RI State Budget must address long term care staffing crisis – Herb Weiss

by Herb Weiss, contributing writer on aging issues

As Rhode Island and states throughout the country loosen COVID-19 mask restrictions with the number of new coronavirus cases dropping by more than 75% since the highs in mid-January, and hospital admissions and death rates declining, AARP Rhode Island warns that now is the time to take steps to protect nursing facility residents from future COVID-19 surges in the state’s nursing facilities. 

In a statement released on Feb. 18, 2022, AARP Rhode Island, the state’s largest aging advocacy group for seniors, says that their “AARP’s Nursing Home COVID-19 Dashboard”, covering the four-week period ending January 23rd “paints a grim picture of the devastation caused by the surge of the Omicron variant in America’s nursing homes and underscores the need for booster shots to protect both residents and staff.”

A snapshot of COVID-19’s impact in nursing facilities

AARP Rhode Island’s statement notes that facility staff cases were more than 11 times as high nationwide as in last month’s Dashboard (covering the four weeks ending December 19), with resident cases nationwide more than eight times as high.

“Here in Rhode Island, staff cases increased nearly tenfold from the rate of 2.96 per 100 residents in December to 24.5 during the same time period in January. Resident cases spiked from a rate of 2.6 to 15.8. Nursing home resident deaths from COVID-19 increased from 0.18 per 100 residents in December to 0.30 in January,” says AARP Rhode Island.

AARP’s Nursing Home COVID-19 Dashboard also shows that as of January 23, 72% of nursing home residents in Rhode Island were fully vaccinated with a booster dose, an increase from mid-December’s 61.8%. Meanwhile, 35.6% of direct care staff had received a booster, an increase from 24.8% in mid-December.

“We know boosters save lives; we know they help prevent infections and severe illness,” said Catherine Taylor, State Director of AARP Rhode Island, which serves more than 130,000 members aged 50 and older in the Ocean State. “Even though the worst of the Omicron surge is hopefully behind us, the pandemic isn’t over. The delivery of booster doses to nursing home residents and staff must remain a high priority as these residents are among the most vulnerable to COVID-19 and its variants.,” she says, noting that the number of facilities in Rhode Island reporting a shortage of nurses or aides has also increased from 32.9% to 52.1%. in the four weeks ending January 23.

“The last two years have highlighted the chronic, ongoing issues that have long plagued nursing homes—such as the shortage of direct care workers, which is now a crisis; low pay that drives workers to take second and third jobs in multiple facilities; and shared rooms and bathrooms (for residents in facilities) – and that are chief contributors to poor infection control,” said Taylor.

John E. Gage, MBA, NHA, President & CEO, Rhode Island Health Care Association, says “AARP Rhode Island’s story is based mostly on national numbers, and RI’s situation is actually quite good” and its data recognizes the achievements of the state’s facilities as deserved. 

Nursing facilities continue to follow strict Covid-19 guidance provided by Rhode Island Department of Health (RIDOH) following CDC Guidance, says Gage, noting that residents and staff are among the highest vaccinated and boosted in the nation which has helped limit the impact of the latest Omicron surge.

“Numbers are dropping as quickly as they spiked, and we are hoping for a return of greater “normalcy” as we enter the Spring,” adds Gage as staff continue to utilize full PPE when providing care to residents, and masks are used at all times in nursing homes. They also continue to follow quarantine and isolation guidance for residents and staff as provided by the RIDOH – this guidance is updated frequently”, he says.

“Staff left early on in the pandemic because of fear of Covid. Remaining staff worked tirelessly throughout the first wave of the pandemic without vaccines and without the availability of sufficient PPE,” recalls Gage, stressing that “they are true heroes, but they are burned out, and many have chosen to leave for higher wages or less stress.” 

“Those who remain are working overtime – picking up shifts to help cover for the 20% vacancy rates in RI facilities,” he says, adding that facilities are paying higher wages, overtime, and bonuses to their existing staff, and they are forced to use temporary nurse staffing agencies at 4 times the pre-pandemic level.

