Nursing home staff shortages and other problems still persist

Many Americans prefer to believe that the Covid pandemic is a thing of the past. But for the nation’s nursing homes, the effects have yet to fully fade, as staffing shortages and employee burnout are still at critical levels and many facilities are struggling to stay afloat, according to a report. new report released Thursday by federal investigators.

The report, by the U.S. Department of Health and Human Services inspector general’s office, found that flawed infection control procedures that contributed to 170,000 nursing home deaths during the pandemic were still inadequate in many facilities. And while acceptance of Covid vaccines was initially strong when they first became available, researchers found that vaccination booster rates among workers and residents have fallen far behind.

The findings were aimed at the Centers for Medicare and Medicaid Services, the agency under the department’s jurisdiction that oversees 1.2 million nursing home residents whose care is primarily provided by the federal government. The inspector general’s report described personnel problems as “monumental,” noting high levels of burnout, frequent employee turnover and the burden of constantly training new employees, some of whom fail to show up for their first day on the job. For nursing homes, the inability to attract and retain certified nursing assistants, dietary services staff, and custodial workers is tied to federal and state reimbursements that do not cover the full cost of care.

Rachel Bryan, a social science analyst at the inspector general’s office, said the report sought to ensure that key lessons from the pandemic were not lost, especially now that the acute sense of urgency has faded.

“Just as airplanes cannot be repaired while in flight, nursing home problems could not be fully repaired during the pandemic,” he said. “We firmly believe that when we emerge from emergency mode, we will take the time to reflect, learn, and take real steps toward meaningful change.”

The Centers for Medicare and Medicaid Services declined to discuss the recommendations and instead directed comments the agency provided for the report to a reporter. Those comments were largely evasive, neither agreeing nor disagreeing with the recommendations, but agency officials asked that some of the proposed recommendations be removed from the report, saying improvements were already in the works.

The agency, for example, cited a new federal program that will provide $75 million in scholarships and tuition reimbursement for those pursuing nursing careers.

The report, based on interviews with two dozen nursing home administrators across the country, paints a picture of an industry in deep turmoil. Many nursing homes are still recovering from the traumas caused by the pandemic, when shortages of personal protective equipment and widespread fear of infection scared away experienced employees and forced nursing home operators to ban workers. outside visitors, aggravating the fear and isolation of its residents.

At the peak of the pandemic in 2020, two in five Medicare beneficiaries in nursing homes were infected with Covid and more than 1,300 nursing homes had infection rates of 75 percent or higher during surge periods, according to a previous report by the inspector general. In April 2020, for example, there were 1,000 additional deaths per day among Medicare nursing home beneficiaries than in April 2019. Death rates were higher in for-profit nursing homes, the researchers found.

In Bethany HouseAt a nonprofit nursing facility in Lindsborg, Kansas, a third of employees quit during the pandemic, many of them motivated by their opposition to vaccine mandates or a national shortage of PPE that forced caregivers to use bags. from trash like gowns and cotton underwear to masks, said Kris Erickson, Bethany’s executive director.

“There were days during the pandemic when I measured success by how long I had gone without crying in my office,” said Mr. Erickson, whose father is a Bethany resident. “It was that difficult.”

Bethany has not yet recovered. Erickson said the facility had to eliminate about 20 of its 85 beds because it couldn’t hire new staff. For the first time in its 100-year history, Bethany has a waiting list, he said.

The biggest challenge in hiring workers is the $13.50 per hour pay Bethany offers entry-level nursing assistants, a rate dictated by reimbursements provided by the federal and state governments, she said. “We’re going to need a base rate in the $16 to $20 range if we want to compete against McDonald’s in the next town,” she said.

Hiring problems have been exacerbated by private employment agencies charging nursing homes up to 50 percent more for workers, some of whom were described by administrators as less trustworthy than their permanent employees. “The agency staff comes in and talks about how much money they’re making and our own staff gets upset because the agency staff isn’t working as hard,” said one trader quoted in the report.

Katie Smith Sloan, president of LeadingAge, a nonprofit nursing home association, said higher federal reimbursement rates would help, but the best way to address staffing challenges is to mobilize multiple government agencies. For example, he said, the Department of Homeland Security could include nursing assistants in temporary worker visa programs that bring in agricultural workers from abroad, and the Department of Education, with support from Congress, could make assistants available to student nursing and culinary worker apprentices.

Ms. Sloan and other nursing home advocates have criticized a Biden administration proposal that would require understaffed nursing homes to hire more workers or face fines. The proposal does not include increased funding that would help facilities meet the new mandates.

“This is bigger than CMS,” Ms. Sloan said, referring to the Centers for Medicare and Medicaid Services. “We have to figure out how to creatively apply the things that work to this difficult workforce problem.”

There were some positive points in the inspector general’s findings. Many nursing home administrators said severe PPE shortages had eased since 2021. And the report highlighted creative solutions that some nursing homes successfully used to retain staff, including hiring bonuses, free staff meals and decision of many institutions to take advantage of the licenses. waivers that allowed them to provide on-the-job training to nursing assistant students.

And despite early stumbles, many experts say the initial vaccine rollout was a success, although the spread of misinformation about the vaccines has significantly reduced the use of Covid boosters among nursing home workers and residents. . Only 41 percent of residents and 7 percent of employees are up to date on vaccinations, according to the Centers for Disease Control and Prevention.

But many experts say the nation’s system of caring for its aging population is fundamentally broken. It’s a problem that’s becoming more urgent as the boomer demographic ages.

Elizabeth White, a professor at Brown University School of Public Health and an expert on long-term care, said the problem reflected a lack of political will to spend what is necessary to support Americans in their golden years.

“The pandemic helped highlight the challenges nursing homes face, but it remains the elephant in the room,” he said. “The funding system is broken and the problem is so huge that it is very difficult to get the political motivation to do anything about it.”