Tonya Landry was able to keep COVID-19 out of her nursing home in the spring. She hasn’t been as lucky this fall.
Landry is the administrator of Bayberry Commons, a 110-bed facility in Burrillville that recently had two residents and an employee test positive for COVID-19 despite stringent safety measures.
The nursing and rehabilitation center’s occupancy rate has already sunk to 70%, and because of the positive tests, some families are signaling they might pull their elderly family members out of Bayberry. Landry said she can’t blame them for feeling anxious, but it’s putting further pressure on a business that’s already been heavily burdened by the pandemic.
Landry said Bayberry is losing about $125,000 a month. Now Bayberry can’t admit new residents and patients because of the positive COVID-19 tests, and low Medicaid reimbursements are further constraining the nursing home’s budget. “I don’t know what I’m going to do to fix this or come out from under this,” Landry said recently.
From the beginning of the pandemic in March, nursing homes across the country have been an epicenter of the crisis. Once the highly contagious virus finds its way into a facility, it can spread quickly, preying upon frail, aging residents.
Nearly 900 nursing home residents have died of COVID-19 in the last eight months – about 67% of the 1,325 COVID-19-related deaths reported in Rhode Island as of Nov. 24, according to the R.I. Department of Health.
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MISSING HIM: Suzanne Champagne displays a photo of herself with her father, Herve Champagne Jr., and her sister, Mary Champagne. Her father moved into an assisted-living facility in July, and she hasn’t been able to visit him. / PBN PHOTO/ELIZABETH GRAHAM[/caption]
And nursing homes themselves are suffering, too. Industry leaders in the state say many of the homes are now in financial trouble for a number of reasons, including the additional costs of fighting the pandemic and a lack of new residents, particularly short-term patients whose care often has a higher insurance reimbursement rate. Rhode Island’s nursing homes typically have a 90% occupancy rate, but the average has dropped to 73% as of September.
Now cases of COVID-19 are soaring again, ratcheting up the pressures on the state’s 84 nursing homes.
One facility has already succumbed. Hallworth House, a 57-bed nonprofit nursing home on Providence’s East Side, closed in late August. The facility had been losing money in recent years, but the pandemic was too much, causing a drop in patients in its rehabilitation unit, a crucial revenue generator.
Others might not be far behind, according to some in the industry.
A survey in August by the American Health Care Association indicated that 72% of nursing homes would not be able to sustain operations at the current pace for another year, while 40% said they would last less than six months.
Scott Fraser, president of the Rhode Island Health Care Association, said none of the 64 nursing homes his organization represents has indicated they’re in imminent danger of closing, but that could change depending on how the pandemic progresses and whether help arrives from the state and federal governments.
“The next six to 12 months is going to be critical for several of these facilities,” Fraser said.
‘EXHAUSTED’
There’s no doubt that nursing homes are better prepared for COVID-19 than they were in March when the virus spread with surprising speed. Since then, facilities have instituted steps such as lockdowns, limited visitation and more testing of residents and staff.
For example, Bayberry Commons now requires patients to test negative for COVID-19 twice before transferring from a hospital. Even then, a new patient must spend two weeks in Bayberry’s quarantine unit.
Treatment of the elderly infected with COVID-19 has also improved. Department of Health data shows 75% of patients who contracted the virus in long-term-care facilities have recovered.
Still, some problems have lingered since spring, including a shortage of personal protective equipment and staff members. At some facilities, anger about working conditions and low pay has boiled over.
Unionized workers at the 161-bed Bannister Center for Rehabilitation and Health Care in Providence went on a three-day strike last month, demanding safe staffing and better wages and benefits. Parent company Centers Health Care LLC, of New York, was forced to hire temporary workers. A spokesman for Centers Health Care, which also owns Oak Hill Center for Rehabilitation and Health Care in Pawtucket and Kingston Center for Rehabilitation and Health Care in South Kingstown, declined to comment.
At Bethany Home of Rhode Island, a 33-bed nonprofit facility in Providence, the staff has shrunk from 80 in February to 57 now, according to Administrator Elizabeth “Libby” Sarro. Some left because they feared getting infected; others found collecting unemployment benefits more lucrative. Even with fewer workers, the Bethany Home has kept the virus somewhat in check, reporting 15 to 19 COVID-19 cases since March and five to nine deaths. (State health officials do not report exact data on positive cases or deaths.)
Sarro said Bethany Home relies heavily on donations from families, disbursements from the Bethany Home Foundation, and grants. In fact, the home recently received a $21,000 grant from the COVID-19 Response Fund created by the United Way of Rhode Island and the Rhode Island Foundation. Where did that money go? Sarro said she gave her remaining staff a $2-an-hour raise.
