The work of a nursing assistant in a nursing home — backbreaking, intimate, and relentless at all hours of the day and night — has never been easy.

But now, with the COVID-19 pandemic sweeping through nursing homes, the challenges and scariness of the job are on a new scale, just as they are for other health-care workers who’ve gotten much more time in the limelight than nursing assistants such as Tisheia Frazier.

“You are in physical contact with the residents; they’re coughing and they’re sneezing. A lot of them are in pain because they’re so weak, they haven’t been eating. They haven’t been drinking,” said Frazier, who works on an Alzheimer’s and dementia floor where all of the remaining residents have COVID-19.

Until recently, before her Philadelphia-area employer was able to obtain adequate protective gear for staff, all Frazier, 40, had to protect herself and her patients was what she described as a “little flimsy mask” that she was supposed to keep for five days, preserving it in a brown paper bag.

Now, Frazier, who spoke candidly about her experiences on condition of not identifying the facility where she works, has reusable gowns and face shields that are kept in little dressers outside the rooms. She also goes through an exhausting process of changing all her protective equipment before going into each room.

Nursing assistants provide most of the direct care in a nursing home, bathing residents, feeding them if necessary, and taking their temperatures, and other vital signs. Registered nurses are typically in supervisory positions.

“It’s extremely hot. Just imagine having a gown over top of your clothes and then a mask and a face shield, or sometimes you might have goggles and sometimes your goggles fog up, because it’s so hot,” said Frazier, who has worked for 13 years off and on in the industry.

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After eight years with her current employer, she earns $15.35 an hour, including the $1 an hour she gets for working from 11 p.m. to 7 a.m. That’s about average for the 39,970 nursing assistants in the Philadelphia region, according to the Bureau of Labor Statistics. About half of them likely work in nursing homes or other facilities for the elderly, if national averages hold.

Frazier said she never knows what to expect when she reports on a shift.

Is it the night she’ll have to do her best to take care of a floor of patients by herself because others called out sick? Will more of the patients she has taken care of for years have died since her last shift? Are more infected?

Is this the day she’ll become infected?

Her floor used to have 45 residents, but that’s now down to 25 because so many have died or had to go to the hospital. When the floor was full, standard staffing called for three nursing assistants, so each was responsible for 15 residents. Because all of the remaining residents on the floor are COVID-positive, they still try to keep three nursing assistants per shift, Frazier said. “It’s like an ICU.

“The days are very uncertain. You know when you walk through the doors that you are putting yourself at risk,” said Frazier, who lives in the Overbrook section of Philadelphia and has two teenagers and a 7-month-old baby whom she fears infecting.

Frazier said she’s seen so many residents on her unit die, five on one day recently, that “we almost don’t have a unit anymore.” She worries that nursing homes such as hers might not survive the pandemic.

The personal side of the work is devastating, Frazier said.

“I cry. The residents we have on the floor, I’ve had them for years. We know the families and everything. They are our families. We spend a lot of time around them.”

It’s brutal “to see them wither away the way they have, to see them lose the weight, crying out for help, asking God to take them home.”