Nursing home staffing plunges as shots go up in long-term care facilities

altarumfig-300x176The Biden Administration faces major challenges as it seeks to tame the coronavirus pandemic’s terrible toll on nursing homes and other long-term care facilities. The roll-out of vaccines for residents and staff plods along, while a big concern may be rising as facility staffing keeps eroding.

The New York Times reported that Walgreens and CVS, the chain pharmacies that the Trump Administration chose to partner with with to deliver vaccine shots to long-term care facilities, have vaccinated 1 million and 1.6 million residents and staff, respectively.

Both companies say the vaccination rollout has been rockier and tougher than expected, with issues in getting required consent for shots for the elderly, sick, and injured, as well hesitancy among staff. Vaccine supplies have been less predictable than would be optimal, though the pharmacies are not reporting shortfalls. Rina Shah, a group vice president at Walgreens, told the New York Times that the logistics and scheduling of vaccinations, with multiple visits at facilities, has required a “monumental effort.”

And despite rising anger by residents, their loved ones, and facility staff at the plodding pace of vaccinations, many areas are finally seeing measurable progress and results, with the newspaper reporting facilities seeing infection declines as well as getting done the vital task of vaccinating what the New York Times reported is 3 million or so people in long-term care.

That number is far lower than earlier federal estimates of 8 or so million Americans in nursing homes and various forms of assisted living care, especially those that may get a lower priority with coronavirus shot.

A plunge in nursing home staffing

But even as public health officials grind on with vaccinating the vulnerable in long-term care, Skilled Nursing News also reported that nursing home staffing issues may be an even bigger concern than before, as it keeps falling.

This matters significantly to the safety and quality of care, the trade industry publication reported, writing:

“In the midst of a devastating pandemic, the nation’s nursing homes lost 264,000 jobs over the course of 2020, even as the health care sector at large bounced back to nearly pre-Covid levels. That figure represents a 7.8% drop for nursing facilities and other residential care settings between February and December 2020, according to an analysis from non-profit health care research firm Altarum. The precipitous decline comes at a time when the workforce crisis in nursing homes has never been more acute: Even before the pandemic, facilities across the country were understaffed, and the effects of Covid-19 exacerbated an already troubling trend.”

It has become the rule rather than the exception that overwhelmed and understaffed long-term care facilities have required their underpaid, poorly trained staff to toil, overtime or in double shifts, Skilled Nursing News reported, adding:

“Research has indicated that well-staffed facilities can contain Covid-19 outbreaks more efficiently than their understaffed peers, while the sharing of workers across multiple nursing homes has been identified as a major spreader of the novel coronavirus.”

Taxpayers, via the two big coronavirus relief bills approved by the Congress, have sought to shore up nursing homes, especially with financial aid with their staffing costs. It is unclear, however, whether that assistance went to the facilities’ major and galloping staffing costs, or if it got applied to other bottom-line concerns for profit-focused owners and operators.

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 by neglect and abuse in nursing homes and other long-term care facilities. The coronavirus has slammed these institutions, which have recorded at least 136,000 deaths — 36% of all virus fatalities — and more than 1.1 million infections, according to the New York Times. Those numbers likely are under reported, and, despite earlier, concerted efforts to slash the disease’s harms, they spiked at year’s end and appeared to be as grim now as they have at any point before.

The top U.S. officials who oversaw the nation’s shambolic oversight of long-term care facilities during the 2020 part of the pandemic have departed with the change-over to the Biden Administration. The new president, as of Jan. 22, had not named a new head of the Centers for Medicare and Medicaid (CMS), which regulates nursing homes.

Still, as McKnight’s Long-Term Care News reported that, under Biden:

“Skilled nursing and other long-term care providers may need to prepare for major nursing home reform efforts, including increased penalties … according to industry advocates and experts.  ‘From a nursing home regulatory perspective, the Biden administration could choose to reverse the Trump administration’s relaxation of enforcement, penalties, and oversight,’ said David Grabowski, Ph.D., Harvard Medical School professor and health care policy expert. Specifically, he noted that could mean the restoration of mandatory penalties for violations when residents are in “Immediate Jeopardy” but did not suffer any harm. He added that the new administration also could move to reinstate the regulator ban on binding arbitration agreements in cases of resident harm or death from nursing home negligence. ‘They could also reject pending regulations that would relax current requirements around an infection preventionist, psychotropic drug use, grievance process, and staffing data retention…’ He added that there could be a push to improve nursing home staffing and training.”

AARP, the nation’s largest and powerful advocacy group for older adults, published in its widely circulated magazine a multipart series on the crisis in long-term care, including paths for fixing an industry that has become a big problem for a graying nation. The new Congress should work with the new folks in the White House to tackle this issue.  Individuals, incensed by the way loved ones have been treated since the pandemic began, may be considering whether to sue facilities.

We have much work to do, with so many challenges confronting the nation right now, to ensure the aged, sick, and injured have good places to live — not die.

Credit: Altarum figure, above, shows overall health care employment recovering
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