The emotional, operational, and financial effects of the COVID-19 pandemic on nursing homes have come from seemingly all angles, but the leader of one of the nation’s largest providers this week identified social isolation as the biggest pain point — backed by a deeply personal connection.
Signature HealthCARE CEO Joseph Steier lost his brother, a long-term resident at one of the operator’s facilities, this past week.
“[He] really died of isolation, because when you think about visitation … we live off volunteers,” Steier said during a Wednesday panel discussion at the virtual Aging Innovation Global Healthcare Summit, hosted by the Louisville Healthcare CEO Council. “We live off church groups, you live off the kids’ schools. That is a family. It takes an external community to run a great community. I don’t think we realized how dependent we were on outside community support around the Signature community. So the loss of visitation was a devastating blow.”
Visitations at nursing homes have been tightly controlled since the earliest days of the pandemic, with the Centers for Medicare & Medicaid Services (CMS) banning all non-essential outsiders from facilities at the beginning of March. CMS has largely left it up to states to handle reopening plans, based on a framework that considers case count declines and access to testing, with varying rules and levels of openness in different areas across the country.
Resident advocates and families have long been calling for wider visitation rights, arguing that the ongoing bans have prevented families from providing supplemental care, provided cover for potential abuse and neglect, and deprived vulnerable seniors of companionship and stimulation vital to mental health.
Steier acknowledged the role that social isolation has played in the COVID-19 trends at his Louisville, Ky.-based company’s facilities.
“Right now we’re at an 86% recovery rate; we’ve had 5,000 COVID cases,” Steier said. “I’m proud of the recovery rate. I still think some of that is not the medical — it’s the isolation part we dealt with.”
The Signature CEO listed off a number of other top problems that the provider — which operates 110 facilities, with the greatest concentration in Kentucky — has faced since the start of the crisis, with strains on the supply chain for personal protective equipment (PPE) and staffing shortages chief among them.
In particular, Steier pointed to the power of fear and COVID-related family issues in scrambling staffing schedules: Many caregivers had an already sick family member, prompting serious concerns about working in the nursing home setting, while school closures — and subsequent child care needs — put increased strain on an already crunched workforce.
“I think everybody in this conference would love to double their caregivers’ salaries, because they’re the real heroes here,” he said. “Nursing homes have always been a little bit short [on staffing]. I think we did a decent job at that, but this really exploded the stability of the family.”
Finally, Steier acknowledged the lack of investment in new nursing home physical plants over the last several decades; older facilities with shared rooms and narrow corridors have been blamed in states around the country for hastening the spread of COVID-19.
“Nursing homes have been notoriously older assets — really the lack of an environment, the lack of infection control technologies that need to be put into post-acute centers,” he said.
The operator has seen its share of operational difficulties during the pandemic, laying off 100 corporate employees in June and projecting an additional $60 million in expenses above a normal year by the end of 2020, with weekly burdens for testing, PPE, and staffing hitting $5 million per week.
“We are at a point where difficult decisions have to be made on how to survive,” Steier said in a June statement at the time of the layoffs. “We know that COVID-19 will not be over in our business any time soon, and even as it may be overcome in the future, our sector and how we do business will never be the same again.”
But the company has also stepped up with an innovative testing strategy based on data analytics, and Signature senior vice president of clinical operations and innovation Camille Rochelle Jordan earned a seat on a White House commission aimed at improving nursing home care; the task force’s work wrapped up at the start of September.
Moving forward, Steier called for providers along the care continuum to develop a common language around data and telehealth, while also advocating for greater investment in aging workforce development efforts that aren’t limited to a single company or site of care.
“That’d be a great way for our employees to feel like we’re all working [toward] the same goals here,” he said.
Based on the staffing struggles of the last six months, Steier also suggested that the entire philosophy around hiring and paying caregivers — and how providers pay for it — take a page from Silicon Valley.
“Like Uber, there’s peak and non-peak times,” he said. “At some point, caregivers have got to get paid for quality. There can’t be an industrial model for wages.”