The pandemic and RI’s staffing crisis

Now, in the midst of this crisis, facilities are expected to comply with the minimum staffing mandate passed during last year’s legislative session, says Gage, warning that it is impossible for the state’s 77 facilities to comply with the mandated staffing levels. “There are not enough willing applicants, Rhode Island Medicaid reimbursement does not allow facilities to make meaningful pay rate increases, and the staffing mandate is woefully underfunded,” he charges. In fact, when fully implemented, the unfunded mandate that is the minimum staffing statute will result in a $47 million/year reimbursement shortfall – that on top of the $50 million/year in pre-existing underfunding,” he says. 

“Then, when nursing homes are unable to meet impossible staffing thresholds in the midst of this workforce crisis, they will be fined millions of dollars for non-compliance (RIDOH estimated $8.3 million in fines in the first quarter alone). These fines will actually divert resources from nursing homes and further imperil the care and services our elder residents who reside in nursing homes so deserve. This is a true crisis in the making,” according to Gage.

“The intent of the minimum staffing statute was to provide more caregivers and better care but did not provide the resources to do so – the workforce or the appropriate reimbursement to pay that workforce. The state’s facilities have always had a reputation of providing among the best nursing home care in the country. That reputation is in peril now,” adds Gage.

“The pandemic will be with us for a while [and that] has highlighted the need to reimagine long term supports and services,” says  Maureen Maigret, state’s Long-Term Care Coordinating Council Aging (LTCCC) in Community Subcommittee.  “We need to provide incentives through low cost loans and reimbursement rates for nursing homes to convert to private rooms and bathrooms which would go a long way to prevent the spread of infections. We also need to enhance access to home and community-based services to give more persons the choice to get care at home. And finally, we must urge our Governor and legislature to take immediate steps to address the workforce crisis by ensuring our direct care workers receive fair, competitive wages and opportunities for specialized training and advancement,” says Maigret, a former Director of the state’s Department of Elderly Affairs (renamed the Office of Healthy Aging).

Increasing Medicaid payments 

Last month, Gov. Dan McKee submitted a $12.8 billion state budget to address the pandemic, build more affordable housing, also providing increased funding to schools and small businesses.  In its statement, AARP Rhode Island called on the Rhode Island General Assembly to ” address the direct care workforce shortage through a combination of wage increases, paid training, professional development and enhanced benefits, and enact an enhanced rate for single rooms in nursing homes, retroactively.” Maigret said: “These are necessary for transforming how we provide nursing facility care. However, the Governor and lawmakers must address the immediate and urgent need to raise wages for direct care staff working in home and community programs as well,” she said, noting that the average wait time to get home care services paid by Medicaid is more than three months.”

Maigret adds: “It’s unacceptable that so many people wait so long to receive services due to the state’s failure to increase provider rates to allow them to pay our workers competitive and fair wages. It also inhibits reaching the state’s goals for providing people choice and receiving services in the least restrictive setting.”  

“The demographics are undeniable,” says Gage, noting that Rhode Island’s 85+ population will double in the next 15-20 years. “ Of course, we want everyone to have the option to live in the setting most appropriate for their needs.  However, this impending wave will overwhelm the state’s entire LTC continuum – home care, assisted living residences and nursing homes,” says Gage.

Gage calls on McKee and Rhode Island lawmakers to make sure that Rhode Island Medicaid ensures the long-term viability of the entire LTC continuum, including nursing facilities, to meet the needs of the most fragile Rhode Islanders today and in the coming years as demand will inevitably rise.

“The recently released AARP Nursing Home Dashboard data underscores the continued necessity of this advocacy, and the need for the legislature to pass these critical reforms this year,” says AARP’s Taylor

Don’t forget the state’s most vulnerable

The AARP Nursing Home COVID-19 Dashboard  analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard, and an AARP story about this month’s data is available here. For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination and booster rates within individual nursing homes and how they compare to state and national averages.

_____

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.