When Rhode Island nursing homes banned visitors in early March as their first defensive move against COVID-19, Susan McGovern and her co-workers at Linn Health & Rehabilitation took on extra layers of responsibility.
New rules suddenly altered McGovern’s daily routine as a certified nursing assistant at the East Providence facility, where she has worked for more than 10 years.
Residents needed to be kept apart. Masks, gloves and protective gowns were required. Cleaning and hand-washing became more frequent and felt more urgent.
“In the beginning it was a little challenging; we wanted to make sure we were going exactly by the rules,” McGovern said. “We’re always making sure we’re doing what we’re supposed to be doing.”
To add to the anxiety, the building’s more than 70 residents were without the support and comfort of visitors, but they were still exposed daily to news about the coronavirus pandemic, complete with frightening stories of the toll inside nursing homes.
Staff members at Linn, many of whom are already close with residents, offered constant distractions.
“We are focusing on other things to talk about with them. We try not to focus on [the coronavirus],” McGovern said. “We try to continue on, especially now when they can’t have family members.
“We always have felt like they’re our family members,” she added.
Linn Health & Rehabilitation is part of Aldersbridge Communities, a nonprofit that runs four assisted-living facilities in Rhode Island. So far, no cases of COVID-19 have been reported at any of its locations.
Others haven’t been so lucky.
Nursing homes across Rhode Island, as well as the nation, have become the high-profile battlegrounds against the COVID-19 pandemic, places that have taken on a siege mentality as nursing home owners and staff members try to keep the coronavirus from getting a foothold amongst its aging and frail residents.
The results have been mixed. Testing shows that the highly infectious virus was present in 29 of Rhode Island’s roughly 80 nursing homes, as of April 23, according to the R.I. Department of Health. Another three assisted-living facilities have also reported cases.
The spread has been more persistent in some locations than in others.
Heritage Hills Nursing & Rehabilitation Center in Smithfield, for example, which can house up to 95 patients, reported between five and nine COVID-19 cases but no deaths, as of April 23, according to health department data.
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LARGE OUTBREAK: Golden Crest Nursing Centre in North Providence is among Rhode Island nursing homes that have seen a large outbreak of COVID-19 cases. As of April 23, 30 lives had been lost at the facility due to the new coronavirus. / PBN PHOTO/WILLIAM HAMILTON[/caption]
In contrast, Orchard View Manor Rehabilitation & Nursing Center in East Providence had seen 125 to 129 cases, with 30 to 34 deaths, according to the state. There also have been large outbreaks at Golden Crest Nursing Centre in North Providence that had claimed 30 lives and Oak Hill Center for Rehabilitation and Nursing in Pawtucket, where nearly 20 had died, as of April 23.
About 55% of Rhode Islanders – well over 100 – who have died from the virus were nursing home residents.
ANOTHER TOLL
Nursing home administrators across the state say both staffing levels and finances are being stretched dangerously thin.
Exposure to, or illness from, COVID-19 is keeping many employees quarantined at home, while others are unable to find child care. And some, fearful of bringing the virus home to their own families, have sought doctors’ notes excusing them from work.
Many workers have demanded hazard pay.
To compensate, homes are paying overtime to employees, and some are hiring more-expensive workers from staffing agencies to fill openings.
At the same time, nursing homes have been spending more to buy personal protective equipment for staffers, even as revenue drops along with new admissions. In normal times, patients rehabilitating from elective surgeries are a dependable source of income for nursing homes. But with most of those procedures postponed, that revenue has dried up.
Even when newcomers are admitted, they require more space because they need to be quarantined alone in a room for 14 days.
At Scalabrini Villa Inc., a 120-bed facility in North Kingstown, nine residents had died and cases of COVID-19 in both residents and staff reached 55 as of April 29. The home stopped admissions in late March after the first resident tested positive. Since then, the occupancy dropped from 84 to 63.
Administrator Joy Ryan said the grief she and the staff feel from residents’ deaths is the worst part of the pandemic.
“The most important impacts have been our personal losses,” she said in an email. “We grieve the lives lost and the good health that has been compromised by everyone who has been affected.”
Adding to the strain, there’s anxiety as staffers either work in facilities where COVID-19 is present, or worry that the virus will get in.
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MATTHEW R. TRIMBLE is chief operating officer of Saint Elizabeth Community. He'll become CEO and president at the end of next month. / PBN PHOTO/RUPERT WHITELEY[/caption]
“I think it’s very stressful for [our staff],” said Matthew R. Trimble, chief operating officer of Saint Elizabeth Community, based in Warwick. “Not only are they putting themselves in the face of this every day, but they’re also dealing with the challenges of home.” Trimble will take over as CEO and president of Saint Elizabeth at the end of June.
Ten staff members at Saint Elizabeth Manor in Bristol, one of Saint Elizabeth’s facilities, recently tested positive for COVID-19. Subsequent testing for all residents in the 133-bed home uncovered another 10 cases in people who showed no symptoms, Trimble said.
“What’s so scary about this virus is that it’s so sneaky and so contagious. These were 10 residents who showed no signs and symptoms,” he said. “If this virus gets into nursing homes, the last thing they should be is criticized. … It’s just insidious.”
HURTING FOR HELP
Dealing with staffing shortages has become nursing homes’ most pressing daily concern during the COVID-19 crisis, said Scott Fraser, CEO and president of the Rhode Island Health Care Association. The organization represents 64 nonprofit nursing homes in Rhode Island.
Testing for COVID-19 can cut staff numbers immediately if workers test positive, Fraser and others point out, potentially creating severe need in an industry that was already seeking to attract more workers.
