More than a month after nursing homes emerged as deadly hotspots in the nation’s battle against COVID-19, Wisconsin citizens remain in the dark about which long-term care facilities are the most dangerous.

Unlike some other states, Wisconsin has not disclosed the number of cases and deaths that have occurred in long-term care facilities, the names of those homes or how the virus made its way into the facilities in the first place.

When the Milwaukee Journal Sentinel asked for the information, state health department spokesperson Jennifer Miller said the agency would not name specific facilities “due to privacy concerns.”

“I can tell you, public health follows up with everyone who tests positive, working with each patient to determine who they may have been in contact with to isolate, quarantine, or test when appropriate,” Miller wrote in an email.

The lack of transparency could have far-reaching ramifications: Nursing home residents are a particularly high-risk population, with many medically fragile patients living in close quarters and interacting with staff who help them dress, bathe, eat and brush their teeth.

Some county health officials also would not release key information.

In Dane County last week, health department spokesperson Sarah Mattes said the agency would not disclose how many long-term care facilities had confirmed coronavirus cases.

But on Monday, after the Milwaukee Journal Sentinel repeatedly requested the data, the county reversed course and said 14 long-term care facilities had at least one confirmed case. Mattes said officials would not release the facilities’ names, nor would she say whether any deaths occurred as a result.

The facilities “have been responsive and fast-acting in order to ensure the safety of staff and residents,” she wrote in an email.

Sixteen people in Dane County have died due to coronavirus, according to health officials.

In Waukesha County, where 11 people have died from coronavirus, health officials confirmed “more than one outbreak in long-term care” but would not specify the number of cases or whether the positive individuals are staff or residents.

“You are asked to not contact me, or any other Waukesha County Public Information Officer, or our Health Officer, with additional questions,” county health department spokesperson Linda Wickstrom wrote in an email last week.

Nationwide, at least 2,300 long-term care facilities in 37 states have reported positive cases of coronavirus, according to USA TODAY. More than 3,000 residents have died.

Wisconsin has 373 nursing homes with more than 29,000 beds, according to the state health department. It has about 4,000 assisted living facilities, which include adult family homes, adult day cares, community-based residential facilities and residential care apartment complexes.

In Milwaukee, Mark Weber said he was shocked to learn that BRIA of Trinity Village took his mother’s feverish roommate to the hospital for a coronavirus test on April 5, then put her back in the same room as his mother to await the results for two days.

By then, the nursing home had already confirmed at least one case of COVID-19, according to voicemails from the facility to residents and family members, a copy of which was supplied to the Journal Sentinel.

With the two women separated only by a thin curtain, Weber said he called the facility demanding they be given separate rooms but could not reach anybody for two days.

Iris Brooks, the daughter of the roommate, said she called the nursing home for three days without answer before she went to the facility in person last Thursday and “banged on the door.” That was when administrators confirmed her mother had tested positive, she said.

According to Brooks, administrators told her they meant to call her but had been short-staffed.

Administrators at BRIA of Trinity Village did not respond to two calls and an email from the Journal Sentinel asking for comment. The facility scores one out of five stars, or “much below average,” in the federal Centers for Medicare & Medicaid Services nursing home ratings.

By the time family members found out about the positive results, Weber said, his mother was feeling feverish, and her oxygen levels had dropped. On Saturday, she too tested positive for COVID-19, he said.

“At what point during a pandemic are you going to take action?” Weber asked.

Long-term care advocates say the COVID-19 pandemic is shining a spotlight on an industry already precariously understaffed and underfunded, with longstanding struggles with infection control.

“We absolutely need transparency about what facilities have positive cases with staff and with residents,” said Robyn Grant, director of public policy and advocacy at Consumer Voice, a nonprofit that advocates for people with long-term care needs.

Grant pointed out that family members, hospital discharge planners and even EMS staff need to know which facilities have cases so they can make safe choices.

“There’s huge anxiety on the part of family members about whether their loved one is in a facility that has the virus, because if it is, they want to know, what are you doing to keep my loved ones safe and protected, and what are you doing to contain it?” Grant said. “The anxiety is enormous.”

But John Sauer of LeadingAge Wisconsin, a trade association representing nonprofit long-term care facilities, said nursing homes are already doing a good job of reporting cases to health officials, residents and staff.

“I’m not sure of the greater public interest in needing to know every facility that has COVID-19,” Sauer said. “There will be facilities that don’t want to be painted as doing something wrong because COVID-19 is in the building.

“What’s most important is what the facility does in terms of notifying residents and families and staff,” he said.

Democratic U.S. senators are pressing the Centers for Disease Control and Prevention to release a national list of nursing homes with coronavirus outbreaks. Some states like Colorado, Louisiana and Minnesota have previously released the names of infected nursing homes statewide.

