A COVID-19 outbreak at a skilled nursing facility in Nuuanu that has infected 54 patients and more than two dozen employees is straining the nursing staff and creating unsafe conditions for both nurses and patients, according to the Hawai‘i Nurses’ Association.

The union says that last week the Care Center of Honolulu, which has 182 licensed beds, began mandating that its nurses work four 12-hour shifts a week and has been requiring nurses to also work extended shifts that can last as long as 20 hours.

“Excessive hours and short staff are a recipe for disaster,” Daniel Ross, president of the Hawai‘i Nurses’ Association, said in a news release. “This is clearly not sustainable and does not do justice to the nurses or residents. It should also alarm family members who have entrusted CCOH to care for their loved ones.”

Ross said that nurses at the facility are exhausted and one was suspended when she told management that she was too tired to work extended hours.

The Honolulu Star-Advertiser was told that leadership at the Care Center of Honolulu was focused on delivering care and so could not be available for an interview. But in written comments the company said that patient care has not been affected due to the outbreak. The company also said that nurses weren’t working 20-hour shifts, but that in a few cases, have worked as long as 16 hours.

“Every member of the Care Center of Honolulu’s staff has been making an extraordinary effort to provide the highest levels of care for our patients,” according to the Care Center of Honolulu. “We have nothing but praise for our nurses, who like their counterparts everywhere, are meeting the challenges imposed by the pandemic in a heroic fashion.”

The company also said that no nurses have been suspended.

But Ross told the Star-Advertiser that the nursing facility is playing semantics when it says no nurses were suspended. He said the nurse in question, who was not identified, was taken off the work schedule after she protested her work hours and told that she was being investigated for “patient abandonment.”

“It’s not all hunky-dory” at the nursing facility, said Ross. He said that the nurses had reached out to the union for help.

The Care Center of Honolulu says that 91% of its staff and, on average, more than 80% of its patients are vaccinated against COVID-19, but that the highly-contagious delta variant made it hard to stop this month’s outbreak. The company says that six people were hospitalized, two of whom have been released from isolation.

The company says that the majority of patients infected during the outbreak were vaccinated, but didn’t provide a specific breakdown. The company did not respond to a request for specifics about infected staff members.

“Upon learning of our first infected resident, we immediately tested residents and staff in the facility and took steps to isolate infected residents and institute protocols to protect staff and residents,” according to the Care Center of Honolulu. The company says it has been testing staff and residents every two to three days.

One area of agreement between the nurses union and management is that there is an overall shortage of nurses in long-term care facilities statewide that has grown even worse during the pandemic.

“They really need the state to step in and help,” said Ross. “The nurses cannot go on this way. It is not safe for them, it’s not safe for the residents. And I think even the management would be happy if the state came and helped. The acute care hospitals have FEMA nurses helping out. These guys have nothing.”

The state has brought in 650 nurses and other medical staff from the mainland to assist hospitals during this latest surge.

The Care Center of Honolulu is hoping that a bill introduced this week by U.S. Sens. Brian Schatz and Mazie Hirono of Hawaii will eventually help. The bill would allow for cost-of-living adjustments when determining Medicare payments at skilled nursing facilities.

“Nursing homes are on the front lines of this pandemic and need all the support they can get to care for our most vulnerable residents,” said Schatz in news release this week announcing the introduction of the measure.“Our bill fixes the Medicare reimbursement rates so that Hawaii nursing homes get their fair share of federal dollars and have the resources to continue to provide high quality care.”

A companion bill was also introduced in the U.S. House of Representatives.

That measure won’t address the current situation, however. On Wednesday, the state Department of Health reported 12 new coronavirus-related deaths and 330 new infections.

Hawaii Department of Health Director Libby Char warned that while Hawaii’s case numbers and hospitalizations have been declining, the state is “by no means out of the woods.”

Char told the Star-Advertiser’s Spotlight Hawaii on Wednesday that she was particularly concerned about the number of patients in the state’s intensive care units, which have averaged about 75 to 80 people. “We are still very, very concerned and watching that,” she said.

Char said that if the state can maintain its restrictions and safety precautions, Hawaii could begin to emerge from the health care crisis.

“If we can be patient and sit tight for about four weeks, we are going to be in a really good place,” she said.