The two nursing aides were supposed to start work at the Manchester Manor nursing home in early December, a welcome addition to a staff that has put in long hours under risky conditions and now faces a new wave of coronavirus cases.
But the week they were supposed to begin, both would-be employees informed management that they had instead taken jobs with Amazon in Connecticut, a safer prospect as COVID-19 cases among nursing home staff and residents are again on the rise.
“They just said they were more comfortable working at Amazon than they felt working in a nursing home,” said Paul Liistro, who owns the Manchester Manor and Vernon Manor facilities. “The turnover is pretty high, even if you get employees who think they want to work with people. They don’t really know how closely they’re going to be working with people until they get here.”
During the first surge of coronavirus cases last spring, infections among nursing home residents grew rapidly. While resident cases are again increasing, infections among staff members have also been rising steeply as community spread escalated this fall.
Between Nov. 25 and Dec. 1, the most recent data available, an additional 388 nursing home employees statewide tested positive for COVID-19. From June 17 – when the state began releasing data on worker illnesses – to Dec. 1, a total of 1,918 staff members were infected. The absence of those workers, along with dozens of others who were forced to quarantine because of exposure, has led to staffing shortages in many buildings.
Data from the state Department of Public Health show that 116 of the state’s 211 nursing homes – more than half – had at least one COVID-19 case among employees between Nov. 25 and Dec. 1.
The impacts of the staffing shortages are numerous: In some cases, employees who already are exhausted from the constant stress of working in a nursing facility during the pandemic are asked (or required) to pick up additional shifts or to work copious amounts of overtime, a tricky endeavor for those who must coordinate child care or other responsibilities. In other instances, nursing home operators have been forced to turn to staffing agencies for temporary workers.
Liistro said he brought on temporary employees this fall for the first time in 30 years.
“Once the staff started getting infected and more people were out, we had to resort to an agency,” he said. “We haven’t used an agency in three decades.”
Part of the problem with bringing on temporary workers is the consistency of care. Nursing home employees who know the facilities and the residents are able to deliver better care, operators say. And during the pandemic, when many residents have been unable to see their families and friends for months, having familiar faces on staff is comforting.
The employee shortages have had other consequences for resident care. Mairead Painter, Connecticut’s long-term care ombudswoman, said complaints about staffing have reached her office.
“We’re hearing things – from [residents] spending longer periods of time in their rooms waiting for someone to give them care, to not being able to take a shower,” she said. “Some of those things are being impacted due to staffing concerns.”
In some cases, when a staffing situation is so dire, sick residents are transferred out of a facility to one of the state’s four COVID-19 recovery centers – buildings or units that are designated for COVID-positive residents. During the first coronavirus surge last spring, those buildings were devoted to nursing home residents who were discharged from a hospital. This time around, they’re also accepting transfers from other nursing homes where employees are having a hard time treating people in place.
But shuttling between buildings can be stressful for residents and their families.
“You can see their importance in terms of an overall strategy – not just for a hospital surge, but also in the event that a nursing home gets to the point where it can’t staff the building to take care of its COVID-positive residents,” Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, said of the recovery centers. “At the same time, I think transferring older folks with underlying health conditions isn’t optimal as a first measure.”
‘They can’t continue’
The rise in worker illnesses has been a key factor in the staffing shortages. But complicating the issue is a slew of early retirements and departures among employees who decided they no longer want to work in nursing homes amid the pandemic.
Over the summer, thousands of workers were laid off or had their hours drastically reduced as occupancy in the facilities plunged – to 72% in August, down from 88% in February as residents died of COVID-19 and the homes saw far fewer new admissions. Officials with New England Health Care Employees, District 1199 SEIU, said in August that 2,000 of the union’s 6,000 nursing home employees were laid off or had their hours cut by 50% or more. As infections started to spread more aggressively in the fall, many of the workers were asked back.
By that point, however, hundreds of them had found work in other, less risky professions, or decided to collect unemployment as they focused on home-schooling their children.
“What we’re finding is a very good chunk of those people claimed unemployment in the summer and, therefore, they are eligible for six months of the enhanced COVID unemployment benefit,” said Jesse Martin, a vice president with 1199. “A lot of those employees have just taken themselves out of the marketplace. Some of them are making more money on unemployment or are just breaking even by not working.”
Others have elected to retire earlier than they had planned or are choosing jobs in warehouses, where they can make the same amount of money – or more – with less chance of exposure.
“There’s been a lot of competition with warehouses. Several new Amazon warehouses are starting to open up in Connecticut, and they’re actively recruiting,” Martin said. “Some of the warehouses are offering competitive wages as high as $20 an hour. None of the nursing homes we represent has a minimum wage of $20 an hour right off the bat. They can’t compete with that.”
Some of the departures and retirements come from worker burnout or post-traumatic stress disorder. The constant fear of catching the virus and spreading it to loved ones, or of watching residents die in the homes, has taken a toll on employees.
“There are a number of members I have had discussions with who are just psychologically broken,” Martin said. “There are people who have told me they’ve watched over 10 people pass away during a daily assignment. And they can’t continue to do that.”
