The ranks of health care workers available to provide critical care for frail and older adults have plunged to dangerously low levels at senior homes across the state — undercutting efforts to keep seniors safe as the coronavirus surges in Minnesota.

A rash of new outbreaks has strained already short-staffed nursing homes and assisted-living facilities and is forcing a growing number of providers to reach out to the state for emergency assistance. In a troubling repeat of the early outbreaks this spring, some senior homes report that up to 20% of their staff are either out sick from COVID-19 or are quarantining at home because they were exposed to someone with the virus.

The chief culprit is the rampant community spread of the virus. Even though facilities have imposed strict limits on family visits and employed more aggressive testing, they continue to be overwhelmed by a surge of infections in the communities that surround them. Between October and the end of November, the number of new COVID-19 cases in Minnesota's long-term care facilities soared by more than 400% — the biggest two-month spike in cases since April, state health officials said. So far, 67% of the 3,845 COVID-19 deaths have occurred in long-term care communities, state records show.

Minnesota's 2,100 senior care homes are better prepared to deal with the virus than they were nine months ago, but improvements in testing and infection-control protocols are being threatened by staffing problems, facility administrators and public health experts say.

Health Commissioner Jan Malcolm said Friday that 57 long-term care facilities have "some degree of staffing crisis" and are receiving support from the state, including help from federal health nurses. Last week, the agency reported that 90% of Minnesota's nursing homes and 58% of the state's assisted-living facilities have active virus outbreaks. That includes more than 70 senior care homes that didn't have any residents with COVID-19 one month ago.

"We are unfortunately seeing the effects of community spread in these facilities that care for our most vulnerable Minnesotans," Malcolm said in a Friday briefing. "Unfortunately, even the strongest flood walls aren't sufficient if the waters rise high enough."

At some places, the pool of nursing assistants and other caregivers has become so depleted that facilities have reached out to the Minnesota National Guard. Since the start of the pandemic, the Minnesota National Guard has dispatched teams of medical professionals to 17 long-term care facilities with severe staffing shortages. The National Guard has personnel at six long-term care sites across the state.

"Not one of our soldiers or airmen envisioned themselves performing care in a long-term care facility when they voluntarily [raised] their hand and joined the Minnesota National Guard," said Major Gen. Shawn Manke of the National Guard. "I wholeheartedly wish we did not have to do this mission, but the fact of the matter is, we are."

Cheryl Hennen, Minnesota's long-term care ombudsman, said her office is receiving a surge of calls about staffing problems from seniors and their families. Some residents in senior care facilities have reported as few as one caregiver for every 40 residents on certain shifts and that has led to slow or substandard care, she said. The shortages are so severe that many families are debating whether to remove their loved ones and care for them at home, she said.

In recent weeks, concerns about staffing — and whether to keep a loved one in a long-term care facility — have accounted for 35 to 40% of the calls the long-term care ombudsman's office has received from residents and families. They are second only to calls about the strict visitor restrictions that many senior homes have imposed since the spring to contain the virus' spread and have prevented many seniors from having physical contact with their loved ones.

"The ripple effect of the staffing crisis is wide," Hennen said in an interview Friday. "Families and residents are really having to make tough decisions they've never had to make before, and it all ties back to staffing. Residents cannot survive without adequate staffing."

Amanda Johnson, a nurse and vice president of clinical operations at Tealwood Senior Living, a Bloomington-based company that operates 30 senior facilities in Minnesota, said the staffing crisis is "very real." About 100 of Tealwood's employees, or 10% of its direct support staff, are unable to work either because they have COVID-19 or they are in quarantine at home because they were exposed to someone with the virus.

"The crisis we have been fearing is here," Johnson said. "The dedicated staff of the long-term care profession continue to amaze us by stepping up, filling shifts, and caring for those who are most vulnerable. We ask everyone to please help us keep our seniors safe."

The staffing shortage is forcing caregivers to make brutally difficult choices about whether to stay home when they are sick and whether to care for vulnerable seniors who are showing symptoms of the virus — knowing that if they miss work these clients may go without adequate care.

Debra Howze, a professional caregiver from St. Paul, said "my heart fell to my stomach" after she received news that she tested positive for COVID-19 last month. Not only was Howze worried about her own health — she has a heart condition and high blood pressure — she was worried about who would care for her most vulnerable clients. Among them is 101-year-old Polly Mann, who caught the virus about the same time and was struggling with fatigue and weight loss.

Even though she was infected, Howze continued to provide round-the-clock care for Mann — even sleeping on an air mattress in Mann's living room to make sure that she would make it through the night.

"I kept saying, 'Don't die on me. Don't die on me.' I was distraught," Howze said.

By November's end, both Howze and her client had fully recovered, but the harrowing experience has left her feeling more anxious about the virus.

"The worst thing in the world is having to call someone and tell them that you have the virus and you should go get tested," Howze said. "It makes you think about death and about getting your things in order — and about how fragile life is."

Chris Serres • 612-673-4308

Twitter: @chrisserres