Retirement homes in the eye of the “perfect storm”


LACONIA – As fatigue among nurses has become more common due to anxiety, burnout and fears related to COVID, nursing homes are struggling to retain staff at a time when the need to Quality elderly care has become particularly critical.

The chronic shortage of nurses nationwide, coupled with fears of catching the COVID virus, have turned what was a chronic problem into an acute crisis.

“It’s a perfect storm,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association, which represents most of the state’s private nursing homes and some assisted living facilities.

The situation is particularly alarming at the Belknap County Nursing Home, where the challenge of retaining staff is further compounded by its inability to offer wages comparable to other long-term care facilities in the area.

Currently, the nursing home has job postings for 12 full-time nurses posted on its website – eight licensed practical nurses, two licensed practical nurses and two registered nurses.

For LNAs – the category with the most openings – the advertised salary starts at $ 12.76 per hour. In comparison, the average salary for LNAs statewide is $ 19 an hour.

Nursing Home Director Shelley Richardson and County Administrator Debra Shackett both said they were unable to fill the vacancies despite all the publicity, including the newspaper ads.

“Nobody responds to our job postings,” Shackett said at a recent meeting of county commissioners.

The retirement home has been operating at two-thirds of its capacity of 94 residents for months due to understaffing.

Things can get worse, and soon.

Richardson is worried about the impact the federal COVID vaccine mandate will have on already exhausted staff at the home. As of Thursday, 27 unvaccinated people were working at home, including 14 nurses. If those workers all refuse to be vaccinated by the Dec. 5 deadline, they will be fired unless they qualify for a warrant exemption for medical or religious reasons.

Shackett told commissioners last Thursday that she believed peer pressure was a big reason for the number of staff who have so far refused to be vaccinated against COVID.

St. Francis Nursing and Rehabilitation Center in Laconia put in place a mandate that its staff be vaccinated against COVID in September and seven “very good staff” have resigned as a result, according to Brenda Buttrick, the administrator. fireplace.

“I feel very good that we have taken this step,” said Buttrick of the mandate, which applies to all nursing facilities operated by Catholic Charities New Hampshire.

Richardson is concerned that if staff numbers take another blow, she will be forced to take steps to close another wing of the nursing home, which means the home will have to find new places for 19 residents.

Sadly, the predicament Belknap County Home finds itself in is not unique, which begs the question of where these 19 residents might go.

St. Francis, which has a capacity of 51 residents, currently has 39, said Buttrick.

Merrimack County Nursing Home has closed a wing. Meanwhile, the Hillsborough County nursing home has 68 empty beds due to understaffing. He is currently looking to hire people to fill the equivalent of 89 full-time positions, Williams said.

In 2019, the state’s nursing homes were operating at 86 percent of capacity, Williams noted. Today it is 76%.

The nursing shortage began in 2012 and is expected to continue until 2030, according to the Federal Bureau of Labor Statistics.

The reasons for the decline in numbers are that nurses are retiring or choosing to leave the profession due to mental and physical demands, that the aging of the population means that patients need an increased level of care, that “There is a shortage of nursing teachers and because of burnout,” said Pamela DiNapoli, executive director of the New Hampshire Nurses Association.

But long-term care facilities face an even greater challenge in recruiting nurses, compared to hospitals, she said.

“It’s especially tough working in long-term care,” DiNapoli said, “but it doesn’t have the adrenaline rush you get in other areas of nursing.”

She said that many nursing school graduates are more likely to be attracted to work in emergency rooms or intensive care units because they feel these settings will give them the best opportunity to ” use and improve their nursing skills.

“There’s this idea that to work in nursing homes you just need to have foundational skills,” she said.

DiNapoli said nursing schools need to do more to encourage students to enter the field of geriatric nursing.

“Retirement homes have always been difficult to staff. We have to change our perspective. “

In order to maintain the necessary staff-to-patient ratios, healthcare facilities are increasingly turning to staffing agencies that place traveling nurses to fill the void.

DiNapoli said 21% of all health care assignments in New Hampshire were for itinerant workers. The rate in Belknap County was the lowest at 12%, she said.

Some agencies charge rates as high as $ 70, $ 80, or $ 90 an hour, a situation Williams has called “price prediction.”

Beyond the high cost, the presence of mobile nurses has the potential to undermine the team spirit so essential in healthcare settings.

Acknowledging that agencies are paid part of the contract rate (20% to 25%, according to the website), Williams said: “It’s demoralizing for the permanent staff to know that mobile nurses are getting so much more.

Belknap County Nursing Home currently has two traveling nurses. They work alongside permanent nurses who pay close to $ 30 an hour.

Recently, one of the permanent nurses at the home resigned to work in an agency and now works as a traveling nurse.

With the demand for nurses outweighing the supply and the health care ramifications of COVID, pay is an important factor in retaining staff.

At Taylor Community, staff turnover was in the order of 50% five to six years ago, according to Michael Flaherty, president and CEO of the retiree community, which has 35 skilled nursing residents among its members. more than 400 residents of its three campuses in Laconia and Wolfeboro. This turnover has now fallen to 15%.

Flaherty did not give details of what Taylor pays, but said, “We are towards the higher end of the salary scale, but not the highest.” Taylor recently increased his minimum wage to $ 15 an hour.

But like other facilities, it has openings for nurses – orderlies, licensed practical nurses, and registered nurses. He did not choose to employ itinerant nurses, Flaherty said.

Belknap County Home has struggled to overcome the shortage by having staff work consecutive shifts. In recent months, they have further turned to offering wage incentives to get employees to work long hours or take shifts at night, on weekends or on holidays.

Williams said Belknap County Home is in its current position due to a failure to keep up with what similar facilities offer in terms of compensation.

“It suffered from years of neglect in funding,” he said, stressing that he was not criticizing the facility itself. “It was already a drawback before this pandemic. “

Richardson said nurses often work 60 to 70 hours a week and go to extraordinary lengths to maintain the quality of care for residents.

“I knew it was dark,” Richardson recently told county commissioners. “But I didn’t know it was that dark.”

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