Kirsten Johnson, director of the health department of Washington and Ozaukee counties, said she chose to publish the names of infected facilities after much discussion.

Health officials in those two counties identified at least seven outbreaks at senior communities and long-term care facilities, including Village Pointe Commons, a retirement community and assisted living facility in Grafton. The facility has at least 22 confirmed cases and three deaths.

Johnson said early investigations suggest the virus may have been spread by nursing home staff who worked in multiple facilities.

“If families are thinking about moving from one to another, they should be aware if it’s safe,” she said. “Managers who manage staff should be aware if they have staff who work in multiple facilities. It’s a matter of being transparent so people can make good decisions for their loved ones and themselves.”

Not all counties have been forthcoming.

In Eau Claire, Manitowoc and Walworth counties, officials would not say whether any long-term care facilities had COVID-19 cases.

“This is done to protect privacy,” Mike Rindo, spokesperson for Eau Claire county health department, wrote in an email.

Some people, like Shirley Reinhard, said they are so anxious about the spread of COVID-19 in nursing facilities that they are considering bringing their loved ones back home. Her 93-year-old mother is confined to her room, dependent on staff to bring her food, count her pills, change her sheets, give her baths and deliver the clean clothes that Reinhard drops off in the lobby.

Increasingly, she said, there are workers that her mother has never seen before — temporary employees who just started wearing facemasks recently. After more than five weeks in assisted living at LindenGrove Waukesha, Reinhard said, her mother has yet to have her sheets changed.

“I’m ready to pull my hair out,” Reinhard said. “All they keep telling my mother is that we’re all so short on staff.”

In a statement, LindenGrove Communities CEO Linda Joel said the company has a strict policy on bringing in outside staff and revised its staffing plan “to provide consistency and reduce staff assigned to different units or buildings.”

Joel added that management has “quickly and consistently responded to the evolving directives” from federal and state agencies. Regarding Reinhard’s complaints, she said housekeepers “clean resident rooms daily including bed linen changes.”

LindenGrove Waukesha has no positive COVID-19 cases, she said.

According to federal Medicare ratings, the facility gets a below-average overall rating of two out of five stars. For health inspections, the facility rates one out of five stars, or "much below average.”

In mid-March, the Centers for Medicare & Medicaid Services first called on nursing homes to ban visitors, cancel communal activities and screen residents and staff for fever. The agency updated its guidelines April 2, directing all long-term care personnel to wear facemasks.

But compliance has been spotty, according to nursing home employees across the country.

In Detroit, Trece Andrews, a laundry worker and union representative at nursing home Regency at St. Clair Shores, said staff who asked for masks and hand sanitizer were turned down. At one point, administrators gave three facemasks to a dozen food service workers and told them to share, Andrews said.

She said she filed a complaint three weeks ago. The facility, which was previously allowing visitors, is now locked down, and employees are receiving hand sanitizer and facemasks, she said.

Still, “they’re the throwaway kind,” she said. “They’re not the N95. They’re like paper.”

Administrators at Regency at St. Clair Shores did not return a call for comment. Neither did Ciena Healthcare, which owns the facility.

In Chicago, certified nursing assistant Tainika Somerville said she was fired from a nursing home April 2, two days after she petitioned administrators to provide more protective gear, offer hazard pay and do a better job notifying employees about confirmed cases.

She said staff at Bridgeview Health Care Center found out only through news reports that a resident died from COVID-19 complications.

Somerville, who earned $13.70 an hour, said upper-management put “profit over lives.”

“It’s totally unfair,” she said. “Who gives you the right to play God?”

Bridgeview Health Care Center did not return a call for comment, but a copy of Somerville’s termination letter shows she was fired for “violating the collective bargaining agreement,” “failure to follow reasonable instructions” and “verbal abuse of supervisors,” among other things.

The facility scores 1 out of 5, or “much below average,” on both its overall rating and health inspections rating from the Centers for Medicare & Medicaid Services.

In March, the agency suspended its routine nursing home inspections to focus only on those with coronavirus outbreaks.

Last week, the agency revealed that out of its first wave of surveys, a quarter of infected facilities were not properly using personal protective equipment, and another third were not washing hands properly.

On Wednesday, a CMS spokesperson said the agency finished one such survey at Oak Park Place nursing facility in Janesville, where 12 people have tested positive and two residents have died. Another 13 nursing homes in Wisconsin are currently undergoing inspection, the spokesperson said

Grant, with Consumer Voice, said the pandemic highlighted the need for stronger enforcement of infection control violations at nursing homes.

“It is our fervent hope that when we all get through this, that we take the opportunity to fix these problems,” Grant said. “Otherwise, we’re going to be right back here again — and more residents will die and more staff will die.”