TABLE 1.

Administrators described several stages of the COVID‐19 pandemic.

Concept	Representative quote, nursing home characteristics
Initial Stage: Fear & confusion	“I think in the very beginning everybody was afraid. I think we just did not know what this COVID‐19 virus was like. We just did not know because the only thing we would hear from is from the news, and, ‘This is the scariest pandemic we have ever faced and if you get it and you could be young and healthy, you could die,’ and what have you.” S8N3.1, October 2020, West, 151+ beds, Star rating 5, For profit
Initial Stage: Frequent changes	“People need to understand that in the beginning, nursing homes…were being told to do different things every other week.” S2N3.3, April 2021, Northeast, 151+ beds, Star rating 1, For profit
Second stage: “The new normal”	“Of course, we have to wear PPE that we were not regularly wearing before, so masks at all times…Overall, though, I feel like, as this has gone on over the months, we have hit a bit of an adjustment phase to it where this is kind of our new normal, but certainly at the beginning, there was a heightened sense of anxiety and fear.” S7N1.1, September 2020, South, <100 beds, Star rating 4, Not for profit
Second stage: Second outbreak	“I think having stockpiles of really anything has become our new norm. I hate that word, new norm. But, it's just weird. It's like, ‘Okay, it's new, it's not the norm.’ [laughs] But, I think I feel well prepared. As I said before, I felt well supported by the company, because they worked hard to procure a stockpile of PPE for us, hand hygiene, sanitizers, you know, whatever we needed to get, they got. And, we have a whole dedicated room, like a room out of service, that is nothing but precautions, PPE, sanitizer, face shields, everything that we would need like you know for an outbreak. So, I feel like we are well prepared, and I feel like we have a good system.” S2N4.4, August 2021, Northeast, 151+ beds, Star rating 3, Not for profit
Third stage: Availability of vaccinations	“We just got our second dose of the vaccine, Monday. So I think overall you are starting to see a turn for the better among the attitude of the staff.” S3N2.2, January 2021, South, 100–125 beds, Star rating 5, Not for profit
Third stage: “A light at the end of the tunnel”	“It seems since the vaccine, since the clinic, it seems that we have been allowed to kind of take a breath. Things are more encouraging than they were at this time last year, of course, like a light at the end of the tunnel.” S3N3.2, April 2021, South, 126–150 beds, Star rating 2, For profit.
Fourth stage: COVID variants dim hope	“We had gone a year with no COVID‐positive patients so we had a good experience, but then the Delta variant really hit us hard and we had 80 residents who tested positive….roughly, 97% were vaccinated.” S6N2rep.3, September 2021, South, 100–125 beds, Star rating 5, For profit
Fourth stage: Caregiver fatigue	“When you are in it and working through it, sometimes you do not even have time to stop and think or reflect, and that's what's happening to a lot of us is that we are just doing it…When I had time to reflect on it, I came back and realized how much it had affected morale. People are just tired of caring and tired of doing and tired of just being in health care nowadays because everything is just so consuming.” S4N2.4, September 2021, Midwest, <100 beds, Star rating 5, Not for profit
All stages: Perseverance	“You've got corporate demanding things and expectations from, you have got the state and federal government demanding expectations and stuff, you have got family members…You've got residents who are just, ‘I do not want to be here’… And then you got staff who are: ‘I cannot take more, this work is too hard.’ If you cannot take all that, because it's very negative sometimes, and if you cannot try to turn that into a positive, you have got to be, ‘I see the glass half full, not half empty,’ because if you see it half empty, you are going to empty your whole pitcher. And you know as well as I do this, that you got to keep your pitcher full so that you can take care of others, and it really is. You got to be able to have that temperament to where that they are not going to get to you.” S7N4.4, September 2021, South, 151+ beds, Star rating 3, For profit)