Home Health Steps Up to Fill Staffing Gaps in Nursing Homes Amid COVID-19

The COVID-19 pandemic struck the Northeast with particular force, with skilled nursing facilities sitting on the front lines.

One of the pressures stemming from the pandemic came on the workforce front, as frontline caregivers such as nurses and certified nursing assistants fell ill with COVID-19. And as the spread of the virus accelerated in New Jersey, one home health company saw the chance to ensure that its aides were able to stay employed — while also helping ease the burden on some of its skilled nursing referral partners.

It’s another example of ways health care providers have crossed the lines of the continuum for COVID-19, much as an ambulance company on the West Coast found success in sending its emergency medical technicians into SNFs that were short-staffed because of the pandemic.

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The program in New Jersey started toward the end of March, when the state signed off on a waiver that allowed home health aides to work in SNFs as CNAs; prior to that waiver, home health aides were not allowed to work in SNFs, Senior Company executive director Calvin Bynum told Skilled Nursing News in a June 1 interview.

The Totowa, N.J.-based Senior Company provides private-duty home care, as well as skilled and non-skilled services, in counties in the northern part of the state — some of the counties hardest hit by COVID-19, Bynum noted.

These included Bergen, Essex, Hudson, and Passaic counties — which as of June 4 had 18,408, 17,912, 18,465 and 16,311 positive test results for COVID-19, respectively, according to the state’s dashboard for tracking the illness.

When some of the SNFs in the Senior Company’s footprint began to experience staffing struggles, it came at the same time as the firm had lost many of its private-duty clients that were its “bread and butter,” Bynum told SNN. As a result, the company was looking for ways to keep its own employees supplied with shifts.

“We had gotten a couple phone calls from facilities that we’re close with, asking if we had any staff, and that’s when we became aware of the waiver,” Bynum told SNN. “So at that point we really ramped up our recruiting. Some of our current aides that worked in the homes were okay with working the facilities; some were not.”

As a result, the company focused on recruitment for two weeks and almost doubled its staff, adding more than 100 aides and CNAs in that timeframe, creating an entirely new division of the company. While the same office employees are used, the Senior Company is now working with staffing coordinators, administrators, and directors of nursing at its SNFs.

As of June 1, the Senior Company has about 100 aides deployed in 18 different facilities. The firm already had relationships with the social workers and administrators, among other SNF workers, at some of those locations because of their work transitioning patients to the home setting. Many of those facilities called to ask if there were some aides willing to come in; the original plan was that they would only help maintain the required staffing ratios and not work with a SNF’s COVID-19 patients.

That plan did not last long.

“Eventually all the aides started working with COVID patients,” Bynum said. “We set very clear expectations. We did not smoke-and-mirror any of our employees; we made them sign waivers, we explained what was going on, we explained the hazard pay we were going to be paying and made sure they were completely comfortable with it before they went in.”

Typically, the Senior Company prefers to see four days to a week’s notice in terms of filling shifts at a SNF, but Bynum acknowledged that sometimes a facility will have last-minute callouts. The workers themselves are under the supervision of the director of nursing in a facility, even though they’re employed by the Senior Company.

The SNF is also responsible for ensuring that the aides are protected with adequate personal protective equipment (PPE), which was a problem toward the beginning of the COVID-19 pandemic for some facilities, Bynum noted.

“We really set clear expectations with any employee that we were sending in that if they didn’t get masks, gloves, gowns — everything that they needed to protect themselves when they walked into that facility — they don’t take a step further,” he said.

The program itself can only work with home health aides as long as the COVID-19 waiver is in effect, but Bynum said he believes the Senior Company will continue to focus on staffing — including the hiring of CNAs — even after the waiver expires.

“It’s a way to expand our business, create new jobs and kind of further our relationship with the facilities we already have relationships with, and new facilities,” he told SNN.