, social workers will not receive any cash rewards, despite repeated requests from their unions. “We are absolutely forgotten, even civilians only care about helping the elderly. I don’t understand why they don’t think about us,” a caregiver employed at a Western Hungarian nursing home for disabled people told Direkt36. Tibor Migács, head of the Democratic Trade Union of Social Workers, summed up the situation: “Our members always say that they forget about us. I used to tell them that, no, they didn’t forget you, they never cared about you in the first place.”
The Directorate-General for Social Affairs and Child Protection (SZGYF), which oversees state-run nursing homes and belongs to the Ministry of Human Capacities (EMMI), responded to our inquiry stating that they provide protective equipment for their homes and the county offices were involved in coordinating procurement. Neither the Coronavirus Task Force (the government body tasked with coordinating epidemic control) nor EMMI answered our questions about nursing home institutions.
In Hungary, a total of about 90,000 people live in nursing homes. Most of them (54 thousand in 2019, according to the Hungarian Central Statistical Office, HCSO) live in nursing homes for elderly. Their situation was also highlighted by the Coronavirus Task Force, and their concerns were frequently raised in daily press conferences and government communications. However, the second largest group living in nursing homes was barely mentioned during the epidemic. They are people with disabilities living in such homes, and psychiatric patients (according to HCSO, the former were more than 14,000, the latter 8,000 in 2019). These more than 22,000 people across the country are cared for by thousands of nursing, caring and other support staff on a daily basis. Some of the institutions are integrated, meaning that the elderly live together with people with some kind of disability.
The majority of those infected with the coronavirus in Hungary live in nursing homes. According to government data, the virus has appeared in 33 institutions, where a total of 5,991 people are cared for by 2301 caregivers. Of those cared for, 899, of workers, 142 were confirmed to be infected, and 127 of the patients have died.
The virus has spread not only in nursing homes for the elderly but also in nursing homes for the disabled. Infectious cases were reported at the end of April in the Szeged Nursing Home for the Blind (where psychiatric patients are also cared for). And on May 11, Chief Medial Officer Cecília Müller spoke about the spike in the number of infected people in Zala County due to nursing homes and “other type of nursing home institution”. Hungarian daily Népszava wrote that most of these infected people can be linked to the Sunflower Home of the Zala County Joint Social Institution, which cares for people with severe, multiple disabilities.
The government is also aware of how threatened nursing homes are by the spread of the virus. The World Health Organization (WHO) issued a warning about this in March, but a Hungarian government guideline in April also stated that “COVID-19 infections and epidemics in nursing home institutions can have particularly severe effects and consequences”. “Superiors also say we have to get through these few weeks because if the virus gets in here, it’s all over because we have so many patients with chronic illnesses,” a nurse told Direkt36.
However, on May 19, Secretary of State for Social Affairs Attila Fülöp acknowledged that nursing homes for people with disabilities and psychiatric patients have received less attention in recent weeks. On May 26, the Chief Medical Officer said that the biggest challenge is to eradicate the virus in closed communities, so in the second phase they will continue testings in additional nursing homes. However, the Coronavirus Task Force did not reply to our repeated requests for information on how many illnesses and deaths occured in nursing homes that care for patients other than the elderly. Similarily, they did not answer our question on whether they collect information on how many of those who died of the virus had some form of disability.
The National Public Health Center (NNK) issued protocols on infection prevention in nursing homes in early April. The protocols provide detailed descriptions on proper protective equipment use, for example, they include illustrations on the correct way to wear gloves. Although Minister Kásler claimed that there was sufficient protective equipment supplied, sources talking to Direkt36 said that even if there were protective equipment provided, there was not enough to change them regularly. Among the homes caring for the disabled, the infection first appeared in the Szeged Nursing Home for the Blind. A source working there claimed that the state did not give much support to nursing homes when the epidemic broke out. “Now that the situation is tough, they have given a few things, but it is still too little,” the source added.
„In the beginning, I was very angry as due to rationing of supplies, we received a very small amount of disinfectant liquid.Staff working at the wards only got one liter. We only had a few surgical masks, old types of masks made of paper, and home-made fabric masks,” wrote a source working in the largest nursing home in Hungary, a 720-bed institution in the city Szentgotthárd.
