In-House Worker Pool Crucial During Omicron Surge to Fill Staffing Gaps

The omicron surge – coupled with an ongoing staffing crisis – has added pressure to facilities that would have to further tighten occupancy if not for an in-house pool of floating staff between buildings, operators say.

Facilities that can pull from a wider pool of resources attached to larger operators, such as staff and personal protective equipment (PPE), are in a better position to handle the latest surge, according to Nancy Gelsinger, executive director of Hilltop Skilled Nursing and Rehabilitation in Charleston, Ill.

Hilltop, an 88-bed facility, is owned by Illinois-based Crest Healthcare; Crest owns 13 properties including Hilltop.

The SNF operator has put together its own staffing agency, Gelsinger said, pulling from a pool of staff members across its 13-facility company. If Hilltop needs extra workers, sister facilities in the area can answer the call, she said.

Hilltop has had a “handful” of its regular staff out either due to testing positive or exhibiting COVID-19 symptoms.

On a national level, weekly case counts for nursing home staff are currently ten times more than they were prior to the holidays. The Centers for Disease Control and Prevention (CDC) reported 34,242 the week of Jan. 2, compared to 3,422 at the end of October.

Resident case counts increased from 3,039 the last week of October to 14,623, according to CDC data, nearly five times the weekly count.

The latest numbers are starting to look less discouraging as omicron appears to be on the retreat, news outlets have reported. Case counts overall appear to have fallen by more than 30% in New York, New Jersey, Maryland and Connecticut, according to a New York Times report.

In-house, agency and international workers

In-house staff, even if they’re from a sister facility, are preferred to agency workers, Gelsinger said. It takes time to get agency staff up to speed on Crest policies and procedures, not to mention familiarity with residents.

Wesley Rogers, CEO of Golden LivingCenters, said agency use in his 23 facilities varies based on demographics – some have more than 50% on the floor while others facilities have seen only 10% during the latest COVID surge.

Currently, Golden Living has less than 80 COVID-positive staff members out of a 2,000-plus roster, Rogers said, a number that’s doubled over the last two weeks. The CDC shortened return to work guidelines for nursing home staff from 10 to five days, if a facility is not in a “crisis” mode.

The Indiana operator is also contracting with international nurse staffing company PRSGlobal to bring health care workers in from the Philippines, Rogers said. The relationship was formed only months ago. PRS uses a prevailing wage index depending on where nursing are needed, and nurse candidates receive assistance with housing, and transportation as part of the program.

“That’s not an overnight fix. It can help us build something into the future,” Rogers noted of the three-year program. “[PRSGlobal] really built an outstanding program for facilitating a really important need right now.”

Golden Living is looking to hire 50 to 100 nursing staff through PRS.

Less than one percent of Oklahoma-based Elmbrook Management Company residents have tested positive for COVID as of January, Elmbrook CEO Tom Coble told Skilled Nursing News, while staff are becoming infected despite vaccination status with the highly contagious omicron variant.

“Out of 600 residents or so in our company, only five are COVID-positive today,” said Coble. “We’ve been able to protect our residents. It’s how it’s hitting our staff. It seems it’s 50/50, whether you’re vaccinated or not. We have vaccinated people getting it, unvaccinated people that have medical or religious exemptions that are getting it – it seems like everybody’s getting it.”

Elmbrook has 12 facilities, 11 SNFs and one assisted living facility, all “fairly close together,” Coble said. The operator has been able to use staff from different facilities, depending on how severe an outbreak is at a given location.

“Because of how regional we are as a company, it’s allowed us to share staff,” Coble said. “We’re using everybody that we can recruit and get our hands on at this moment.”

The first wave of staff members that got ill from omicron are due to come back this week, Coble added, indicating the replenishing of staff will help “a great deal.”

“I think it’s gonna burn through here, if we can just hold on,” Coble said.

For Gelsinger, vaccination education is still very much needed for direct care staff at this point in the pandemic, with outbreak cases happening to fully vaccinated and boosted staff as well as residents.

“It’s hard … even though someone is fully vaccinated and even boosted, they still come down with this omicron variant. What we have to educate is, look how they’re getting through it so much easier. Some go through it without ever having a symptom,” said Gelsinger.

Rogers has seen the mortality rate for Golden Living residents “significantly decreased” with the omicron variant, despite a combined 500 residents and staff members testing positive during November and December of 2021.

Golden Living resident mortality rate dropped from 17% in 2020 to 5% in November, Rogers said of the Indiana facilities.

Visitation creates viral ‘hotbed’ during omicron surge

Coble said visitation changes issued by the Centers for Medicare & Medicaid Services (CMS) during the busy holiday season created a “hotbed” of potential viral spread during the omicron surge, with family and friends of residents coming in and out of facilities.

CMS issued several memos on visitation right in the middle of the holiday season, initially requiring nursing homes to allow visits to “all residents at all times.”

Concessions were made in December providing operators some flexibility. Nursing homes could limit visitation in “rare exceptions, in accordance with residents’ rights.”

Several days later, CMS updated visitation FAQs yet again to give facilities more leeway – the agency left it up to operators to “restructure” visitation to implement staggered time slots or limit the number of visitors allowed in a facility of resident’s room.

Hilltop has its own system in place concerning visitation safety – masks and shields for all visitors, staff takes the temperature of everyone entering the building and families are updated weekly if not sooner of COVID outbreaks on a hotline.

“That’s one of the points that we have learned through this, how we can have visitations and still protect everyone concerned,” said Gelsinger. “When COVID-19 first started, that was one of the hardest things because they made visitation almost nonexistent. We went a long time without being able to allow families to see their residents. Of course, we had window visits, we had FaceTime. We implemented all of those but that’s not the same as one on one with your loved one.”