As the COVID-19 pandemic continues to sweep through the nation’s nursing homes, the industry’s already strained workforce could soon reach a new breaking point as caregivers become sick themselves — or fear spreading the virus to their loved ones.
The staffing crisis hit the national media last week, when a nursing home in Riverside, Calif. was forced to evacuate more than 80 residents after a large group of employees missed work on consecutive days, according to multiple reports.
Leaders at companies that provide temporary staffing for skilled nursing facilities say the true workforce troubles are only just beginning.
“I can guarantee you that stress is going to be hitting the high point in the next week or so,” David Coppins, co-founder and CEO of nurse staffing software company IntelyCare, told SNN last week.
While stories of outbreaks and deaths at nursing homes have dominated the news for weeks now, the post-acute setting’s position in the health continuum — particularly as a destination for hospital discharges — could mean that the worst is yet to come.
“There’s definitely a lag from what you see happening in communities on the acute side,” Matt Levesque, CEO of connectRN, said. “It seems like the skilled nursing facilities are about two, three weeks behind what you see in any city from the acute perspective.”
Even before COVID-19 began spreading quickly through nursing homes around the country, operators had long grappled with staffing shortages, and workforce development representing something of a perpetual, intractable challenge in the industry.
But the coronavirus added to that already daunting challenge on multiple fronts.
First, younger and relatively healthy caregivers can serve as unwitting vectors of the disease: An early analysis of an outbreak at a facility in Kirkland, Wash. from the Centers of Disease Control & Prevention (CDC) determined that the sharing of staffers across multiple buildings helped to hasten the virus’s spread.
Based in part on the CDC’s findings, the most recent guidance from the Centers for Medicare & Medicaid Services (CMS) requires nursing homes to use dedicated teams to care for the same groups of residents — both so the workers don’t spread COVID-19 throughout a facility, and so they can more closely monitor specific residents for signs of viral infection. This adds another layer to nursing homes’ staffing struggles, reducing operators’ flexibility when looking to fill gaps in shifts.
Finally, there’s the human toll of COVID-19 on nurses and other caregivers, who must go into work every day knowing that they could potentially contract the disease and perhaps spread it to members of their household.
A survey of more than 1,100 nurses in IntelyCare’s system, conducted earlier in the crisis, found that 60% were unconcerned about the virus and would not change their work habits — but more than a quarter said they would either work less or not at all due to safety concerns.
A little under 15%, meanwhile, said they’d actually work more, given the potential for more available hours and a desire to help during the crisis.
In addition, about 38% indicated that they would reduce the number of sites where they provide care, focusing only on “a limited number,” while around 17% said they were “very concerned” and would only take shifts at one or two facilities.
Aside from fears over contracting COVID-19, the logistical strains on caregivers will continue to grow as strict social distancing measures enter their second month. With schools closed and governments urging people to stay home as much as possible, nurses and other workers with children may not be able to find child care options, forcing them to stay home and out of the workforce.
“You’re going to see, on the margins, a lot of people not being able to work, and not being able to show up for work,” Charles Turner, CEO of Kare — an app that pairs workers with shifts at senior housing and care facilities — said.
Kare, which recently expanded its footprint to include more markets in its home base of Texas in response to the COVID-19 crisis, conducted a similar survey of its workforce — and found that around a third cited “logistical hurdles … that will prevent you from or limit your ability to work,” Turner said.
But the nursing labor pool has both entrances and exits amid COVID-19, according to Levesque.
While his company, which also provides an app that matches facilities with available nurses, has seen workers leave the platform due to logistical issues at home, some are coming back after extended periods away.
“We’re definitely seeing re-engagement,” Levesque said. “We’re seeing nurses who maybe had not worked on our platform for two years, all of a sudden, are back and working.”
To retain existing workers, and potentially entice nurses to come back into the workforce, connectRN implemented hazard pay for anyone who picks up shifts at a facility with COVID-19 cases. The platform also allows facilities to create dedicated coronavirus shifts, helping them comply with CMS guidelines while providing full disclosure to nurses before they arrive on site.
“Overall, our nurse pool continues to grow, and you continue to see very vigorous engagement, but I do think you have a mix,” Levesque said. “Some folks are coming back off the sideline, and unfortunately, you have some folks who need to put themselves on the sideline and remove themselves from the situation just because of their own personal situation — which is completely understandable.”
That growth of the labor pool is vital as the need for their services has spiked: connectRN has seen a 50% increase in demand for hours on its platform, according to Levesque.
At IntelyCare, Coppins also confirmed that demand has grown, though he noted that not all operators have turned to outside staffing to help beat back the tide.
“It’s binary in terms of how they’re approaching it,” Coppins said. “They’re either taking the extreme of no outside help, or they’re taking the other extreme of: ‘Give me all the help I can get.'”
For instance, one IntelyCare client that had previously used the platform to fill 1,500 hours per week abruptly stopped in favor of in-house staff only, in part based on fears of temporary workers spreading the virus.
But for other providers in other areas, the need is acute and immediate.
“They are in desperate need, and a lot of their own staff is out — because they’re sick, or they’ve been directly exposed outside of their facility, and so they have curtailed their involvement,” Coppins said. “We end up with massive increases in demand in some areas and reduced demand in other areas.”