At Tewkesbury nursing home, labor shortages reveal a struggling industry

To fill the void, he hired temporary nurses and increased overtime hours — and closed more than 20 hospital beds.Limiting admissions significantly reduces revenue while costing the facility an additional $1.5 million per year to nursing facilities to address chronic staffing vacancies. Existing employees were asked to work long hours, causing more employees to leave.

All six of Romano’s Essex Group Management’s nursing homes in Massachusetts, as well as two assisted living facilities and other senior service facilities, face similar workforce challenges. He raised wages several times, but the bleeding still hasn’t stopped. Hospitals seeking placement for elderly patients kept sending in requests, but Romano’s center was often unable to accept them.

“It’s a death spiral,” he said. “If we don’t get help, we’re going to collapse.”

Nursing homes get special treatment at a time when people are quitting at a record rate Devastating blow. Labor shortages, already an issue before the pandemic, have ballooned to record levels, with 6,900 vacant nursing positions at long-term care facilities statewide, or a 22% vacancy rate, according to the Massachusetts Association for Senior Nursing. Industry trade group.most or these skilled nursing facilities are heavy Dependent on Medicaid Reimbursement, which means pay is often not as competitive as a hospital or other medical facility. There has also been a sharp drop in immigration, many of whom work in nursing homes.

This problem will only intensify as the population ages.

“There is nothing more important than caring for our frail elderly,” said Tara Gregorio, president of the Massachusetts Senior Nursing Association.

However, due to the limited salary and high job requirements, I feel That’s all there is to it. The admiration for healthcare workers at the start of the pandemic faded quickly. As one nurse told Gregorio in the summer of 2020: “We went from heroes to zeros in the blink of an eye.”

Romano started the nursing home business after returning from the Vietnam War and decided he didn’t want to spend the rest of his life working as an IBM salesman. His father was a doctor who converted several old estates into nursing homes, and Romano knew the need to care for the elderly. Soon Romano’s wife was working in IT and his three grown children were joining the family business.

When the pandemic hit, COVID devastated senior care facilities, causing lockdowns and putting severe strain on those caring for sick and isolated residents. At Blaire House of Tewksbury, staff sleep in cribs during the outbreak. In 2020, COVID killed 23 residents and one employee; since then only one resident has died from the disease.

Maura Ratchford, Nursing Staff Development/Incumbent at Blair House, is pictured on the ward floor. Jim Davis/Universal Staff

The pandemic has also exposed staffing shortages that have plagued nursing homes for years. According to a study by the University of California, San Francisco, more than half of U.S. facilities are staffing less than experts suggested in 2014, and a recent USA TODAY survey found that severe shortages continue.

At Blaire House of Tewksbury, each resident must provide an average of 3.58 hours of care per day to be fully reimbursed by Medicaid, and the average daily patient care hours in the third quarter was 3.42 hours. That resulted in a shortfall of more than $18,000, which Romano largely attributes to temporary agency nurses failing to show up. According to industry estimates, approximately 45 percent of the state’s nursing facilities do not meet the requirements of 3.58.

Healthcare workers say burnout levels are as high now as they were at the peak of the pandemic, if not higher. At Blair House, nurses either retired early or moved to hospitals, temporary agencies and insurance companies, where the pay was higher and in many cases less stressful. Food service workers, housekeepers and nursing assistants will head to Amazon, local colleges — pretty much anywhere — in search of better wages.

State Mandated COVID Vaccination Requirements Nursing school teacher shortages and Immigration policies make it difficult to bring in foreign-trained nurses. (Romano hired 40 registered nurses from the Philippines 14 months ago, all of whom had green cards and passed licensing exams, but none passed immigration). Some employees are tired of being required to wear masks; others who have worked throughout the pandemic just need a change.

in the past year, 75 workers Away from Blair House, some positions have been vacant for months.

Housekeeping, laundry and maintenance services are all suspended Five workers; Dining Services has seven vacancies; and the Nursing Department needs 10 full-time nurses and 13 nursing assistants. The director of nursing jumped to a health care company in June, and this position has been vacant.

Julissa Rivera, a human resources employee, said some people quit without finding work. Filling open positions is a scramble. Rivera reached out to applicants who never called back and scheduled interviews for those who never showed up.

“It’s just a battle,” she said.

The head of another company’s Worcester-area retirement facility, who asked not to be named, said in an interview that job seekers have an “entitlement mentality” that didn’t exist 10 years ago: They don’t want to work hard, they don’t want to get vaccinated , refused to hand over the mobile phone during work. Some new college graduates go directly into respite or travel care facilities because of the flexibility offered.

