It was past midnight and an exhausted Jasmine Laducer-Kitto tried to strip off her blue scrubs and move gingerly toward her bedroom without waking her four children.

It had been a difficult night at the Maplewood nursing home where Laducer-Kitto, 35, works as a certified nursing assistant. She had to bathe, feed and reposition more patients than usual because of a persistent staff shortage. The constant ringing of bedside call buttons had left her with no time for a break. A patient with dementia suffered a panic attack and kept asking if she would die from the coronavirus.

“It was unrelenting, all night,” Laducer-Kitto said as she collapsed on the couch.

Laducer-Kitto began working as a caregiver 16 years ago because she was abused as a foster child and felt her “life mission” was to help society’s most vulnerable. But since the coronavirus outbreak began, there have been moments when the pressures of working on the front lines of the pandemic while caring for her own family have been overwhelming, when she has struggled with feelings of doubt, anxiety and guilt. Who would look after her children if she caught the virus? Who would comfort the many nursing home patients who relied on her warm smile and upbeat demeanor?

Those anxieties reached a new height last week after Laducer-Kitto learned that the nursing home where she works, the Ramsey County Care Center in Maplewood, confirmed its first case of a patient infected with COVID-19, the respiratory illness rampaging through nursing homes across the state and the nation. The patient was immediately moved to an isolated room, but Laducer-Kitto found herself questioning whether it made sense for her to continue risking her life and the lives of her family.

“At times like this you can’t help but wonder if it’s all worth it,” she said. “Is it worth my baby getting sick and possibly not existing?”

No refuge for caregivers

For the past two months, there has been little respite for the front-line health workers caring for the roughly 90,000 Minnesotans who live in nursing homes and assisted-living facilities. These senior communities have been at the heart of the coronavirus pandemic, accounting for a staggering 81% of deaths from the virus statewide. Deadly clusters of COVID-19 have ravaged several of the state’s largest nursing homes, killing more than 550 residents and infecting scores of health care workers. One nursing home, St. Therese of New Hope, has reported more than 50 deaths — among the deadliest coronavirus clusters in the nation.

Inside the Ramsey County Care Center, a 164-bed nursing home, workers face unprecedented challenges.

At times, nursing assistants have to work extra shifts because as many as 20% of the staff are out sick or in quarantine. Hidden under a protective layer of gowns, gloves, masks and goggles, workers often emerge from patient rooms drenched in sweat. Shifts can drag on for several hours longer than usual because workers must repeatedly change their gear to prevent infections from spreading. And with nursing homes across the nation on lockdown, caregivers like Laducer-Kitto are under pressure to fill the emotional void left by family members who can no longer visit them.

“I say to our staff, ‘You don’t have to look far to see a hero, you just have to get up and look in the mirror,’ ” said Michael Schultz, administrator of the Ramsey County Care Center.

The fever came on suddenly.

Laducer-Kitto had just arrived at her Brooklyn Park home from the night shift on April 26 when her teenage daughter came rushing to the door with a message: Her 6-month-old son, Angel, was crying and “felt warm” to the touch. Laducer-Kitto quickly removed her soiled work clothes and dumped them in the washing machine before checking Angel’s temperature. It had already climbed to 104 degrees. Laducer-Kitto tried not to panic, hoping the fever was brought on by the child’s teething.

Then a few days later, Laducer-Kitto also started feeling sick. She had body aches and a runny nose — symptoms that are showing up in many people infected with COVID-19. Fearing the worst, Laducer-Kitto called in sick and began to isolate herself at home with her children, whose ages span from 6 months to 13 years. Meanwhile, her son’s high temperature persisted, even with doses of anti-fever medication.

As she isolated at home, Laducer-Kitto began to retrace her steps and wondered: Had she let her guard down at the nursing home? Had she forgotten to shower one night after work before hugging her children?

“Every hour is a battle,” Laducer-Kitto said of her work. “We are the frontliners. We are the ones wiping the bottoms. We are the ones giving the showers. ... We are the ones who are face to face with folks when they are coughing and sneezing.”

Eventually both Laducer-Kitto and her infant son were cleared of having the corona­virus, but her relief would prove short-lived.

At 8:21 a.m. Thursday, she got a text from a co-worker saying that a patient had tested positive for COVID-19, the first one at the facility. Anxiety began to set in as she replayed her many interactions with the infected patient. There were times when she would bring trays of food to her bedside and push her down the hallways in a wheelchair.

That night, Laducer-Kitto broke the news to her longtime partner when he picked her up from work. On the drive home, the couple had another long and emotional conversation about whether it made sense to continue working at the nursing home.

“The scary part is, this virus just latches on and sucks the life out of people,” she said. “I have family members who want me to quit.”

Once again, Laducer-Kitto began weighing her limited options.

Taking a physical toll

Several years ago, she enrolled in nursing school during the day and she was finally nearing graduation. Besides, caregiving was the only work she had ever wanted to do. Laducer-Kitto traces her passion to her troubled childhood in the foster care system, when she and her little sister were abused and bounced from home to home without adequate care. At age 20, Laducer-Kitto took custody of her little sister, who has a cognitive disability, to protect her from abusive foster parents.

“I can’t just walk away from this,” she said. “People need us to be doing this work. Because if we don’t, then who is going to be there during their time of need?”

Even so, the long hours and late nights are taking a toll on Laducer-Kitto. Her back aches each morning from lifting and repositioning patients. And her muscular hands are chapped from the hundreds of times she must wash her hands during every shift. There are nights when her 2-year-old son, Eloheem, rushes screaming to the doorway when he hears his mother enter the house.

Laducer-Kitto must resist the temptation to lift him in her arms until after she’s washed away the day’s germs.