Miriam Bago uses a hand sanitiser before eating lunch. AP

From Miami to Seattle, nursing homes and other facilities for the elderly are stockpiling masks and thermometers, preparing for staff shortages and screening visitors to protect a particularly vulnerable population from the coronavirus.

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In China, where the outbreak began, the disease has been substantially deadlier for the elderly. In Italy, the epicenter of the virus outbreak in Europe, the more than 100 people who died were either elderly, sick with other complications, or both.

Of the 21 deaths across the U.S. as of Saturday, at least 14 had been linked to a Seattle-area nursing home, along with many other infections among residents, staff and family members. The Seattle Times reported that a second nursing home and a retirement community in the area had each reported one case of the virus.

"For people over the age of 80 ... the mortality rate could be as high as 15 percent," said Mark Parkinson, president of the nursing home trade group American Health Care Association.

  The staff at Little Havana Activities and Nutrition Centers prepares lunch for seniors in Miami.

The federal government is now focusing all nursing home inspections on infection control, singling out facilities in cities with confirmed cases and those previously cited for not following protocol.

In Florida, where about 160,000 seniors live in nursing homes and assisted-living facilities, mandatory visitor screening is not in place "because we're not at that stage,” said Kristen Knapp, a spokeswoman for the Florida Health Care Association.

But elder care centers are posting signs urging visitors to stay away if they have symptoms, and are looking into alternate ways for families to connect, such as through video chats, Knapp said.

Concierges in the 14 Florida nursing homes run by the Palm Gardens corporation are now giving all visitors a short questionnaire asking about symptoms, recent travel and contact with others, said company Vice President Luke Neumann.

Nursing assistant Natasha Borges, right, helps Rene Gonzalez, left, dry his hands after washing them. AP

Juana Romero, left, talks with nursing assistant Dulce Torres, right, at Little Havana Activities and Nutrition Centers. AP

Seniors gather in an auditorium for morning announcements at Little Havana Activities and Nutrition Centers. AP

Vietnam War veteran Leo Marchand, 71, sits in his room at the South Shore Rehabilitation and Skilled Care Center, in Rockland, Mass. AP

Nursing assistant Dulce Torres leads seniors during an exercise. AP

Alina Canel, nursing assistant, talks about the COVID-19 virus at Little Havana Activities and Nutrition Centers. AP

Guilherme Gomes sanitizes a hand rail at the South Shore Rehabilitation and Skilled Care Center, in Rockland. AP

Many facilities across the country have said they were having trouble getting medical masks and gowns because of shortages.

"Some of the visitors have been quite reluctant to comply, and that has been stressful," said Janet Snipes, executive director of Holly Heights Nursing Center in Denver.

Under federal regulations, nursing homes are considered a patient’s residence, and the facilities want to keep them connected with family, especially when they are near death.

An adult day care center in Miami's Little Havana neighborhood bought long-lasting prepared meals in preparation for possible shortages. The Hebrew Home in Riverdale, New York, is running nursing staff through drills to see how they will handle situations at the 750-bed facility if the virus progresses. Their IT department is setting up infrastructure for staff to work remotely if they become sick.

"If one of our sites has an outbreak, we quickly will deplete the staff in that location," said Randy Bury, CEO of The Good Samaritan Society, one of the largest not-for-profit providers of senior care services in the country, with 19,000 employees in 24 states.

Associated Press