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Nursing home staffing shortages and other problems persist, U.S. report says

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Many Americans prefer to believe that the Covid pandemic is a thing of the past. But for the nation’s nursing homes, the effects have not yet fully subsided, with staff shortages and burnout still at crisis levels and many facilities struggling to stay afloat, according to a new report released Thursday by federal investigators.

The report, authored by the U.S. Department of Health and Human Services’ Office of Inspector General, finds that faulty infection control procedures that contributed to the 170,000 nursing home deaths during the pandemic were still inadequate in many establishments. And although uptake of Covid vaccines was initially robust when they became available, investigators found that vaccination booster rates among staff and residents lagged far behind.

The results were directed to the Centers for Medicare & Medicaid Services, the agency under the department’s jurisdiction that oversees 1.2 million nursing home residents whose care is provided primarily by the federal government. The inspector general’s report calls staffing problems “monumental,” highlighting high levels of burnout, frequent staff turnover and the burden of constantly training new employees, some of whom do not show up for their jobs. first day of work. For nursing homes, the inability to attract and retain certified nurse aides, dietary services staff and housekeeping workers is linked to federal and state reimbursements that do not cover the full cost of care.

Rachel Bryan, a social science analyst with the inspector general’s office, said the report aims to ensure key lessons from the pandemic aren’t lost, especially now that the acute sense of emergency has faded.

“Just as airplanes cannot be repaired in flight, nursing home challenges could not be fully repaired during the pandemic,” she said. “We are confident that as we move out of emergency mode, we take the time to reflect, learn and take real steps toward meaningful change. »

The Centers for Medicare & Medicaid Services declined to discuss the recommendations and instead directed a reporter to comments the agency provided for the report. Those comments were largely evasive, neither agreeing nor disagreeing with the recommendations, but agency officials requested that some of the proposed recommendations be removed from the report, saying improvements were already underway.

The agency, for example, cited a new federal program that will provide $75 million in scholarships and tuition reimbursement for those pursuing careers in nursing.

The report, based on interviews with two dozen nursing home administrators from across the country, paints a picture of an industry in deep turmoil. Many nursing homes are still reeling from the trauma of the pandemic, when a lack of personal protective equipment and widespread fear of infection drove veteran employees to flee and forced nursing home operators to ban outside visitors, thereby worsening the fear and isolation of their residents.

At the peak of the pandemic in 2020, two in five Medicare beneficiaries in nursing homes were infected with Covid and more than 1,300 nursing homes had infection rates of 75% or more during peak periods, according to a previous report of the inspector general. In April 2020, for example, there were 1,000 more deaths per day among Medicare nursing home beneficiaries than in April 2019. Death rates were higher in for-profit nursing homes, the researchers found. investigators.

At Bethany Home, a nonprofit care facility in Lindsborg, Kansas, a third of employees quit during the pandemic, many of them motivated by opposition to vaccination mandates or the national shortage of PPE that required caregivers to use trash bags as cotton gowns and underwear for masks, said Kris Erickson, Bethany’s chief executive officer.

“There were days during the pandemic when I measured success by how long I spent without crying in my office,” said Mr. Erickson, whose father resides in Bethany. “It was so hard.”

Bethany hasn’t recovered yet. Mr. Erickson said the facility had to eliminate about 20 of its 85 beds because it was unable to hire new staff. For the first time in its 100-year history, Bethany has a waiting list, he said.

The biggest challenge in recruiting workers is the $13.50 hourly wage Bethany offers entry-level nurse aides — a rate dictated by reimbursements provided by the federal and state governments, he said. declared. “We’ll need a base rate of between $16 and $20 if we want to compete with McDonald’s in the next town over,” he said.

Recruitment problems have been exacerbated by private employment agencies charging nursing homes up to 50 percent more for workers, some of whom administrators have described as less reliable than their permanent employees. “The agency staff comes in and talks about how much money they make and our own staff is upset because the agency staff doesn’t work as hard,” one operator was quoted as saying in the report.

Katie Smith Sloan, president of LeadingAge, a nonprofit nursing home association, said higher federal reimbursement rates would help, but staffing challenges would be best addressed by mobilizing a number of government agencies. For example, she said, the Department of Homeland Security could include nurse aides in temporary worker visa programs that bring in agricultural workers from overseas, and the Department of Education, with support from Congress, could provide Pell Grants to nursing students. culinary worker trainees.

Ms. Sloan and other nursing home advocates have criticized a Biden administration proposal that would force less staffed nursing homes to hire more workers or face fines. The proposal does not include an increase in funding that would help institutions meet their new mandates.

“It’s bigger than CMS,” Ms. Sloan said, referring to the Centers for Medicare & Medicaid Services. “We need to figure out how to creatively apply the things that work to this intractable workforce problem.” »

There are some positives in the inspector general’s findings. Many nursing home administrators said severe PPE shortages had eased since 2021. And the report highlighted creative solutions some nursing homes have successfully used to retain staff, among them pay bonuses. hiring, free staff meals, and the decision of many institutions to take advantage of licensing. waivers that allowed them to provide on-the-job training to practical nursing students.

And despite early stumbles, many experts say the initial vaccine rollout was a success, even as the spread of misinformation about vaccines significantly reduced the reliance on Covid boosters for nursing home staff and residents. Only 41 percent of residents and 7 percent of employees are up to date with their vaccines, according to the Centers for Disease Control and Prevention.

But many experts say the nation’s system for caring for its aging population is fundamentally broken. This is a problem that is becoming more pressing as the baby boomer demographic ages.

Elizabeth White, a professor at the Brown University School of Public Health and an expert on long-term care, said the problem reflects a lack of political will to spend what it takes to support Americans in their golden years.

“The pandemic has helped shine a light on the challenges facing care homes, but it’s still the elephant in the room,” she said. “The funding system is broken and the problem is so enormous that it is very difficult to find the political motivation to fix it.”

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