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He brought in temporary nurses to fill the gaps and added overtime — and closed more than 20 beds. Limiting admissions would significantly reduce revenue, while also costing the institution an additional $1.5 million per year. to nursing agencies to address chronic staffing gaps. The long hours demanded by existing employees are driving out the door.
All six Romano Essex Group managed nursing homes in Massachusetts, in addition to two assisted living facilities and other senior services, are facing similar staffing challenges. Wages rose repeatedly, but did not stop the bleeding. Inquiries are constantly coming in from hospitals seeking placements for elderly patients, but Romano’s centers often can’t accommodate them.
“It’s a death sentence,” he said. “If we don’t get help, we will scream.”
At a time when people are losing their jobs at high cost, nursing homes are particularly vulnerable Terrible beating. The labor shortage was an issue well before the pandemic, and now the state has 6,900 open nursing staff positions in long-term care facilities — a 22 percent vacancy rate — reaching historic highs, according to the Massachusetts Senior Care Association. Industrial trade group. Most of them There are many of these skilled nursing facilities Dependence on Medicaid Reimbursement, meaning payment is less competitive than hospitals or other health care facilities. The number of immigrants, many of whom work in nursing homes, has also dropped significantly.
And the problem only gets worse as the population ages.
“There is no greater purpose than caring for the elderly and frail,” says Tara Gregorio, president of the Massachusetts Senior Care Association.
But with limited wages and high demand for work, feeling Purpose only goes so far. And the admiration for health care workers that swelled at the beginning of the epidemic quickly faded. As a nurse told Gregorio in the summer of 2020: “We went from heroes to zero fingers.”
After returning home from the Vietnam War and deciding he didn’t want to be an IBM salesman for the rest of his life, Romano went into nursing home work. His father, a doctor, had converted several old estates into retirement homes, and Romano knew there was a need for elderly care. Before long, Romano’s wife was working in the IT department, and his three grown children joined the family business.
When the pandemic hit, COVID devastated senior care facilities, prompted lockdowns, and caused severe stress on those caring for sick and isolated residents. At Tewksbury’s Blair House, workers spent the night in bed during the outbreak. In 2020, Covid killed 23 residents and one worker. Only one resident has died since.
The outbreak has exposed a staff shortage that has plagued nursing homes for years. A study by the University of California, San Francisco, and a recent study by USA Today found that in 2014, more than half of U.S. facilities had staffing levels below what was recommended by experts.
At Blaire House of Tewksbury, where a resident must provide an average of 3.58 hours of care per day to receive full Medicaid reimbursement, the average number of daily inpatient care hours in the third quarter was 3.42. This resulted in a shortfall of more than $18,000, which Romano said was largely unaccounted for by temporary agency nurses. 45 percent of nursing facilities in the state do not meet the 3.58 standard, according to industry estimates.
Health experts say the current outbreak is as high, if not higher, than at the peak of the epidemic. At Blair House, nurses have retired early or shipped off to hospitals, temp agencies and insurance companies, where the pay is higher and, in many cases, the pressure is lower. Food service workers, housekeepers and nursing assistants are heading to the Amazon, community colleges — pretty much everywhere — to earn higher wages.
Government mandated covid vaccine requirements For all nursing home workers, they are also firing people, such as a shortage of nursing school teachers and Immigration policies that make it difficult to bring in foreign-trained nurses. (Romano contracted 40 registered nurses from the Philippines 14 months ago, all with green cards and passing licensing exams, but none cleared immigration). Some workers are tired of being forced to wear masks; Others who have worked throughout the pandemic simply need a change.
Last year in 75 employees Blair has left House and some posts have been vacant for months.
Housekeeping, cleaning and maintenance are reduced five employees; Food Service has seven openings; And the Nursing Department needs 10 full-time nurses and 13 nursing assistants. The director of nursing left for the health care company in June, and the position has been vacant ever since.
Some people are quitting without having any jobs lined up, said Julissa Rivera of Human Resources. And filling vacancies is a hassle. Rivera contacts applicants who don’t call back and sets up interviews for people who never show up.
“It was just a war,” she said.
The director of a Worcester-area residential care facility at another company, who asked not to be named, said in an interview that job applicants have an “entitlement mentality” that didn’t exist 10 years ago: They don’t. They don’t want to work hard, they don’t want to get vaccinated, and they refuse to leave their cell phones at work. Some new college students are heading straight to temporary or travel nursing agencies because of the flexibility they offer.
