The U.S. health care system and all who rely on it may be reaching painful reckonings on how the coronavirus pandemic keeps affecting caregiving personnel, whether with highly trained nurses who are forcing hospitals to pay them more or see them leave or with poorly paid and ill-trained aides who still aren’t getting Covid-19 shots to protect themselves and their vulnerable patients.
Great doctors, of course, may be vital to patients’ positive outcomes. But ask anyone knowledgeable how hospitals succeed — or don’t — and they will point to nurses. And that’s a professional treasure that has been battered by the pandemic, Kaiser Health News service reported in partnership with NPR and WPLN radio in Nashville, Tenn.
Broadcast news reporter Blake Farmer found in Tennessee and nationally that hospitals are struggling to maintain their nursing ranks, particularly among their most seasoned and specially trained pros. They have spent grueling months giving patients the round-the-clock, intensive care demanded in serious cases, notably for coronavirus infections.
Hospitals and administrators have offered their thanks for the nurses’ toil. But nurses say this too often has come with inconsequential recognition events like pizza parties — not with hiring additional personnel to provide relief. Or paying nurses more for their hard duty.
Relying on ‘traveling’ nurses
Too many hospitals, instead, have relied on “traveling” nurse fill-in programs to rapidly ramp up, then shed staff. Traveling nurses can make as much as $10,000 per week — far more than what staff earn. And savvy veterans, especially those with high credentials and extensive experience in intensive- or emergency respiratory-care, have determined that it works better for them to quit hospital jobs (maybe giving up long-term security and likely benefits such as retirement plans) and become traveling nurses. Their “travels,” incidentally, may simply take them across the street or across town to another facility in need.
Hospitals, though they have gotten some financial help from states with coronavirus relief programs, are sweating their spiking personnel costs, especially for nurses, Farmer reported, quoting Dr. Iman Abuzeid, co-founder of a San Francisco nurse recruiting company called Incredible Health:
“[F]or many hospitals, the higher costs are straining their budgets, which is especially difficult for those that have suspended elective surgeries — often a hospital’s biggest moneymaker — to accommodate Covid patients. ‘Every executive we interact with is under pressure to reduce the number of traveler nurses on their teams, not just from a cost standpoint but also from a quality-of-care standpoint,’ Abuzeid said.”
A reality check: When health providers experience cost challenges, it is all but inevitable they will pass them on to patients, who will be hit with higher charges or higher insurance premiums.
Nurses also may make another decision about their individual careers that will be highly detrimental to patients and the health care system — they may leave their profession. It has been no secret that policy makers have failed to adequately address a huge personnel problem in U.S. health care: forecast shortages of doctors and nurses. Experts say our rapidly graying nation, with sharply increasing health care needs, may see shortfalls of as many as 125,000 doctors by 2034 and 1 million nurses by 2030.
Increasing fire over unvaccinated nursing home aides
Nursing homes already have slammed against a staffing wall with their increasingly desperate need for health aides who provide the hard, round-the-clock care for the aged, sick, and disabled in various kinds of long-term care facilities.
The owners and operators of such homes, critics say, have dragged their feet for too long and put those in their care at elevated risk from the coronavirus by failing to require staff, especially poorly paid and ill-trained aides, to get vaccinated. Management asserts its glaring staffing problems — with high vacancies and few qualified applicants — will worsen if individual homes or chains impose vaccine mandates.
The federal government said it would require staff in nursing homes and other long-term care facilities to be vaccinated or the institutions could lose Medicaid, Medicare, and other U.S. funding on which the institutions rely. Regulators, though, had to delay the nursing home vaccination rules after the Biden Administration expanded mandates to most health care workers, in general.
Nursing homes say they need the broader, encompassing requirement to take effect before they start to deal with unvaccinated staff to ensure they don’t lose personnel to places that simply pay more or that do not require coronavirus shots. That has angered residents and their loved ones, the New York Times reported, noting that the summer’s Delta-variant surge fueled concerns even more:
“[M]onths of delays and vaccine resistance have had wrenching consequences for families … who once again are barred from visiting because of outbreaks ….After steep declines earlier this year, Covid cases and deaths in nursing homes climbed in August and September, resulting in about 4,000 deaths — even though nearly 90% of the nation’s nursing home residents were fully vaccinated. Residents are particularly vulnerable to breakthrough infections because so many are older and suffer from serious medical conditions, like the multiple myeloma the former secretary of state Colin Powell was being treated for when he died from complications of Covid …
‘It is medically wrong and borders on unethical to have unvaccinated nursing home staff caring for residents,’ said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. ‘The vaccine works. It has made a profound difference.’”
The newspaper reported this key statistic about nursing home staff vaccinations:
“Vaccination rates among nursing home staff increased to 69% by early October from 62% in early August, when Mr. Biden announced the [health worker] mandate, but some facilities still report a staff rate of half or fewer, according to the latest federal data.”
Residents and their loved ones, interviewed by the newspaper, assailed the nursing homes’ slow-walking vaccine requirements for health staff, with one older patient saying she “feels like a sitting duck” when cared for by unvaccinated staff and facing a potential breakthrough coronavirus infection.
Federal regulators declined to say when they expect to announce or put in place the health care worker vaccine mandate.
Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care facilities.
Owners and operators of these institutions, almost from the pandemic’s onset, have cried “poor us,” and insisted they are doing their best to deal with unusual circumstance. But, as with hospitals fretting about their nursing challenges, patients, politicians, and regulators may need to be skeptical to the nth degree.
The pandemic and other recent circumstances have forced us as a nation to reconsider big, critical issues about equity and compensation. The $15-an-hour minimum wage, presto, became a pragmatic reality after years of political wrangling when the public realized how our society can’t function without “essential workers” in groceries, restaurants, shipping, public transportation, and more.
Health care saw an employment boom in recent years — not for frontline caregivers, including doctors, nurses, and other direct-care providing staff. Nope. In hospitals and nursing homes and other facilities, offices full of MBA-holding suits suddenly abounded, as did armies of billing and payment staff, as well as specialists in advertising and marketing. Institutions cranked up their prices as much as they could to see what the market would bear.
We have much work to do to ensure the most talented, compassionate, and able people flourish in providing all of us safe, affordable, efficient, and excellent health care.