A big sign of more long-term care problems: Nursing homes’ staffing struggles

agedcare-300x200Nursing homes and other long-term care facilities keep bleeding staff, and their inability to hire and keep  workers poses significant risks to the well-being of aged, sick, and injured residents — a vulnerable group already savaged by the coronavirus pandemic.

The long-term care industry employed 3 million  personnel in July, which is 380,000 fewer staff than were on facilities payrolls in February 2020, the Wall Street Journal reported of federal labor statistics. Terry Robertson, chief executive of Josephine Caring Community, a long-term-care facility in Stanwood, Wash., told the newspaper this:

“I’ve been in the industry for 40 years and I’ve never seen it this bad.”

As the news article also noted, quoting Robertson:

“’Turnover has been twice as high as it was before the pandemic, he said. ‘We turned down 138 admissions from hospitals last month because we didn’t have the staff to open another unit,’ he said. Nursing-home staff have quit — and stayed away — because of the pay, burnout and fear of Covid-19, administrators and workers say. Enhanced unemployment benefits and competing job opportunities also have played a role, they say. Sheena Bumpas, a nursing assistant in a dementia unit at a long-term-care facility in Duncan, Okla., said staffing shortages create a cycle that wears down workers who enter or remain in the field. ‘When you’re short on people, you have to work extra because someone has to be there to take care of the residents. You work and you work and after a while you just get burned out,’ said Ms. Bumpas, who has been in her job for 19 years and is the vice chair of the National Association of Health Care Assistants, a nonprofit professional association.

The threat to residents due to facilities’ staffing problems is stark, the Wall Street Journal reported:

“Research shows that when homes are understaffed, the care of residents can suffer as they wait longer to be fed, brought to bathrooms, or receive responses to their calls for assistance. A study last year found that facilities with higher levels of nursing staff tended to have fewer Covid-19 outbreaks and related deaths. The scarcity of workers is a long-term predicament for the industry. Dissatisfaction with wages, combined with the fact that certified nursing assistants typically receive little training and therefore develop few specific skills tying them to the field, mean workers frequently switch jobs or leave the industry altogether for roles that pay slightly more or offer better hours or benefits. Median pay for nursing assistants was $14.82 per hour in 2020, according to the Bureau of Labor Statistics. Thousands of nurses and aides got sick over the past 18 months and many reported being fearful of bringing the virus home to their families, according to federal data and academic research. Those who remained on the job coped with heavier workloads, new protocols related to personal protective equipment and distraught families and residents who were separated during Covid-19 lockdowns.”

Owners and operators of facilities complain that they cannot maintain profit margins they must hit to satisfy investors, if they follow other businesses and seek to attract staff with bonuses, higher pay, and improved working conditions.

They also say they worry that the significant, needed federal money they get — via Medicaid and Medicare — is at risk. That’s because the Biden Administration’s recently announced that health workers in long-term care facilities must get coronavirus vaccinations, if their employing enterprises want to keep their lucrative support from Uncle Sam.

Taxpayers already have poured billions of dollars to prop up desperately needed nursing home and other long-term care facilities, and Congress is in the midst of brutal wrangling about administration proposals to deal with the giant but silent crisis in how our graying nation will deal with its elderly, especially if they need intensive care.

Tough choices on long-term care

Families already struggle with the burdens of institutional care, with the median cost of a private, single-room in a nursing home running $102,200 annually. Loved ones have shown greater reluctance to sign seniors into homes after months in which the coronavirus killed at least 186,000 residents and staff at nursing homes and other long-term facilities and infected roughly 1.3 million of them.

But their options may be limited. With nursing homes confronting staffing shortfalls, they may not be accepting or re-admitting residents. That may add to crushing burdens for families and friends, as they consider home care options for the vulnerable.

Vox, a news and information site, has posted a wrenching article, describing the awful situation sinking all too many people coping with heavy caregiving responsibilities, often for multiple older, debilitated, and declining relatives and friends. The great news is that advances in medicine mean more of us live longer than ever. The bad news is that, as we grow older, our need for help doesn’t creep up, it soars, especially as our health dips — and then plunges.

The news article says that sexism, ageism, and racism tragically shadow loved ones’ valiant and desperate efforts to help those most dear to them. Society devalues their toil because it occurs at home, often is taken up by women, is not compensated financially, and may be assisted by workers who are poor and people of color. Caregivers, of course, also suffer huge financial loss.

As reporter Anne Helen Petersen reported:

“Talking to dozens of adult caregivers, I heard variations on the same theme over and over again: It’s brutal, it’s tearing my family apart, it makes me resent everyone, including the people for whom I’m providing care. The suffering is not new. The crisis has just further expanded within the middle class and the population at large, gradually making it less and less ignorable.”

Few members of the giant baby boomer generation, experts note, have planned and saved enough for retirement, much less for what can be the staggering costs of long-term care and bankrupting medical services. If women, and, yes, men, must devote sizable portions of their working day to caring for aged, sick, or injured relatives and friends, can the country also sustain a booming economy?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care facilities.

Accountability and reforms

The pandemic became a deadly way for the public to see the many unacceptable ways that nursing home owners and operators pursued profits at the expense of residents and their loved ones. The industry claims it did the best it could under tough, unforeseen circumstance. But after dumping taxpayers’ hard-earned money into them, where is the accountability for the debacle that occurred with them?

Critics love to slam malpractice lawyers and the civil justice system. But many nursing home residents and their families, struggling still with the consequences of the pandemic, are thinking hard if their best recourse may be lawsuits to seek justice for wrongs done to them.

Democrats in Congress have filed bills to start dealing with the many, big nightmares with nursing homes and other long-term care facilities, including improving their staffing, infection-control problems, and oversight and accountability. The administration and Congress by late September may act on a big package on an array of long-ignored health and long-term care issues. The opposition to this spending is ferocious, even as the tragic wind-down of the conflict in Afghanistan is reminding Americans how this nation poured $2.2 trillion into the incursion there in two decades — and to what end?

We have many crises to deal with on our own shores, and we have much work to do to tackle them without further delay.

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