National Guard Deployment ‘Buys a Little Bit of Time’ For Short-Staffed Nursing Homes

As members of the National Guard are being sent to nursing homes across Minnesota and New York to help short-staffed facilities — for an industry that lost 8,400 last month and an estimated 234,000 jobs since the beginning of the pandemic — the deployment may have only bought facilities a little more time to figure out what to do next. 

“There will be a few of the buildings, especially if they’re smaller, rural communities where the [National] Guard is just going to be there to make the transition easier for closure and eventually the residents will have to be transferred somewhere else,” Care Providers of Minnesota President and CEO Patti Cullen told Skilled Nursing News. “That’s why we are doing this. We know that without them, there would be far more closures. With them, it buys a little bit of time.”

Minnesota’s National Guard deployment, announced last month, enlisted 400 members trained to serve as nursing assistants and temporary nursing aides for up to three-week deployments at a time.

Monarch Healthcare Management had its first National Guard members show up at Green Prairie Rehabilitation Center in Plainview, Minn. last week where they will help out with support services for the community.

“We had four that arrived right away and we’re trying to figure out exactly what they are going to be doing,” Monarch Chief Operating Officer Marc Halpert said. “They said they’re gonna do housekeeping, laundry, and maybe some other activities. We’re going to see if we can train them to become CNAs.”

For Monroe Community Hospital, located in Rochester, N.Y., deployment of the National Guard has been “fast and furious.”

“From the time that we were notified that there was going to be a deployment of a National Guard, I was on the phone with the Department of Health at about eight o’clock at night on a Tuesday and they were walking in the door on a Saturday morning,” Monroe Executive Health Director Alyssa Tallo told SNN.

The nursing home received 26 medics and four general purpose soldiers that act as “support” for the rest of the facility.

“In New York, we were still required to put them through training under the CMS waiver. So we put everyone through facility TNA training and now they’re out on the units acting as TNAs,” Tallo said. “We don’t know for certain [how long they will be here]. Mid-January is when they’re supposed to do a review. I’m going to try to push to have them as long as they’ll give them to me, just because we know it’s a short-term fix.”

She said finding the best way to utilize them has been a balancing act between all the current needs of the facility and the health care system as a whole.

“If we bring those 26 in, what support can we provide to the rest of our staff, what amount can we actually stretch our staff a little bit further to try to alleviate some of the acute care hospitals that are functioning over 100% capacity right now,” Tallo explained. “It’s been a very fine line. We’re struggling as a region right now, the entire system.”

While it’s difficult to pinpoint exactly how many staff Monroe Community Hospital is down at the moment, Tallo said that it would struggle to meet New York’s new staffing mandate that goes into effect on Jan. 1, 2022.

“It requires 2.2 hours per resident per day for CNA staffing, even with the 26 medics, we would struggle to meet that for existing patients every day,” she said.

Tallo wants to see additional long-term solutions to try to “incentivize people” to go into health care and to fix the reimbursement structure for nursing homes.

“We are just struggling to make ends meet and there’s a lot of facilities that are going to be shutting our doors because of the increased cost,” she said. “Some of our acute care partners are paying upwards of $100 an hour for RNs. I can’t compete with that when my Medicaid rate actually loses me $200 a day.”

For some nursing homes the influx of National Guard, even if only temporary, will buy them some more time to assess and plan their future. For some that transition could even mean moving to assisted living.

“One of our members closed their nursing home and converted it to assisted living because assisted living communities need fewer staff,” Cullen explained. “That could be one of the options. So it does buy a little bit of time so that you don’t put any of the residents at risk while you’re doing this transition.”

Cullen felt the National Guard deployment and the governor’s initiative to train 1,000 CNAs serve as short-term solutions to “try to get us through the holiday season.”

“The biggest thing we need to do is boost up the starting wage,” she said. “We think the starting wage for CNAs needs to be at least 20 bucks an hour with additional benefits. So we have been talking to legislators and administration on what other initiatives can be done, including loan forgiveness and childcare, about 70% in our communities are moms.”

Minnesota Senate Republicans also recently proposed an estimated $150 to $200 million nursing home relief package that includes a multi-prong approach to retain current staff, recruit new nursing home staff and replace staff expected to leave.

Some of the solutions proposed in the relief package include providing $1,500 to each current employee to remain working until at least June 30, 2022 in order to be eligible for the entire grant amount. Others include providing $1,500 to former employees who recently left the profession to return and work at least until June 30 and allowing RNs, LPNs and CNAs licensed in other states to work in Minnesota for up to six months.

“Again, this is one-time money that’s being used, and it’s not a permanent solution … a permanent solution is going to be to increase wages and to make it a profession that’s valued,” Cullen said. “The longer term solution is going to be a lot more expensive than roughly $150 million of one-time money, but as I told everyone, if any of those provisions in any proposal allows us to recruit or retain any number of staff, we embrace it.”

Opening up the state to more traveling nurses is also something Cullen strongly supports.

“I think 38 states are nurse compact states and Minnesota is not one of them,” she said.

Under the Nurse Licensure Compact (NLC), nurses can practice in other NLC states, without having to obtain additional licenses.

“For those facilities that we have on the borders, they really wish that would pass because right now, you can only temporarily get someone to come in and work under waivers,” Cullen said.

Across the southern border from Minnesota sits a technical school in Iowa that offers a wide range of classes for nurses.

“The facility that I talked about earlier that converted to assisted living did so because they had three nurses leave,” Cullen explained. “They’re located about a half hour from Iowa, if they could have gone and actively recruited and hired from that college that would have solved it. None of these solutions are broad, sweeping silver bullets, but every single one can help.”

With legislative sessions in the state not officially starting again until the new year, Cullen doesn’t expect longer term solutions to take effect until the summer at the earliest.

“So again, the purpose of the [National Guard] is to do a short-term bridge,” she said. “One of our buildings that had National Guard [come in] is in a unique circumstance, they have quite a few immigrants who work for them who traditionally take time off to go to their home country over the holiday. So they’re using the National Guard, frankly, as a bridge, because they have some staff leaving over the holidays, and they fully plan on them to come back.”