Nursing home staff shortages and other problems persist, according to a US report

Many Americans prefer to believe that the Covid pandemic is a thing of the past. But the impact has not completely disappeared for the country’s nursing homes, with staffing shortages and employee burnout still at crisis levels and many facilities struggling to stay afloat, according to a new report published Thursday by federal investigators.

The report from the U.S. Department of Health and Human Services’ Office of Inspector General found that flawed infection control procedures that contributed to the 170,000 nursing home deaths during the pandemic remained inadequate in many facilities. And while uptake of Covid vaccines was initially robust when they first became available, researchers discovered that vaccination booster rates among staff and residents are seriously lagging behind.

The findings were addressed to the Centers for Medicare & Medicaid Services, the agency under the department’s jurisdiction that oversees 1.2 million nursing home residents whose care is provided primarily by the federal government. The inspector general’s report described the workforce problems as “monumental,” noting high levels of burnout, frequent employee turnover and the burden of constantly training new employees, some of whom don’t show up for their first business day. For nursing homes, the inability to attract and retain certified nursing assistants, dietary staff, and housekeeping staff is tied to federal and state reimbursements that do not cover the full cost of care.

Rachel Bryan, a social science analyst with the inspector general’s office, said the report wanted to ensure that key lessons from the pandemic were not lost, especially as the acute sense of urgency has faded.

“Just as airplanes cannot be repaired in flight, the problems in nursing homes during the pandemic could not be fully repaired,” she said. “We strongly believe that as we emerge from emergency mode, we take the time to reflect, learn and take real steps toward meaningful change.”

The Centers for Medicare & Medicaid Services declined to discuss the recommendations and instead assigned a reporter to report on comments the agency provided for the report. These comments were largely noncommittal and did not agree or disagree with the recommendations, but agency officials asked to remove some of the proposed recommendations from the report, saying improvements were already in the works.

For example, the agency cited a new federal program that will provide $75 million in scholarships and tuition reimbursement to those pursuing a career in nursing.

The report, based on interviews with twenty nursing home managers from across the country, paints a picture of a sector in deep turmoil. Many nursing homes are still reeling from the trauma wrought by the pandemic, when shortages of personal protective equipment and widespread fear of infection drove away veteran workers and forced nursing home operators to lock out outside visitors, exacerbating the fear and isolation of their residents worsened.

At the height of the pandemic in 2020, two in five Medicare beneficiaries in nursing homes were infected with Covid and more than 1,300 nursing homes had infection rates of 75 percent or higher during peak periods, according to an earlier report by the Inspector General. For example, there were in April 2020 1,000 additional deaths per day among Medicare nursing home beneficiaries than in April 2019. Death rates were higher in for-profit nursing homes, researchers found.

Bee Bethany Homea nonprofit nursing facility in Lindsborg, Kansas, has laid off a third of its employees during the pandemic, many of them driven by their opposition to vaccination mandates or by the nationwide shortage of personal protective equipment that has forced health care providers to use trash bags as gowns and cotton underwear for masks, says Bethany CEO Kris Erikson.

“There were days during the pandemic when I measured my success by how long I hadn’t cried in my office,” said Mr. Erikson, whose father lives in Bethany. “It was so hard.”

Bethany still needs to recover. Mr Erikson said the facility had to cut about 20 of its 85 beds because it was unable to hire new staff. For the first time in its 100-year history, Bethany has a waiting list, he said.

The biggest challenge in recruiting employees is the $13.50 hourly wage that Bethany offers to entry-level nurses — a rate determined by reimbursements provided by the federal and state governments, he said. “We need a base rate between $16 and $20 if we want to compete with McDonald’s in the next town,” he said.

Recruiting problems have been exacerbated by private staffing agencies charging nursing homes as much as 50 percent more for workers, some of whom administrators described as less reliable than their permanent employees. “The agency staff comes in and talks about how much money they make and our own staff gets upset because the agency staff doesn’t work as hard,” the report quoted an operator as saying.

Katie Smith Sloan, president of LeadingAge, a nonprofit association of nursing homes, said higher federal reimbursement rates would help, but that staffing issues could best be addressed by mobilizing some government agencies. For example, she said, the Department of Homeland Security could include nurses in temporary worker visa programs that bring in agricultural workers from abroad, and that the Department of Education, with support from Congress, could make Pell grants available to student nursing assistants and interns culinary employee.

Ms. Sloan and other nursing home advocates have criticized a Biden administration proposal that would require nursing homes with the thinnest staffs to hire more workers or face fines. The proposal does not include increased funding that would help facilities meet the new mandates.

“This is bigger than CMS,” Ms. Sloan said, referring to the Centers for Medicare & Medicaid Services. “We need to figure out how to creatively apply the things that work to this persistent workforce problem.”

There were some bright spots in the inspector general’s findings. Many nursing home administrators said the acute shortage of personal protective equipment had eased since 2021. And the report highlighted creative solutions some nursing homes used successfully to retain staff, including hiring bonuses, free staff meals and the decision by many facilities to take advantage of licensing. waivers that allowed them to provide nursing assistant students with on-the-job training.

And despite initial stumbles, many experts say the initial vaccine rollout was a success, although the spread of vaccine misinformation has significantly reduced the uptake of Covid boosters among nursing home staff and residents. According to the newspaper, only 41 percent of residents and 7 percent of employees are aware of the vaccines Center for Disease Control and Prevention.

But many experts say the system of care for the country’s aging population is fundamentally broken. It’s an issue that will only become more pressing as the boomer demographic ages.

Elizabeth White, a professor at Brown University School of Public Health and an expert on long-term care, said the problem reflects a lack of political will to spend what is needed to support Americans in their golden years .

“The pandemic has helped highlight the challenges nursing homes face, but it is still the elephant in the room,” she said. “The financing system is broken and the problem is so big that it is very difficult to get the political motivation to do something about it.”