With omicron, staffing crisis in nursing homes worsens
Of more than 200 nursing homes in Connecticut, there were fewer than 10 that didn't report any COVID-19 cases among residents or staff for the two-week period ending Tuesday, the state Department of Public Health reported.
These two weeks saw 1,616 COVID-19 cases among residents and 58 coronavirus-related deaths, compared to 550 cases and 177 deaths during this period last year, when residents and staff were just getting their first vaccine dose. Booster shots have lowered the risk of hospitalization and death for residents, and some also may have natural immunity from a prior infection with the virus.
More than 80% of nursing home residents have gotten a booster but that figure is only in the 30s for staff. Gov. Ned Lamont on Jan. 6 signed an executive order requiring all employees of long-term care facilities to get a booster by Feb. 11.
But behind these numbers are burnt-out workers and tired residents, who are feeling the impacts of severe staffing shortages and have once again seen social activities curtailed.
"I feel bad for the people that are working now, because they are so stressed, and they're in burnout mode," said Jeanette Sullivan-Martinez, a resident of Pendleton Health and Rehabilitation Center in Mystic and president of the residents' council there. "They're doing the best they can, and when you have part of your staff out sick because of COVID, it just puts more on those staff that have been faithfully working."
The surge in infections caused by the omicron variant of the virus had hit Pendleton earlier: There were zero cases reported among residents for the last two-week reporting period, but 15 cases from Dec. 22 to Jan. 4. No deaths were reported in either period.
Sullivan-Martinez said with staffing shortages, residents wait longer for care and "the workers are not able to have the amount of time they would like to give, so that each patient feels like they're special."
Like many other nursing homes, Pendleton has resorted to using workers from staffing agencies, called pool staff, to offset shortages. Sullivan-Martinez said the nursing home has brought in about four or five nurses and a few certified nursing assistants from such agencies.
"For the most part, I will say, they've all been wonderful," she said. But they don't know the residents unless they've been there a while, and the temporary help costs nursing home operators a lot of money.
Jesse Martin, vice president at SEIU District 1199 New England, said staffing agencies are recruiting from among full-time nursing home staff but offering them two or three times the hourly wage, and "when you're a single parent taking care of your kids and you're struggling today, that short-term money is very enticing." He said the industry needs to be better funded so workers have competitive wages and benefits, and a career path. The union represents employees in 65 nursing homes across the state.
The Connecticut Association of Health Care Facilities/Connecticut Center for Assisted Living and Leading Age Connecticut sent Attorney General William Tong a letter asking him to review "anti-competitive and ongoing price-gouging practices" among staffing agencies. The Associated Press reported that Tong said his office and other state agencies are reviewing the claims.
CAHCF/CCAL President and CEO Matthew Barrett would like to see fees for staffing agencies capped either by executive order or statute.
Bill White, president and administrator of Beechwood in New London, said he has used staffing agency workers for a little under a year, and they've been a great but "very, very expensive resource." He said with rare exception, he signs them to contracts for two or three months to provide some continuity.
Beechwood has been hit hard recently: After having about eight residents test positive for the coronavirus throughout the pandemic, the facility has had 20 residents and 25 staff test positive since Dec. 31, and a few residents have been hospitalized, White said. Beechwood still hasn't had a single COVID-related death.
"Omicron has been a depressing revelation. Very, very difficult," White said. He added, "We've learned a lot in the last two weeks, and I'm glad we've learned so much, because if we were expert at it, it would've meant we had a really hard time the whole time."
Industry responds to state actions and guidance
On Saturday, an executive order from Lamont took effect that requires visitors to all nursing homes in Connecticut to either show proof they have been fully vaccinated — and received a booster, if eligible — or proof of a negative COVID-19 test. However, a nursing home can't deny entrance to someone who is willing to take a rapid test but can't get one from the nursing home.
The Connecticut National Guard has supported DPH in distributing 50,000 rapid tests to nursing homes, for the purpose of visitation.
Barrett said his association sees this executive order as an important measure "that will further prevent the spread of the virus."
Mairead Painter, the state's long-term care ombudsman, said Wednesday in a Facebook Live update that she thinks this policy will help "ensure that the people who are visiting the nursing homes are COVID-negative, and continue to have those visits taking place, but to allow people to be safe."
White said Beechwood has been asking visitors about their vaccination status for months. It can't deny admission to visitors who are unvaccinated, though the vast majority are vaccinated, with most boosted.
Lamont has gotten pushback for asking nursing homes to take COVID-positive patients from hospitals. DPH guidance from Jan. 6 says that post-acute care providers — which includes nursing homes — "should be equipped to safely care for individuals with active COVID-19 who are ready for discharge from acute care."
It added that any skilled nursing facility unable to care for people with COVID-19 should report reasons why they can't to DPH.
Senate Republican Leader Kevin Kelly, R-Stratford, released a statement Jan. 6 calling on the governor to immediately reverse the policy, saying it's alarming that the governor "has not learned from Connecticut's past experience when it comes to keeping nursing home residents safe" and that we "must explore all other avenues including recovery centers."
Lamont said Thursday that COVID-positive people are "not going to be intermingling with the rest of the population. This is not what you saw in places like New York 18 months ago — very different — and I think we'll be able to do that and keep people safe."
Barrett said Friday the guidance protects facilities' "longstanding and very appropriate authority to deny an admission" when they are unable to address that person's care needs. He also said we have to view the health care system as a whole, which will falter if hospitals are overwhelmed.
White said DPH has been reasonable and understands Beechwood may not be able to accept COVID-positive patients because of lack of staffing or handling its own COVID patients.
Painter said she didn't really understand why there was a question on this issue, as long-term care communities have been admitting people with COVID-19 for over a year now. "They are required to let the residents and other family members know when they admit someone who has COVID, or even if someone within the building acquires COVID," she said.
She added that complaints she's getting from residents are more related to staffing than the coronavirus at this point.
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