Twenty-plus states called the National Guard to support nursing homes most recently during the winter months of 2021, with the more contagious omicron variant leaving staff out sick at a time when the workforce was already hobbled. The variant left state leadership with no other choice but to call in extra help.

For nursing homes in New York and Minnesota, the use of the National Guard has transformed from an emergency stopgap to an opportunity to rebuild its staff roster – troop presence has given operators some breathing space to focus on recruiting and retention on a long-term basis.

National Guard troops were tasked to do everything from clinical work to household chores at facilities.

While Minnesota saw the last of its troops leave on March 1, New York Gov. Kathy Hochul has extended the national guard’s presence at nursing homes in the state through May 31.

Minnesota’s legislature has taken the brief personnel boost as a chance to expand its state-run staffing pool, increase Medicaid reimbursement to boost wages and remove financial roadblocks for nursing students in the form of loan forgiveness and less upfront costs for certified nursing assistant (CNA) classes.

Staffing pools at the state level

Minnesota Gov. Tim Walz was sent a bill on Thursday to appropriate more than $1 million to permanently establish a staffing pool, after the state legislature greenlit the program last week.

State-run supplemental nursing agencies, Minnesota’s version of staffing agencies, were born out of the pandemic and appear to be sticking around on a more permanent basis, according to Patti Cullen, president and CEO of Care Providers of Minnesota.

Care Providers is a nonprofit membership association and state affiliate of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

Minnesota currently has 23,000 vacant positions throughout its nursing homes, Cullen said, representing 20% of the industry workforce in the state. Facilities have experienced 1 ½ times more resignations than hires, according to a recent Care Providers survey.

On a national level, nursing homes have lost 238,000 direct care workers since the beginning of the pandemic; workforce levels are the lowest they’ve been in 15 years, the Bureau of Labor Statistics found.

House File 2914/Senate File 2876 would provide staff to nursing homes in the state of Minnesota for up to 21 days after all other options have been used to get temporary workers.

An existing pool of workers has been apportioned based on outbreaks up until this point, Cullen said, starting a couple months into the pandemic. The state’s health department partnered with online scheduling company Aladtec to provide workers.

“We’re in the stages right now of trying to privatize that a little more, to let nursing facilities themselves access the database of Aladtec,” said Cullen. “Now we’re testing it for non-outbreak situations.”

The state-run pool is made up of CNAs and other nursing positions, but Care Providers is working on getting the state to add dietary and housekeeping staff to the roster, according to Cullen. She expects pool expansion to occur in June since they are pilot testing those additions right now.

Private staffing agencies in the state are capped on how much they can charge, somewhat of a rarity compared to other operators paying three to four times more for an agency worker than their own staff.

The association is also working with the legislature to increase Medicaid reimbursement in order to boost wages, create programs for student loan forgiveness and expand CNA certification routes so students don’t have to pay upfront for classes.

“The biggest thing we need to do is we need to pay people better,” Cullen said. “They need to have a livable wage so they don’t have to work two jobs. We have to be able to compete with all the private businesses.”

Cullen’s goal is to get the wage for CNAs and other positions like dietary aides up to $25 per hour, a steep climb from the current state average of $17 an hour.

For Northridge Health and Rehab in Minnesota, the past three months have been spent working to stabilize the facility’s staffing situation, onboarding new hires and pulling from staffing pools as needed for licensed nurses and CNAs.

The facility used state-run agency staff, actually hiring them on a temporary basis and at a 20%-30% higher rate of pay than regular staff, said Austin Blilie, vice president of operations for upper Midwest facilities at Mission Health Communities. Northridge is part of the Mission Health system.

Northridge is working to stabilize and grow its workforce to a point where it can take on more residents. The 320-bed facility is currently 100 beds below its ideal capacity, he said.

“The challenge will be to grow back to the capacity for what our building can handle and being able to staff for that,” said Blilie.

While Blilie believes it’s always good to “plan for the worst,” he doesn’t expect Northridge to be in that same situation again to need the National Guard.

“Where we’re at now, it’s hard for me to picture that it would get to that place. Maybe for other smaller providers … being a large facility, there’s a lot of resources and systems that mitigate that but I can see for the rural providers it being much more of a challenge,” added Blilie.

Cullen met with the head of the National Guard and state health officials to discuss the possibility of troops returning this winter – nursing homes won’t say no to more help, but operators in Minnesota are working harder to fill roles so they are not in this position again.

“We certainly appreciated their availability, but we don’t want to take advantage of it, nor assume that’s going to be a regular solution,” Cullen added.

‘Good respite’ when it was needed

Minnesota nursing homes discontinued use of the National Guard, with the state seeing slight improvement to staffing levels as Covid no longer rages though facilities.

Cullen said about 50 nursing facilities in the state had a guard response team on site, ranging from five to 30 individuals.

“They provided really good respite at a time we needed it,” said Cullen.

At the moment, members have fewer staff out sick and work intensity has lessened due to fewer outbreaks. No outbreaks translates to less testing, providing more time for “no holds barred” nursing assistant training, Cullen said.

She refers to an interagency initiative to train 1,000 nursing assistants before the end of January.

“[The state was] a little late to that goal, but they still got pretty close,” added Cullen.

Schools have more availability to take on CNA trainees, but there is still a crushing workforce shortage, she added.

“The Guard was used as a crisis reliever for facilities that were about to close. I will also say that since the start of the pandemic, we have had 10 nursing facilities close and a few assisted living [facilities],” Cullen said. “There are a few more that are, we’re just saying they’re on the bubble. So in some cases, the respite services that the guard provided, just got them to the point where they could close.”

Nursing homes in New York are still utilizing troops, with some facilities hoping the support continues past Hochul’s extension through May.

Father Baker Manor in Orchard Park, N.Y. will have six troops on site during that time frame, administrator Mark Wheeler told Skilled Nursing News, helping with housekeeping and dietary services.

Regular staff have gotten more comfortable with troops on site since they came on Feb. 10, initially unsure if things would run smoothly if they took a Friday off, he said.

“The other piece of it is giving us some breathing room to keep our recruitment going,” added Wheeler. “During this timeframe we’re still actively recruiting for our own staff … we know there’s an end date for the Guard, but we’ve got a little bit of breathing room to be able to do some of that recruitment and get our new staff on board.”

Prior to coming into facilities, the majority of troops went through a fast, intensive training in order to do clinical care as CNAs, Cullen said.

CNA troops spent several weeks at Camp Ripley with area nursing colleges while those that didn’t have the opportunity to train helped out in dietary or housekeeping.

Other nursing homes in the state used the National Guard in a more preventative measure, to avoid burnout or lessen its effects if staff were already experiencing symptoms.

Northridge was one of the first nursing homes in the state to use the National Guard for three weeks between December 2021 and January 2022 – the facility had a total of 29 troops on site.

About 80% of Northridge’s Guard assistants did CNA work while 20% helped in the kitchen.

“We have so many staff that work doubles a lot and work six, seven days a week and this support from the National Guard really provided us the opportunity to give them a break during holidays, so they can be with their families,” Blilie said.

Troops helped with staff being out with the omicron variant, Blilie added.

“National Guard support really provided us a nice bridge to be able to get through the holidays [while] providing for our residents,” Blilie said.