This inability to fill nursing home jobs has painful knock-on effects. Some 62% of the state’s skilled nursing facilities had to freeze new admissions in October because of staffing shortages, according to industry data, meaning hospitalized patients preparing to be discharged could spend weeks or months in the hospital waiting to be recruited from nursing homes. The slot opens. This has created a serious backlog as some hospitals run to capacity and face staffing shortages themselves. For example, admitted patients at UMass Memorial Medical Center in Worcester waited an average of 17 hours for a bed in the emergency room.

Nursing home administrators have been alarmed by the mass exodus of labor.

“It’s like a tsunami,” said Damian Dell’Anno, CEO of Next Step Healthcare, which is closing several nursing homes in Massachusetts as rising costs, underfunding of the state and temp agencies lure nurses away with higher salaries .

And it’s only expected to get worse. Nearly one-third of registered nurses in the U.S. say they are likely to leave direct patient care in the next year, according to McKinsey & Company. The health care system could be short of as many as 450,000 nurses over the next three years, according to the survey.

“If we are at the tipping point Now, what happens in 2025? said Romano.

In Massachusetts, a declining birth rate, an aging population, a drop in international immigration and the fourth-highest number of people leaving the state last year added to the shrinking workforce. Massachusetts Taxpayers Association.

At Tewkesbury, RN Maura Ratchford remembers a time when on-the-job training was a pleasant experience, complete with policy refreshers over lunch. Now, Ratchford has to pull the people at the nurses’ station aside to review procedures on the fly.

“They can’t be off the floor that long,” she said. “They were lucky enough to eat.”

Ratchford also helped the acting head of nursing – who was sometimes called in for weekend shifts – until recently back at Blair House in Tewkesbury. For seven months, Larchford worked part-time as director of nursing at Blair House in Worcester, an agency that has cobbled together interim directors for more than a year.

“There was a lot of robbing Peter to pay Paul,” Ratchford said.

Plant manager Rafael Torres, who oversees Tewkesbury’s housekeeping, maintenance and laundry staff, closed the laundry at night and went to work to help overwhelmed workers. Last winter, Torres did all the snow removal himself, working 16-hour days and telling his three children not to wait.

An assistant left a year and a half ago to drive for Amazon, and the person Torres hired to replace him quit a few months later. Finally, in July, Torres hired a new assistant at $19 an hour instead of two at $13.50 each: “I hope he can at least make it through the snow,” he says.

Long-term care facilities have been relying heavily on respite facilities to make up for nurse shortages, and the number of respite facilities has skyrocketed during the pandemic, from 43 in 2020 to 205 in 2022, according to estimates from the Massachusetts Department of Public Health. But nursing home executives say the facilities are also exacerbating the problem, luring full-time nurses away with higher salaries and greater flexibility. Last year, the state raised the cap on what agencies can charge nursing homes, leading to an average 25% increase in nurse salaries.

At Blaire House, there are twice as many temps as there were a year ago, and RNs making $34 an hour can work alongside facility nurses making $50 to $55 an hour who, unlike employees, can choose not to work nights or weekends . Lilybeth Solis, the 24-year-old executive director of Tewkesbury, which took over a year ago with the help of a mentor, said the inequity caused tension. This is her first job after graduating from college.

At Next Step Healthcare, a nurse called in sick and tried to pay for her shift through an agency to do That’s an extra $10 an hour, Dell’Anno says.

President John Shagoury said IntelyCare, a respite care facility in Quincy, sees itself as a “strategic partner” with long-term care facilities that can help with retention by offering employees more flexibility. When benefit costs and vacation pay are factored in, the hourly cost of a full-time nurse is about the same as a temporary nurse’s facility wage, according to a report commissioned by the company.

Romano dismissed the finding as “bullshit.”

The state has taken steps to ease the nursing home workforce crisis, recently earmarking $165 million in wages and deploying state-funded nursing teams to senior care facilities.

Beyond funding, what’s really needed, say nursing home administrators and advocates, are structural changes: More teachers to boost capacity in nursing schools; paid career ladder Support for employees participating in nursing programs; immigration policies to expedite the licensing process for foreign-trained nurses.

At Essex Group Management, the Romano family has itself been hit by a staffing crisis. The son of a Milford executive director recently resigned, citing pressure from a labor shortage. Romano’s retired wife has been helping another son at the Milford assisted living facility, volunteering in the kitchen three days a week and helping with admissions and hiring.

Romano, 80 years old, works full time and tries to make site visits every Saturday. He takes pride in his job, which he likens to running a country inn – right down to the garnish on guests’ plates.

Romano enjoyed cracking jokes with his staff, and despite the stress, he had an easy laugh. But his company is “losing money,” he said.The only time in his life that was tougher than him was the year he fought in Vietnam and he didn’t know what day it was Possibly his last.

He feels similarly about his business. If things continue as they are now, he said: “We’re dead in the water.”

Katie Johnston can be reached at her on Twitter @ktkjohnston.

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