“We don’t know how she’s going to survive this,” said Gerry Baker, one of the sisters. “When we couldn’t see her, it felt as if my mom had transitioned, and we were waiting to have the funeral.”

New York’s nursing homes have long been chronically understaffed, leaving family members to fill critical gaps, from feeding their relatives to checking for bedsores or infection. Now those family members are barred from entry, and existing workers are getting sick, quarantined or quitting because the work has become too dangerous.

At the same time, some nursing homes say they cannot get the protective equipment they need because it is going to hospitals. At ArchCare, which runs five nursing homes,, workers wear rain ponchos and beauticians’ gowns. By Sunday the five homes had around 150 cases of COVID-19 and a number of deaths, said Scott LaRue, the president.

“I can't test; I don’t have PPE,” he said, using the acronym for personal protective equipment. “What am I supposed to do?”

The coronavirus is pushing what was once a problem toward a crisis.

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“Coronavirus in a nursing home,” Gov. Andrew Cuomo said Sunday, “can be like fire through dry grass.”

In New York City, nursing homes account for 1 in 4 coronavirus deaths.

Nearly 1.5 million Americans live in nursing homes.

Depleted staffs means more residents per worker — and also more room for error or neglect, less time to fully scrub between residents and greater opportunities to carry the virus from one room or wing to another.

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In understaffed homes, “people are not getting medication when it’s needed, are waiting a long time for diaper changes or other hands-on care,” said Susan Dooha, executive director of the Center for Independence of the Disabled, New York. “This was a problem before, but the current pandemic throws it into high relief.”

Michael Balboni, executive director of the Greater New York Health Care Facilities Association, an industry trade group, acknowledged that absenteeism has increased but said that it had not affected care.

“A lot of facilities are developing an incentive program to get people in” or are bringing in workers from outside agencies, he said. “There are callouts happening, but we’re still providing care. But we are concerned about this.”

Many family members declined to come forward about their complaints for fear of retaliation against their relative.

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For Marjorie Fox, who visited her mother, Florence, 98, almost daily at Sapphire Nursing and Rehab in Goshen, New York, all of her aggravations with the home have heightened now that she cannot see her mother.

Sapphire has just a one-star rating, the lowest, from Medicare. “It worries me, that something has happened, and they didn’t tell me,” she said, “like they changed her medications and didn’t tell me.”

The older Fox has Alzheimer’s disease and is largely unresponsive. Even before the epidemic, she had chronic bedsores from not being moved often enough. “There are some very fine people there, but not enough of them,” her daughter said.

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Especially in facilities where residents do not have telephones, families say they have no way to know whether their relatives are still healthy, whether the virus has affected their neighbors or aides, or what steps the homes are taking to protect them.

“They’re completely understaffed, and the staff is running from resident to resident, and they don’t have time to wash their hands,” said Toby S. Edelman, senior policy attorney at the Center for Medicare Advocacy, a national group. “For some residents, family members are the unpaid caregivers.”

With hospitals scrambling to make room for COVID-19 cases, nursing homes may face even higher risks. Last week the state Health Department instructed nursing homes to take back any hospitalized residents who are medically stable — even those with COVID-19.

Staffing at nursing homes has been in a crisis for some time now, especially as for-profit chains have bought up nonprofit facilities. In New York, which has no minimum staffing requirements, the federal Centers for Medicare and Medicaid Services rated nearly three-quarters of the homes in the city “below average” or “much below average” for staffing, according to a 2019 analysis by City Limits.

Low staffing means more citations for infections, which kill as many as 380,000 residents a year, according to the Centers for Disease Control and Prevention.

None of this is a surprise to Gerry and Audrey Baker, whose mother, Grace Marie Baker, 105, is in the Crown Heights Center for Nursing and Rehabilitation in Brooklyn, part of the for-profit Allure Group, which made headlines in 2016 for its role in the closing of a nonprofit nursing home on Manhattan’s Lower East Side.

The Bakers have not seen their mother for two weeks. “We don’t know how our mother is surviving day to day,” said Gerry Baker. “We don’t know what medications she’s getting, if any.”

Medicare rated the home “below average” for staffing and registered nurse staffing. Overall the home received four stars out of five.

“When we left her March 13 she wasn’t sick,” Audrey Baker said, “but there’s so many people coming in and out, we have no clue what our mother’s health status is.” On a video call with their mother arranged by a staff member, they said she looked dehydrated and disconnected. “She was calling out, ‘Where are my daughters?’ ” Audrey Baker said.

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The sisters said that until the lockdown they took their mother to doctors’ appointments, washed her clothes and planned her wardrobe for the week. Often they found too few aides to cover the floor, Gerry Baker said.

“I walked in one night, and there was a man on the floor, who fell off wheelchair. No one saw or heard him. I called for help.”

In a statement, the home responded: “The health, safety and well-being of our residents is always our top priority, especially so during the COVID-19 pandemic.” Though employees have called out from work, others have filled in or worked extra shifts, keeping the ratio of staff to residents constant, the statement said. “We’re following all guidelines issued by the DOH and CDC and remain in constant communication with families,” it added, referring to the state Department of Health.

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At Beechtree Center for Rehabilitation & Nursing in Ithaca, New York, which residents have described as a “ghost town” when the staff clears out on weekends, Mitzi Jones said she fed her husband and changed his diaper almost every time she visited. “He broke his hip last September, and I’m trying to keep some weight on him so he has a fighting chance.”

Like the others, she faced the prospect of her loved one dying alone, without the care or comfort she could provide.

For now, she arranged for someone from the family to stand outside his window and wave to him every day. For all her concerns, she said, “at this point he is alive and in reasonably good spirits when see him.”

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Most days she cannot reach the facility by telephone, she said, taking care not to blame the staff.

“These people don’t get paid a lot of money,” she said. “It’s like child care. We entrust our elders to people on the lowest end of the pay scale. And they do a big job.”

This article originally appeared in The New York Times .