This inability to fill nursing home jobs has a disturbing ripple effect. About 62 percent of the state’s skilled nursing facilities had to suspend new admissions in October due to staffing shortages, meaning hospital patients ready to be discharged are waiting weeks or months in nursing homes. open up. And this creates a serious backlog, as some hospitals have capacity and are experiencing staffing shortages of their own. Patients admitted to UMass Memorial Medical Center in Worcester, for example, wait an average of 17 hours for a bed in the emergency room.
The exit from the workforce has shocked nursing home administrators.
“It’s like a tsunami,” said Damian Dell’Anno, CEO of Next Level Health Care, which is closing several of its nursing homes in Massachusetts because of rising costs, inadequate state funding and temporary agencies luring nurses away with high pay.
And it’s only expected to get worse. A third of registered nurses in the United States say they may leave direct patient care in the next year, according to McKinsey & Co. According to research, the health care system may lack up to 450,000 nurses. In the next three years.
“If we’re on the verge of breaking. Now, what is going to happen in 2025?” Romano said.
In Massachusetts, the shrinking labor force has been driven by declining birthrates, an aging population, a decline in international migration and the number of people leaving the state rising at the fourth-highest rate in the nation last year, according to the report. Massachusetts Taxpayers Association.
In Tewksbury, registered nurse Maura Ratchford remembers a time when in-service training was an interesting experience, a refresher on lunch policies. Now, Ratchford must pull people into the nurses’ station and go through the procedures on the fly.
“You can’t leave the floor that long,” she said. “They are lucky to eat.”
Ratchford, who assists the acting director of nursing — sometimes called in to cover weekends — recently returned to Blair House in Tewksbury. For seven months, Ratchford was filling in part-time as director of nursing at Blair House of Worcester, which has been recruiting interim directors for more than a year.
“There’s a lot of loot to pay Paul,” Ratchford said.
Plant manager Rafael Torres, who oversees housekeeping, maintenance and laundry workers at Tewksbury, shut down the laundry room for the night and went in to help his distraught workers. Last winter, Torres removed all the snow himself, put in 16-hour days and told his three children not to babysit.
An assistant drove to Amazon a year and a half ago, and Torres, who was hired to replace him, quit a few months later. Finally, in July, Torres hired a new assistant at $19 an hour instead of getting two at $13.50 each.
According to the Massachusetts Department of Public Health, long-term care facilities have relied on temporary nursing agencies to make up for nursing shortages, which peaked during the outbreak and in 2018. 43 to 205 in 2020 But these agencies are adding to the problem, nursing home officials say, luring full-time nurses with higher pay and more flexibility. Last year, the state raised the cap on what agencies could pay nursing homes and, in turn, nurses, by an average of 25 percent.
At Blair House, which produces twice as much heat as it did a year ago, staff RNs making $34 an hour may be working side by side with an agency nurse making $50 to $55 an hour. Work nights or weekends. This inequity can create stress, took a year ago in Tewksbury, 24-year-old executive director Lilibeth Solis, with the help of a counselor. It’s her first job since graduating from college.
At Next Level Health Care, a staff nurse called in sick and tried to cover her own shift by working through an agency. to do $10-plus an hour, Dell’Anno said.
IntelyCare, a temporary nursing agency in Quincy, considers itself a “strategic partner” that can provide more flexibility to employees and thus help with retention, said President John Shagori. And when calculating the cost of benefits and vacation pay, according to a company-issued report, the hourly cost of full-time nurses is the same as that paid to part-time nurses.
Romano dismissed the discovery as “hogwash.”
The state has taken steps to address the nursing home workforce crisis, recently earmarking $165 million for salaries and deploying state-funded nursing teams to senior care facilities.
Along with funding, what’s needed, nursing home administrators and advocates say, is structural change: more teachers at nursing schools, paying professional standards to increase capacity. and support staff who attend nursing programs; Immigration policies that expedite the licensing process for foreign-trained nurses.
At Essex Group Management, the Romano family itself has been plagued by personnel problems. Son, who served as Milford’s executive director, recently resigned, citing stress over staffing shortages. Romano’s wife, who is retired, has been helping another son at a Milford assisted living facility, volunteering three days a week in the kitchen and helping with admissions and hiring.
Romano, 80, works full-time, and tries to do site visits every Saturday. He takes pride in his work, likening it to running a country inn — right down to the garnishes on guests’ dinner plates.
Even under stress, Romano likes to joke around with his staff and laughs easily. But his company is “bleeding money”. The only time in his life he could remember being the hardest was the year he spent fighting in Vietnam, he didn’t know which day. It may be the last.
He feels the same way about his business. “We are dead in the water” if things continue as they are now, he said.
Katie Johnston can be reached at katie.johnston@globe.com. Follow her on Twitter. @ktkjohnston.
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