It was the day after Thanksgiving and Bill Tiedemann faced a once-unthinkable dilemma: Whether to evacuate a group home in Stillwater for older adults living with H.I.V.

A sudden outbreak of the novel coronavirus had sickened all three residents of the nonprofit home that Tiedemann oversees, and he was running out of staff to bathe, feed and administer medications. Eight of the home's nine caregivers were unable to work because they had just been infected or exposed to the virus or were afraid of getting sick. Tiedemann had to suspend his normal duties and care for the residents himself.

Yet a deeper crisis was narrowly averted with a single telephone call. That same day, Tiedemann reached out to a new state program that provides emergency staffing to residential care facilities in crisis. Within 48 hours, the program connected Tiedemann with six qualified applicants — all ready and willing to care for people stricken by a rampaging respiratory illness that has killed at least 4,658 Minnesotans and sickened nearly 390,000.

"It was a godsend," said Tiedemann, executive director of Hope House of St. Croix Valley, which has been caring for residents with H.I.V. since 1991. "Within hours, I went from feeling very alone to feeling elated."

Hope House is among nearly 150 residential care centers across Minnesota that have filled essential caregiving positions — and, in many cases, avoided catastrophe — through an aggressive new hiring initiative. In just a few months, the Minnesota Department of Human Services (DHS) has developed a large pool of workers who can be deployed rapidly to care centers that face critical staffing shortages.

The hiring program has helped fortify the state's health care workforce at a critical and precarious moment in the pandemic.

Across Minnesota and the nation, the ranks of workers available to provide lifesaving care to the most vulnerable populations has fallen to dangerously low levels. Frontline health workers report feeling deepening levels of fatigue and anxiety over the unrelenting tide of new infections. Some have left their jobs out of frustration — or fear of catching the illness. The shortage leaves those still on the job caring for more residents, which exposes them to burnout and threatens patient care, say public health observers.

Finding caregivers was difficult long before the pandemic, but new state workforce data shows that staffing shortages have deepened considerably since the spring. The number of unfilled positions for registered nurses and nursing assistants — the two jobs in highest demand in the state — have more than doubled since May to more than 3,600 positions. Job postings for personal care aides, social workers and other caregiving positions have also reached new heights, according to the state Department of Employment and Economic Development (DEED).

Amid a rash of new outbreaks, state officials are trying to avoid a repeat of the harrowing scenes during the pandemic's early weeks, when a surge of infections plunged many congregate care facilities into a staffing crisis. A small number of senior homes had to evacuate their residents by ambulance or rush them to hospitals because a third or more of their staffers were out sick.

This spring, the staffing shortages became so severe that some facility administrators feared testing their workers for COVID-19 because anyone who tested positive would have to quarantine and miss work, further straining staff.

Residential care centers are better prepared to respond to the virus than they were in the spring, but officials are still concerned by the rapid rate of community spread. An alarming 91% of Minnesota's nursing homes and 61% of assisted-living facilities had active outbreaks as of Dec. 7, state records show. Nearly a third of all group homes for people with disabilities or mental illnesses also have active outbreaks.

"The biggest thing is ... we don't want to see facilities have to evacuate," said Dan Pollock, assistant commissioner for continuing care for older adults at the Department of Human Services. "That's particularly hard on older adults and the relocation trauma itself can be fatal."

Rapid relief

This summer, DHS officials turned to third-party staffing agencies and gave them a simple directive: "To hire more people than you've ever hired before in Minnesota, potentially," Pollock said. "We wanted to have a contractual relationship where we could tell you on a dime that we are going to need 'this many people at this site' for a short-term, 14-day period."

The emergency staffing initiative will not solve Minnesota's staffing woes, but it has already provided rapid relief to dozens of nursing homes, assisted-living facilities, group homes, homeless shelters and substance abuse treatment centers. All told, 139 workers have filled more than 500 two-week shifts at care facilities across the state. With aggressive recruitment, state officials said they hope to deploy as many as 700 workers at care settings by the end of December, when federal funding for the program will run out.

The initiative has had such a quick and far-reaching impact that at least one other state is already moving to replicate it. Vermont, which also is struggling with pandemic-related staffing shortages, last week issued an urgent call for able-bodied adults to work in long-term care facilities, and launched an emergency staffing pool closely modeled after Minnesota's initiative.

Applicants do not need direct caregiving experience: State officials said they are welcoming restaurant and other hospitality-industry workers who may have been laid off from the prolonged economic downturn caused by the pandemic.

To compensate for the risks of caring for people with COVID-19, entry-level workers who join the hiring pool can make up to $25 an hour — about twice the typical hourly wage for personal care aides. Licensed practical nurses and registered nurses can make up to $35 and $50 an hour, respectively.

"Ideally folks who are unemployed from the service economy ... who are willing to be 'health care heroes' and give back to the community could get more involved," Pollock said.

Tiedemann said he was surprised at how quickly the state program was able to find qualified caregivers. All the residents of Hope House have complex health needs, such as help administering insulin throughout the day and assistance preparing for dialysis treatment. Because of their age and health problems, they were at an especially high risk of dying from the coronavirus.

"We put the lives of our residents in their hands, and they came through like heroes," Tiedemann said.

Michelle Smith, a nurse who lives in Rochester, said she felt "an overwhelming sense of duty" to join the program after witnessing the immense suffering caused by the virus. Early in the pandemic, Smith was among hundreds of medical professionals who rushed in to virus hot spots, including New York City and Miami, Fla. to provide emergency support to overwhelmed hospitals and intensive care units. In Brooklyn, Smith held the hands of dying patients on ventilators. And in Miami, she watched as a six-year-old boy waved goodbye to his mother before she succumbed to the virus.

"I have seen my fellow colleagues, health care professionals, cry and break down on the job. I mean, how do you ignore that?" said Smith, 45. "I thought to myself, 'Well, God spared my life, maybe this is what I'm called to do.' "

For now, Smith is assigned to a nursing home in Austin, Minn., which has been short of direct support staff since a small cluster of residents contracted the virus. Most days, she rises before dawn and works back-to-back shifts with little rest, from 6 a.m. to 10 p.m., before making the 40-minute drive back to her apartment in Rochester. On rare days off, Smith tries to relax and talk to her mother and college-age daughter on FaceTime, but it can be hard to disconnect: Her phone beeps and rings almost every hour with alerts from staffing agencies trying to fill vacant nursing positions.

"There are still people who think this virus is a joke," Smith said, after returning home from a late-night shift. "But I've seen this up close and personal, and it's no joke."