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Staffing has always been a challenge in long-term care settings – the vaccine mandate could make it worse

Dr. Umair Shah, the Washington state Secretary of Health, talks with the media after touring the mass vaccination site at the Spokane Veterans Memorial Arena during a February visit. Shah said the state expects to find more cases of COVID-19 from the omicron variant in the coming weeks.   (SSR)

Long-term care facilities could face critical staffing shortages this fall as Gov. Inslee’s vaccine mandate takes hold Oct. 18.

Robin Dale, CEO of the Washington Health Care Association, which advocates for long-term and post-acute care facilities in the state, said staffing shortages in facilities are a huge problem and only going to be getting worse.

“In the last month, we’ve been in situations where I’ve had a couple facility members of mine being one staff (person) away from having to shut the facility and move residents,” Dale said.

So far, this hasn’t happened, but Dale is wary of what the vaccine mandate could do to facilities already operating with too few caregivers.

These are difficult jobs to fill in the best of times; the shortage of nursing aides and assistants as well as nurses in long-term care facilities in Washington pre-dates the pandemic.

Since 2016, long-term care facilities in Washington state have reported the most job openings as well as the highest turnover rates in both nursing and nursing aide roles in their settings, according to facility survey data collected by the Sentinel Network.

Bianca Frogner, director of the Center for Health Workforce Studies at the University of Washington, has been studying the state’s health care workforce during the pandemic. She has seen a steady decline of workers from the long-term care sector during the pandemic.

Nursing aides and certified nursing assistants, those who directly care for residents in facilities by helping them eat, bathe and use the restroom among other tasks, must receive hours of training to be certified to do their jobs, but the pay often is only a bit higher than minimum wage .

This workforce is predominantly made up of women, and Frogner said it’s likely many nursing aides quit early in the pandemic when their child care facilities closed and kids were in school online from home.

When COVID-19 hit Washington state in 2020, long-term care centers were the focus of concern as illness swept through facilities before vaccines were available, killing hundreds of elderly residents.

Keeping the virus out of these facilities was challenging early in the pandemic and exhausting to keep up in the long run. Fatigue and burnout also likely contributed to some workers leaving their jobs, Frogner said, especially because their jobs got a lot tougher with their health as well as potentially their clients’ health at risk.

More recently, long-term care workers are being hired away to larger facilities or different health care businesses that can afford to pay large hiring bonuses and better wages, Dale said.

Hospitals statewide have reported shortages of nurses and other staff during the current COVID surge. The Department of Health is working with federal agencies to bring in contracted workers to shore up the system.

But as one vacancy is filled another opens.

And while there are staffing challenges in many sectors throughout the health care system, Frogner worries the long-term care workforce, predominantly nursing aides and home health aides, is at risk.

“I worry we’ll face an even more acute crisis even further down the line if we don’t invest in this workforce,” Frogner said.

With a vaccine mandate across the health care sector in Washington state, employees cannot leave a nursing home and go work in a hospital without being vaccinated. Member facilities of the Washington Health Care Association reported losing hundreds of employees due to the impending mandate, Dale said.

Federal data shows that statewide 76% of skilled nursing facilities staff in Washington are vaccinated as of mid-September.

“That is a vastly improved number from where we were a month ago, and I’m heartened by that,” Dale said.

But the percentage does not include assisted living or other types of health care facilities.

As of Sept. 19, the last date federal data for nursing homes was updated, staff vaccination rates varied widely.

Spokane nursing homes that submitted vaccine data to the Centers for Medicare and Medicaid reported staff vaccination rates that range from 33% to 83%.

The Department of Health has contracted with ACI Federal to bring health care staff to hospitals and health care facilities across the state. Facilities have to pay for these workers unless they can contact FEMA to reimburse the care.

Dale said long-term care facilities for the most part do not have the funds to cover the hefty costs of paying for contract workers, at least not for an extended length of time.

Separately, the Department of Social and Human Services has established strike teams that work on an emergency basis if a facility needs help in order to stay open. Dale said these teams have helped support facilities for days at a time, and that the department is trying to create even more teams to assist long-term car facilities.

Hospitals, which have seen patient loads begin to slowly decrease in the past few weeks, are still holding patients who are ready to be discharged but cannot be because there is no space in rehabilitation or long-term care facilities.

Taya Briley, executive vice president at the Washington State Hospital Association, said hospital officials are worried patients no longer in need of hospitalization will not be able to be discharged to step-down facilities such as rehab hospitals or skilled nursing center.

Some facilities, Dale said, have come very close in recent weeks to having to move their residents due to staffing shortages. In essence, there comes a time when the number of patients cannot be cared for by a dwindling number of staff. Dale fears more of this could be on the way.

“Just about every nursing home in the state is running up against this problem of having to limit admissions in order to properly take care of the patients they have and that is a systemic issue,” Dale said.

Editor’s note: This story has been changed to reflect that the Center for Health Workforce Studies is at the University of Washington.

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.