“They’re exhausted, and they deserved it,” she said.
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TAKING NO CHANCES: Elizabeth “Libby” Sarro, right, administrator at Bethany Home of Rhode Island, helps office manager Linda Wilson, center, and David Bragga, director of therapy, don protective equipment at the entrance of the Providence nursing home. / PBN PHOTO/MICHAEL SALERNO[/caption]
SHAKEOUT COMING?
With nursing homes in the spotlight, industry leaders have renewed calls for the state to boost funding for Medicaid, the state and federal insurance program for the poor and disabled that covers about 65% of Rhode Island nursing home residents.
Fraser said state officials have failed in recent years to follow the Medicaid Inflation Index, instead approving reimbursement increases lower than the 3% inflation index average. Gov. Gina M. Raimondo’s proposed state budget for fiscal year 2021 would set the rate increase at 1%.
“Homes were barely getting by on a shoestring prior to the pandemic because of all of the years of Medicaid cuts,” he said.
The lower reimbursement rates are adding to the financial pressures, according to nursing home administrators. Sarro said the Medicaid reimbursements aren’t enough to cover the cost of care, so the Bethany Home can only take up to six Medicaid patients at a time. She said the home loses $240-$250 each day for each Medicaid patient.
Without a boost in Medicaid funding, Fraser has said, nursing homes will struggle to address issues such as higher wages for workers.
Raimondo’s office did not immediately respond to messages seeking comment.
James Nyberg, director of LeadingAgeRI, which represents 14 nonprofit facilities that offer care for older people, said these facilities also desperately need an infusion of aid from the federal government. Industry leaders are urging Congress to pass a relief package that focuses on nursing home residents and staff.
If aid doesn’t come, Nyberg believes some nursing homes may not survive. “It’ll be very difficult,” he said. “There will be some sort of shakeout.”
At the same time, Nyberg is concerned about the effects the pandemic is having on developing a future workforce, particularly as many nursing home administrators are approaching retirement age. Attracting younger workers is difficult with a pandemic raging because of the perceived dangers and staffing shortages.
“It’s not seen as a desirable place to work, until they become part of the workforce and become close with residents,” Nyberg said.
Indeed, Dawn Auclair said her family begs every day for her not to go to her job as a certified nursing assistant at Hopkins Manor Ltd. in North Providence.
Auclair still goes, as she has for the 21 years she’s worked at the 200-bed Hopkins Manor. But now she arrives hoping the elderly residents she cares for are still there. In the pandemic, that often hasn’t been the case.
Some have died from COVID-19; others have been hospitalized for treatment when their conditions have deteriorated. “You can see it in their eyes,” Auclair said. “They know they aren’t coming back.”
Hopkins Manor has had 105 to 108 COVID-19 cases and 20 to 24 deaths related to the virus since March, according to state data.
“It’s traumatizing,” Auclair said.
VULNERABLE
Infection-control procedures also threaten to have long-term effects on placements at congregate care facilities.
When Suzanne Champagne’s 86-year-old father fell multiple times while living alone – the last time in July required hospitalization – the decision was made to move him to Atria Harborhill, an assisted-living home in East Greenwich. Champagne’s home has too many stairs for him to live there.
‘I don’t know what I’m going to do to fix this or come out from under this.’
TONYA LANDRY, Bayberry Commons administrator
But the experience hasn’t been what Champagne had hoped it would be. Efforts to keep COVID-19 out have left her father isolated. She can’t enter the building; he eats meals in his room; and social time is sparsely attended and spread out.
“He feels like he’s in jail,” Champagne said. “I talk to my dad every day over the phone and hope to hear that pep in his voice. It’s just not there anymore.”
Meanwhile, Raimondo’s administration is using $25 million of the state’s federal stimulus funds to support nursing facilities, but also to “reorient the delivery of care” and create more home-based care options for families.
Industry leaders say expanding home care may delay nursing home placements, but there will always be a need for these facilities.
“Our residents have multiple health issues – more than 50% are suffering from dementia,” Fraser said. “In a nursing home, you get 24-hour care. Many of these family members cannot provide that for their loved ones.”
At Bayberry Commons, Landry is holding out hope that the state’s assistance will go further – in the form of more Medicaid funding – particularly if “reorienting” care means more costs for nursing facilities. Bayberry has already lost $600,000 in the first nine months of the year.
“Nursing homes might not survive COVID-19,” Landry said.
Alexa Gagosz is a PBN staff writer. Contact her at Gagosz@PBN.com.
