Virginia day closed its schools in March 2020, Tom Orsini knew he would have a problem.
âIt was devastating,â said Orsini, president and CEO of Lake Taylor Transitional Care Hospital in Norfolk. âBecause our staff are home caregivers. Over the next few months, more and more employees struggled to work shifts at the nursing home as classes remained virtual amid the COVID-19 pandemic.
Industry wide, thousands of other workers fell ill and thousands of people have quit, citing burnout and work stress, according to a survey by the Virginia Health Care Association-Virginia Association of Assisted Living. Since February 2020, the state’s long-term care industry has lost more than 9,500 workers, raising concerns about its recovery and the quality of care residents are receiving.
âI think the concern is also access for people who need nursing level care,â said Amy Hewett, vice president of strategy and communications for the association. âIf there are no direct caregivers there, then facilities have to make these tough choices to reduce admissions. And then we end up in a situation where someone might not be able to find a place to go. “
The problem has not been confined to one region of the state. To get a feel for the effect of the pandemic on the overall workforce, VHCA pulled the most recent data from the Bureau of Labor Statistics, which showed that the industry’s staffing had reached its lowest level since 2012. The losses “erase more than a decade of job growth by these suppliers,” said the association in a press release, going from nearly 79,000 in February 2020 to around 69,300 in September.
They are also creating new stressors for an industry that has suffered some of the worst impacts of COVID-19. According to a survey, the association released last month81% of long-term care facilities said their workforce situation was worse this year than in 2020, when deaths and hospitalizations among residents and employees peaked. Almost 30 percent described their current staffing as a “crisis” and 37 percent said they limited their census because they did not have enough workers.
Joani Latimer, who advocates for residents as Virginia’s long-term care ombudsman, said there is a broad consensus that nursing home staffing is worse than it is has never been. The losses create serious safety concerns for residents, even as new coronavirus infections keep falling.
âRight now we are certainly seeing that there are frightening levels of staffing in some establishments,â she said. For the vast majority of them, certified nursing assistants and other direct care workers are the rarest. Since these workers spend the most time with residents, the losses have a substantial impact on care.
During the pandemic, Latimer said his office had received a growing number of complaints about weight loss from residents in facilities. Another major concern was an apparent lack of basic hygiene.
âIt can be so related to the fact that the staff just don’t have enough time to help someone eat and observe whether they are eating or not,â she said. “Or not being able to help someone right away when they need to go to the bathroom.”
Even in well-resourced facilities, vacancies can have an immediate effect on patients. Dr Jim Wright, medical director of Our Lady of Hope and Westminster Canterbury in Richmond, said the two nonprofit nursing homes had not faced the same challenges as many others across the state. But even with relatively minor staff shortages, the number of patient falls increased almost immediately.
âObviously you can trace this back to less helpers and nurses available to monitor patients,â he said. He and Orsini also pointed out that more administrative staff need to take on direct care roles, which limits their ability to focus on facility-wide improvement projects, such as reducing utilization. antibiotics and other medications.
The continued impact of the pandemic on nursing homes has made staffing a particular policy focus for lawmakers in Virginia. For years, the General Assembly has rejected legislation that minimum personnel requirements for long-term care facilities. The policy is fiercely opposed by industry groups like VHCA, but costs have been another big hurdle, with lawmakers arguing that it would force the state to spend more to increase Medicaid reimbursements.
Many, however, say the pandemic has heightened their sense of urgency. More than a quarter of Virginia nursing home residents died from COVID-19, and facilities with lower staffing levels had a higher incidence of infections. Wright said understaffed facilities are also more likely to be for-profit nursing homes that rely on Medicaid to reimburse the majority of patients. And in Virginia, there is a broad consensus that Medicaid reimbursement rates do not cover the true cost of care.
âYou have to live within your budget, so a low reimbursement on the Medicaid side dictates how much flexibility you actually have for things like salary increases and bonuses,â said Steve Ford, senior vice president of VHCA’s policy and reimbursement. According to Latimer, the majority of direct care workers do not receive health care or other benefits, and Wright said many facilities – especially for-profit establishments that are expected to redirect revenue to shareholders – cannot just not compete with the pay increases. offered in other sectors.
âA lot of employees choose to work at a nursing facility that may have a COVID outbreak or at a Walmart where they answer questions about the location of televisions,â he said. âIt is therefore obvious why we have difficulty attracting staff. ”
Lawmakers at the Joint State Commission on Health Care are currently considering major policy reforms, including increased payments and a value-based purchasing program that would offer higher reimbursements to facilities with better measures. quality – potentially including staff. And there’s a growing bipartisan agreement that increased funding should be tied to minimum staffing standards.
How to structure these standards, however, is a debate that is unlikely to be fully resolved until the next General Assembly session this winter. A commission staff report suggested either a basic requirement in all facilities or a more complicated acuity-based standard that would base minimum staffing expectations on the needs of patients living in a facility.
A baseline could mean that some patients with more serious illnesses still don’t get the level of intensive care they really need. But a standard based on acuity would be much heavier, commission staff said, and would require facilities to frequently recalculate staffing needs based on a fluctuating population. Some vendors and advocates fear that a more complicated standard may prevent the execution of warrants.
âI’m a little worried that this could be a stall tactic,â Wright said. âAnd due to the complexity, there might be a demand to delay implementation. But I don’t think we have time to wait. If we don’t get minimum staffing levels implemented now – shame on us really. We have no excuse.