“The COVID-19 pandemic exacerbated the staffing shortages that were there for a while,” said James Nyberg, director of LeadingAgeRI, which represents 15 nursing homes.
Fraser, citing the American Health Care Association, said nursing home workers total about 10,000 in Rhode Island.
Oak Hill, which has 129 beds, has turned to hiring outside staff members to fill gaps. The center “is able to maintain the state-mandated number of personnel due to [the] hiring of agency personnel to supplement for staff that may be out due to sickness or for other reasons,” said Ray Talamona, Rhode Island’s regional director of operations at the New York-based Centers Health Care, which owns Oak Hill.
Designated in late April by the state as a site capable of admitting and treating COVID-19 patients after they are discharged from hospitals, Oak Hill has taken on at least 14 additional people with the virus.
Saint Elizabeth Community, which in addition to Saint Elizabeth Manor operates the 168-bed Saint Elizabeth Home in East Greenwich and other assisted-living facilities, has seen 150 of its 800 employees take leaves of absence for reasons related to the new coronavirus, Trimble said.
Overtime expenses are mounting, as the system tries to avoid bringing in outside workers and their potential risk of exposure to COVID-19.
Saint Elizabeth, along with many other nursing home operators, is offering bonus pay to retain staffers.
Additional pay for many adds about $2 to the average wage of about $15 per hour, plus incentives of $25 to $50 to pick up extra shifts, Nyberg said.
Richard Gamache, CEO of Aldersbridge Communities, has avoided hiring from outside agencies, where workers often hop from home to home.
“The housekeepers are the unsung heroes here,” he said. “These are the unlikeliest group of superheroes; they are mostly in their 60s, it’s an immigrant workforce, and they don’t miss a day of work. They are so committed. They love the residents, they love their jobs, and they’re one of the reasons why we’ve been able to keep the virus at bay.”
Some facilities, such as Saint Elizabeth and Linn Health & Rehabilitation, are funneling money from a temporary 10% Medicaid rate increase straight into workers’ paychecks to encourage overtime shifts.
“Within 24 hours of receiving notice [of the increase], we met with staff and created bonuses to pick up extra shifts, and bonuses to work all the shifts they signed up for,” Gamache said.
More extra pay was earmarked for those who care for residents with COVID-19 if the virus enters the facility.
The state has stepped in to assist at the front lines in the nursing homes. Gov. Gina M. Raimondo announced in late April that nursing home employees are among those eligible for a raise from a newly created Congregate Care Workforce Stabilization Fund. Employers who apply to the program can secure extra money for staff members who earn $20 an hour or less, Raimondo said.
The move earned praise from the Service Employees International Union District 1199, which represents about 4,000 health care workers in Rhode Island. Patrick Quinn, District 1199 executive vice president, said nursing home workers had been “undervalued and underpaid” for decades.
The governor made National Guard personnel available to help nursing and group homes with issues such as proper infection control, testing questions and advice about personal protective equipment.
Although Fraser, Nyberg and others report that fear is sidelining some, many staffers are continuing to report to work, drawn by bonus pay, dedication to their jobs, or both, said Kathleen Heren, Rhode Island’s long-term care ombudsman.
“I think everybody is short-staffed. … Everybody’s getting together, it’s what can you do to get through the shift,” she said. “There are some people who are getting doctors’ notes to say they can’t come in, but the people who have the fire in their belly are still in there. It sort of separates the people who are really dedicated.”
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DEDICATED WORKERS: Richard Gamache, CEO of Aldersbridge Communities, says he has avoided hiring staff from outside agencies. Instead he’s relied on what he called a “committed” immigrant workforce. He’s pictured outside Aldersbridge facilities in East Providence. / PBN PHOTO/RUPERT WHITELEY[/caption]
UNCERTAIN FUTURE
While the government-backed raises bring some relief for nursing homes and workers, they are only temporary.
Fraser estimated that to stay afloat, nursing homes will need about 30% more than they are receiving from the state for health care services, and at least 25% more for the purchase of supplies, protective equipment and cleaning materials. Requests from the Rhode Island Health Care Association for the increases were submitted to the Department of Health and the governor last month.
“We’re arguing for our share of federal relief money … to even reimburse money that some owners have paid out of their pockets,” Fraser said. “The cost of PPE and staffing has really put some of our facilities on the financial brink.”
Nyberg said he worries that the monthslong combination of extra costs and low revenue will force some homes to close after the pandemic eases.
Occupancy will likely remain low in the near future, and workers will probably need personal protective equipment even after the immediate danger has passed, which can drain strained budgets, he said.
“That is why the funding issue will remain important, since two-thirds of residents are on Medicaid,” he said.
The devastation may lead to other changes, some in Rhode Island predicted.
Ryan, of Scalabrini Villa, hopes for improved inventory systems to keep track of cleaning supplies and personal protective equipment at individual facilities and at the state level.
Heren said lessons have been learned about isolation and infection-control procedures.
“If anything, it’s going to strengthen [those protocols] for longer-term care facilities,” she said.
Others hope the enormity of what nursing homes endure through the crisis may help cultivate widespread appreciation for nursing home workers, and lead to more funding to facilities.
“What I hope can come out of this is people will understand how critical the work is,” said Trimble, of Saint Elizabeth. “I hope we can get to the point where funding matches what we should be paying these folks.”
Gamache, of Aldersbridge Communities, foresees the potential to shift caregiving to one person per nursing home resident, rather than exposing the resident to high numbers of staff members who are in charge of different services and activities.“Maybe one thing that comes out of this is a universal caregiver model,” he said.
(CORRECTS 27th paragraph to note that Matthew R. Trimble, chief operating officer of Saint Elizabeth Community, will take over as CEO and president at the end of June.)