In May, a caregiver from a rehabilitation institution wrote to Direkt36 about masks that “the institution provides us with a limited amount of face masks, there are hardly any disposable masks, and I can count on my hand how many times we have received them since the virus broke out […] One of our patients has a sewing machine so she has been sewing fabric masks for us ever since. Luckily we have her, because that way we already have a couple of good reusable masks”. At the beginning of the epidemic in the Szeged Nursing Home for the Blind, workers sewed masks for themselves from old, used bedsheets, according to a worker.
Union leader Tibor Migács said about the protective equipment that, to his knowledge, the maintainer has been providing some equipment to the institutions since April, but in a sporadic, unpredictable way, and they cannot stockpile reserves. He also highlighted a case from Budapest that was, in his opinion, absurd. The Directorate-General for Social Affairs and Child Protection (SZGYF) informed a nursing home for people with disabilities that it oversees, that it could only provide them with fabric masks for 479 HUF / piece (1,4 EUR). At the same time, the SZGYF acknowledged that it would have been their responsibility to equip the institutions. We also talked to a specialized caregiver in Western Hungary who claimed that they did not receive any protective equipment at all from the SZGYF, even in April.
In recent months, it has also become common practice for institutions not to wait for the state to supply them. A Budapest institution caring for people with disabilities bought protective equipment at their own expense for HUF 10 million (29,000 EUR). According to a source familiar with the institution’s internal affairs, this was such a big expenditure that the institution’s money may run out before the end of the year. Moreover, the equipments did not reach them by the end of April, only later.
We asked SZGYF several questions about the procurement process of protective equipment and the supplying of nursing homes, but their only reply stated that protective equipment is constantly shipped to nursing homes, and the institutions themselves decide the way they are used. They added that the institutions also receive protective equipment from the central national supply, as decided by the Coronavirus Task Force. The Task Force itself did not respond to our inquiry, nor did the Ministry of Human Capacities.
Unions have sent several letters to decision-makers during the epidemic, demanding more protective equipment for the nursing homes. In a letter dated April 17, Prime Minister Viktor Orbán was also asked for more protective equipment and comprehensive testings to prevent institutions from becoming focal points of the epidemic. A reply to the letter was received within a few days, stating that the Prime Minister had forwarded the request to the Ministry of Human Capacities as they are the ones responsible. No response has been received since. One union leader explained the background of the letter, stating that they had specifically written to Orbán because Minister Kásler had already not replied to any of their previous letters.
Although the government announced at the end of May that the second phase of the epidemic control would be about increased protection for nursing home institutions, workers say there are several serious problems with that.
The first cases of the novel coronavirus were registered in Hungary on March 4. Four days later, the Chief Medical Officer ordered a ban on visits to nursing homes and then banned the admission of new residents. In most nursing homes for the disabled, banning visitors was not a big change, as residents are visited by few anyway (the ban was largely lifted in the first week of June). Then, on 6 April, detailed guidelines for nursing homes were published on the National Public Health Center’s (NNK) website. However, a significant part of the required measures are considered unenforceable by the staff of these institutions.
The guidelines set out, among other things, hygiene requirements, proper distancing, regular temperature taking, and the need to designate workers to treat potentially infected people separately from others. “This protocol was drafted by health professionals, they based it on their own conditions and they want to force it on the whole sector. Yet there are so many different institutions and each has different conditions. It shows that the social care sector does not exist in the eye of the government, now it became absolutely clear that they have no idea how we operate,” Ferenc Köves, leader of the Union of Social Sector Workers, told Direkt36. According to him, neither the infrastructure nor the staffing levels and material conditions were ensured for the observance of the protocol, which is otherwise monitored by the NNK.
For example, in many places quarantine rooms could only be designed by crowding residents together elsewhere, which increases the risk of an epidemic. “There has been more overcrowding since the virus, because one of the buildings has been evacuated to be repurposed for quarantine rooms. Regular quadruple rooms now have to accommodate sometimes 6-7 people. As a result, life in the nursing home deteriorated even further,” said a former caregiver from the Polgárdi-Tekerespuszta institution in Fejér County.
Not only the patients but also the caregivers are at high risk in these institutions. Staff in nursing homes are typically over 45-50 years old, and many have developed chronic underlying illnesses because of their jobs, which puts them at higher risk.
