Nursing homes are trying to bounce back from the COVID pandemic — hoping to bring in new residents, trying to hire new workers and pondering the cost of impending new staffing mandates.
There’s still a bit of a wall to overcome there: Nursing homes nationwide suffered high death tolls amid the COVID pandemic. This and other factors tended to limit the number of people living and working in these facilities, or wanting to live and work in them.
Occupancy rates are lagging in many facilities: 15% of beds were vacant in and near the Capital Region in early June 2021, compared with 5% in early June 2019, a state Department of Health database indicates. Statewide, 19% of beds were vacant in late May/early June.
However, the residents of New York’s skilled nursing facilities now are vaccinated at a rate much higher than the state’s adult population, and employees at a rate similar to the adult population, limiting the risk of infection on-site.
The industry was short on workers before the COVID crisis and it’s short on workers now. Nursing homes across the region are advertising vacancies sometimes numbering in the dozens, competing in a very tight labor market for people to do sometimes-difficult work for sometimes-low wages.
And they may need more workers: The state Legislature in May passed legislation establishing minimum hours of staff direct care per resident at nursing homes. If Gov. Andrew Cuomo signs it into law, the mandate would take effect in January 2022.
CAUSE AND EFFECT
Brian Nealon, CEO of the Wesley Community in Saratoga Springs, said Wesley’s nursing home — The Wesley Health Care Center — is gaining new residents almost daily. Occupancy stood at 89.5% Friday, he said.
That’s up from 77% at the end of January.
The late 2020 dropoff in census was due to several factors: the loss of residents to COVID; the slowdown in surgeries performed at area hospitals (hospital discharges are the largest source of nursing home admissions); and a general hesitancy by the elderly and their families about moving into nursing homes after the tragic experiences of 2020.
“At the moment we’re happy to be on our way back up,” Nealon said. “Each of the local hospitals are looking to discharge a number of people into long-term care settings. So there are potential residents for all the local nursing homes.”
Nealon doesn’t see much hesitation now among prospective new residents or their families about COVID: Over 90% of Wesley’s residents and about 65% of employees are vaccinated, ratios as good or better than one would find in most restaurants or supermarkets.
“I think what we do see — and I know this is true in pretty much every nursing home — is that for families, there’s a level of anger. Anger that the pandemic happened, that mom’s 95th birthday happened and they couldn’t see her in person. But we haven’t gotten the sense that people are apprehensive because it’s a nursing home.”
The ability to take in new residents is hampered somewhat by the fact that Wesley is short-staffed.
Nealon said if he had 45 qualified applicants for the various job titles now vacant, he’d hire them all tomorrow.
Wesley held a drive-through job fair Wednesday and did better than expected, he said.
“In today’s world we’ve learned to downsize our expectations, but we were pleased to have 17 people show up,” he said. Seven accepted job offers and three others are in discussions.
“It’s just a different and creative way to recruit staff in a very, very tough labor market.”
The impact ripples through the staff. Nealon recently happened upon the director of nutritional services unloading a pallet of food and stocking it in dry and cold storage because no one else was available to do it.
Nealon himself donned a tuxedo and worked the front desk on Christmas Day, and helped pass out ice cream this past Monday as the temperature soared. Both moves were a show of camaraderie he hoped would keep morale up.
“It’s so much easier to keep the staff you have than to find new staff in this environment,” he said.
Shaker Place Rehabilitation & Nursing Center in Colonie is owned and operated by Albany County, with a unionized workforce. As such, wages are specified in a contract and Shaker Place doesn’t just bump up wages like Wesley did, in an attempt to recruit and retain staff.
And Executive Director Larry Slatky said a significant portion of the workforce seems to not be swayed by the advantage that Shaker Place does have as a public-sector employer: the ability to offer a pension and good health insurance.
“A lot of individuals care about base pay and not as much about benefits,” he said.
Increases and decreases in Shaker Place’s resident census are hard to compare over any recent period because the facility was being renovated and significant portions of it were being kept vacant deliberately.
“Right now we have 45 empty beds,” Slatky said Friday.
The facility’s capacity is 250, and he would like to add more residents and staff. However, he said, “It’s difficult to say how many [full-time equivalents] I would need.”
It’s a moving target: He estimates that, due to vacation and sick leave taken by permanent employees, actual staffing needs are 10% to 20% more than the number of residents would suggest.
So Shaker Place winds up paying overtime, hiring per-diem or bringing in contract personnel from an outside agency.
Slatky supports the intent of the new staffing mandate — “I don’t think there’s a nursing home in the state of New York that would not want to have exactly the staffing pattern they need to care for patients,” he said.
But he calls it a one-size-fits-all solution that doesn’t address the shortage of trained personnel to meet the staffing requirements and the shortage of money to pay them.
“It’s blanket, it’s one-stroke, like all nursing homes are identical. And they’re not,” Slatky said.
A facility that specializes in short-term rehab will need fewer certified nursing assistants and more physical therapists, he said. A facility with a large number of chronically ill or dementia patients will need more CNAs, recreational therapists and social workers, he said. But there’s no such distinction in the legislation.
“I analyzed it,” Slatky said. “We would need staff under the new regulatory requirements.”
The health care industry was opposed to the new staffing mandates, which also would apply to hospitals. Unions representing the health care workforce were in favor.
The unions appear to have won the lobbying duel.
James Clyne Jr., president of LeadingAge NY, which represents many nonprofit and municipal nursing facilities, predicted the new mandate would be unworkable if signed into law and would be challenged in court.
“There’ll be litigation, I guarantee,” he said.
On top of that, the problem the legislation is trying to address is partly of the state’s own making, he said.
“The biggest continuing issue is the state’s continuing lack of investment in nursing homes,” Clyne said, noting that the state cut its already-low Medicaid reimbursement by 1.5% in the midst of the pandemic.
“The problem is the state’s unwillingness to pay for quality of care,” he added. “There’s only so much to recruit and retain people.”
The legislation LeadingAge NY thought was in play dictated that nursing homes must devote at least 70% of revenue to patient care and at least 40% to staffing.
“We still had some issues with that, but at least with that proposal it was saying, ‘Of the money you get, this is how you have to use it,” Clyne said.
That might have been doable, he said, but to also dictate the number of people working every single day is not. The legislation in effect says, “Regardless of how much money you get, this is what you will spend.”
Generally speaking, Clyne said, his non-profit membership has had higher levels of staffing than their for-profit counterparts in the nursing home industry, but the mandate would force them to add staff as well.
The nursing home industry in New York did finally catch a break Thursday, Clyne said: The state dropped its mandate that nursing home employees vaccinated against COVID be tested for the virus once a week, at a cost of $100 per test.