More than 3,400 nursing home workers in Connecticut have contracted COVID-19, according to federal numbers, with many of them becoming infected during a shift. “A good chunk” of those staff members have lingering symptoms months after the illness first presented, Martin said.
More than a dozen workers have died of coronavirus in the state, and others passed the disease to a parent or a spouse, killing them.
As more employees leave the profession, Martin said, fewer are also coming in.
“One nursing home in New Haven told me that before the pandemic, it would get five applicants for every job. Now, they’re lucky if they get one applicant for every three open jobs,” Martin said. “There’s no one raising their hand and saying, ‘I’m going to come work in the dietary department of this nursing home for $13 an hour.’”
‘We’ve been struggling’
Nursing home operators across the state have reported challenges in recruiting new workers or have turned to temporary staffing agencies for relief.
“I don’t know if I’ve hired half a dozen people in the last eight months,” said Bill White, whose family owns the Beechwood Post-Acute & Transitional Care Center in New London. “I’ve been trying to hire a nurse supervisor for months. People either aren’t applying, or we get an endless parade of people … who just didn’t make sense.”
Kevin O’Connell, CEO of Geer Nursing and Rehabilitation Center in Canaan, said staffing has always been a challenge, but it’s become worse during the pandemic. His company has hired a full-time recruiter to help fill open positions.
The recent influx in nursing home cases statewide has made him nervous.
“If the virus were to come in and a staff member got ill, that kind of waterfall effect could really be devastating,” he said. “That’s the difficult part, because you can’t just go out and find replacement staff. We have contracts with staffing agencies, we have relationships with local home care agencies and different organizations that we would look to for support, but it is a real challenge.”
As more workers have called out due to positive tests or exposure, Curtis Rodowicz, co-owner of Colonial Health and Rehab Center in Plainfield, has brought on temporary staff. The facility also has reopened its contract with unionized employees and increased base pay for certified nursing assistants.
“We’ve been struggling in the process of retaining staff and also hiring new staff during the pandemic,” he said. “There have definitely been additional retirements and family medical leaves as a result of COVID. We have several staff members who have been exposed due to community-based situations … and we’ve also had positive cases as a result of the weekly testing we’re conducting.”
Nineteen Connecticut nursing homes have reported shortages among nursing staff, clinical workers, aides and other employees, according to data filed with the Centers for Medicare and Medicaid Services in November. Five of those facilities – Mystic Healthcare and Rehabilitation, Woodlake at Tolland Rehabilitation and Nursing Center, Newtown Rehabilitation and Healthcare Center, Orchard Grove Specialty Healthcare at Uncasville and Vernon Manor Healthcare Center – reported staffing shortages for several consecutive weeks last month.
White said he’s been combing through a list of former employees who left on good terms and trying to recruit them back. “I’ve managed to hire back at least two or three people that had been with me in the past,” he said. “That’s been the most successful thing we’ve been able to do.”
Other managers are taking advantage of a new program that allows nursing homes to bring on “temporary nurse aides” – workers who complete an eight-hour course and can help with some duties around the facilities, such as setting up resident rooms, making beds and delivering fresh towels. Those employees don’t have the same level of training or skill as a certified nursing assistant but can help the CNAs with some of their responsibilities.
“Unfortunately, we’re not seeing more people that are fully licensed or certified nurse’s aides or licensed nurses coming back,” said Rodowicz. “We have a lot of temporary staff that have taken that course and are now applying. So we don’t have the experience behind the people that we’re replacing them with.”
Nursing home leaders have asked the state to contribute more than $300 million in additional aid to the facilities to maintain care levels in the face of eroding revenues.
The homes received about $50 million in assistance from the state before the end of the last fiscal year – June 30 – but the aid has not continued in recent months, officials said, putting a strain on the buildings.
The pandemic has caused financial hardship for many facilities that already were operating on narrow margins. A sharp drop in revenue from fewer people seeking rehabilitation and other post-acute care was a troubling setback, officials said. As COVID-19 cases rose last spring, some families pulled loved ones out of nursing homes or decided against putting them into one. And since the pandemic started, 3,161 nursing home residents have died – 63% of the state’s coronavirus fatalities.
The homes have also faced increased costs associated with protective equipment and testing materials.
Barrett of the Connecticut Association of Health Care Facilities said the staffing issues have made the request for support more pressing.
“It’s clear that Connecticut’s increased community spread is the major contributing factor,” he said. “But it’s one thing to explain what’s going on. It’s another thing to address the consequences of that. And the consequences of that are staffing shortages that could potentially cripple the system.”
As of Nov. 20, the state had about $196 million left of the $1.4 billion in coronavirus relief funds it received from the federal government, according to the state Office of Policy and Management. But it was not clear how much of the remaining funds were already committed to other endeavors. Several other entities, including the state’s cash-strapped hospitals, have sought financial support.
Connecticut also has just under $3.1 billion in its rainy day fund.
Max Reiss, a spokesman for Gov. Ned Lamont, said discussions with nursing home officials are ongoing.