“They do heavy, demanding physical work, as people with severe disabilities, for example, have to be constantly lifted. They also have a lot of health problems because they are assigned to too many shifts due to staff shortages, which also results in more stress. At one time, it was so evident, that we started collecting the names of colleagues who died much younger than the average,” said Ferenc Köves. A nurse with a medical degree who has been working in the social care field for a long time, told Direkt36, that over 40, if someone has been working in such institutions for years, they develop lots of illnesses. Tibor Migács said that all their union members in their 40s and 50s are struggling with some kind of chronic illness. These are typically musculoskeletal or cardiovascular problems that may have developed due to increased demanding physical activity.
All sources talking to Direkt36 agreed that the epidemic had exacerbated the already grave problems of social care institutions. Tibor Migács told Direkt36 that there are workers who left their jobs because of the epidemic as they are afraid for their own health or that of their family members. This has been confirmed by other sources working as caregivers or nurses from several parts of the country.
The operations of a nursing home can easily be upset by the resignation or incapacity of even a few nurses, as this sector has traditionally struggled with chronic labor shortages. It has been a regular practice in the past for a caregiver to supervise 40-50 patients in a shift alone. A source from one of the institutions in Western Hungary, home to more than a hundred severe and mildly mentally handicapped people, told Direkt36 that even patients with milder disabilities had to be deputized to help care of the more severely disabled as labor shortages became very critical.
At the end of last year, the Hungarian Civil Liberties Union (TASZ) requested and received detailed public data from the SZGYF and the HCSO on the labor shortage affecting state-maintained nursing homes. The data show that there is a systemic shortage of professional labor in state-run nursing homes for people with disabilities and psychiatric patients, which also threatens the care of residents and safe working conditions. Some regions have been hit particularly hard by labor shortages even before the coronavirus. One such example is Budapest, where the labor shortage was almost 39% for all institutions. In addition, Pest county, the Budapest-Székesfehérvár axis, Győr-Moson-Sopron County, the pre-Alpine region and all other regions where there are more opportunities for employment, are severely affected. Typically, small deteriorating villages and poor regions are where people are willing to work at social care institutions,as there are not many other job opportunities..
The Tómalom Street Home for the Disabled in the city of Sopron was in a very difficult situation after the outbreak of the epidemic. The head of the institution spoke openly about the shortage of staff in the local daily Kisalföld in hope that they could recruit labor. “We are currently struggling with an unprecedented, severe staff shortage. (…) After passing a medical fitness test, we would immediately employ twenty nurses and caregivers, ten cleaners and three kitchen staff at the nursing home for the disabled,” the director of the institution told the paper. The article helped them fill a couple of positions, but they are still only able to fulfill the epidemic control protocol imposed on them by working around the clock, according to one of our sources working at the institution. “This is an extra workload on top of already too much work, but nurses are self-sacrificing. Besides doing their normal job, if it is needed, they clean, disinfect or even sew face masks,” the source said.
Due to labor shortages, the demand for skilled caregivers and nurses is so high that many of them regularly take up jobs in multiple health and social care institutions at the same time. The risks of this have also been shown during the coronavirus epidemic. For example, in the Debrecen Therapeutic House, which houses disabled people and psychiatric patients, an internal investigation was launched against three caregivers. According to union leader Tibor Migács, these caregivers did not disclose that they should be quarantined because they had second jobs in an institution caring for the elderly where a virus breakout was suspected.
Nevertheless, they continued to visit and work at the Therapeutic House, resulting in a scandal after other workers and the head of the Therapeutic House uncovered the situation.
Caregivers complained that low pay and lack of respect and appreciation also contributes to labor problems. Several outraged nurses told Direkt36 that while health care workers receive a one-time bonus of half a million forints (1440 EUR) for their persistence during the epidemic, this does not apply to them. Also, government officials are even more likely to say ’thank you’ to bus drivers and shop assistants than to social care workers.
At the end of April, Prime Minister Viktor Orbán listed in a thank-you video those who are “fighting for us”. Not only did he not mention social care workers, but also highlighted “brave volunteers” as those, whoaccording to him, care for the “most disadvantaged”. In an interview in early June, Minister Kásler explained why, instead of receiving the half-million-forint bonus, social workers can only expect “thanks and gratitude” from the government. He claimed that this is because, unfortunately, their “employers (…) are the churches, companies, NGOs, or the local municipalities.” He forgot to mention in the interview that both the Hungarian state and the state-run SZGYF are employers of tens of thousands of social care workers and they run many nursing homes.
Kristóf Környei (Hungarian Civil Liberties Union) contributed to this article.