Worker Shortages, Lack Of Gear Plaguing Nursing Homes

BOSTON (State House News Service) — Nursing homes in Massachusetts are already being overwhelmed by the coronavirus and face risks of further devastation without immediate state action to expand testing, dramatically increase funding and address staffing shortages, the head of the state's leading skilled nursing advocacy group warned elected officials.

Massachusetts Senior Care Association President Tara Gregorio outlined dire stakes in a Monday letter to Beacon Hill's top three leaders, pleading for more resources beyond the significant steps already taken to stave off the most alarming projections that thousands of nursing home residents may die as a result of the outbreak.

"To date, hundreds of nursing facility residents have died and we are now hearing reports of caregiver deaths," Gregorio wrote to House Speaker Robert DeLeo, Senate President Karen Spilka and Gov. Charlie Baker. "Given the vulnerability of the nursing facility population, this devastation will continue to increase at alarming rates without immediate and urgent action on the part of state government."

Long-term care is already among the state's hardest-hit sectors. Through Tuesday afternoon, the Department of Public Health reported 444 deaths in nursing homes, rest homes and skilled nursing facilities, about 46 percent of all deaths in Massachusetts.

A total of 3,907 residents or health care workers in the industry have tested positive for COVID-19, with 214 facilities confirming at least one case.

Gregorio cautioned in her letter that the trend is poised to become even more harrowing. Models based on data from the American Health Care Association projecting the impact from the virus in Massachusetts are "sobering under any scenario, whether best, most likely or worst case," she wrote.

The worst-case scenario could see the coronavirus hit every single nursing facility in Massachusetts, Gregorio said, infecting more than half of the 38,000 residents and one-fifth of staff and killing close to one in 10 residents.

Even the most likely outcome "offers no solace," she wrote: COVID-19 in every skilled nursing home, more than one-third of the population contracting the disease and 3 percent dying as a result.

"This dire forecast must compel us to act immediately in order to decrease the likelihood of this unacceptable outcome and better protect our residents and staff from this deadly disease," Gregorio said.

Baker and Health and Human Services Marylou Sudders have both described long-term care facilities as some of the most vulnerable to COVID-19. On March 15, the governor banned all visitors from assisted living facilities including nursing homes in an attempt to limit the spread.

Massachusetts was one of the first states to do so, and while Baker said Monday he knows personally how "brutal" the strict policy is — his father resides in a long-term care facility — he said he is happy with the decision.

"When we put that no visitation policy in place, most people weren't talking about the fact that significant portions of the population that actually get infected and are in fact contagious associated with COVID-19 are asymptomatic," he said. "You could have had family members walking in and out of facilities, hugging mom and dad, engaging in the traditional moments of joy that come with that, and all that time being carriers, which would have made this situation dramatically worse than it has been so far."

The administration has implemented several other policies in recent weeks aimed at blunting the impact at long-term care facilities.

The state launched a new website to attract applicants to become caretakers in field hospitals and skilled nursing facilities, and more than 220 faciities have received help from the National Guard with mobile, on-site testing so that residents and staff did not need to leave — and expose themselves to additional transmission risks — to check if they contracted the highly infectious disease.

Officials have also divided nursing homes to create COVID-19 isolation spaces where residents who have tested positive can stay with a lesser chance of infecting their neighbors. Sudders said Monday that the state is working to reopen decommissioned nursing homes as coronavirus-specific facilities and that the first one could open by this weekend on Cape Cod.

When it announced an infusion of $800 million into the state's health care infrastructure last week, the administration said $50 million would fund nursing facilities and another $30 million would boost those that are specifically expanding capacity for COVID-19 patients.

Gregorio outlined three immediate requests for state leaders to direct additional resources to the staff and the organizations on the front lines: directing additional N95 masks and other personal protective equipment to long-term care facilities that are running low, routinely testing symptomatic and asymptomatic residents and staff, and offering a double-time "hero wage" to help fill critical staffing shortages.

About 40 percent of employee positions at Massachusetts nursing facilities are vacant because of the outbreak, leaving the industry 17,000 direct care workers short of having a basic staffing level, according to Gregorio. She argued the only way to fulfill staffing needs is to double what caretakers on the front lines are paid and to use the National Guard or Medical Corp for supplemental staffing.

The Baker administration previously added $13 million per month to essential provider rates, she said, but Gregorio warned that amount "is now not nearly enough to allow facilities to cover the increased overtime and temporary contracted staffing increases and PPE costs." She asked instead for that amount to be increased tenfold to $130 million more in provider rates per month with a process that would allow for reimbursement of full Medicaid COVID-19 costs once the crisis ends.

"Without this, many or most nursing homes will not have the finances to survive this crisis and pay their staff," Gregorio said.

Even before the pandemic, nursing homes in Massachusetts faced growing strain amid declining usage rates. A potential 2020 ballot question would update the rates that state government pays to nursing homes at a cost of $272 million, about half of which would be reimbursed by Washington, according to Gregorio's group.

By Chris Lisinski, State House News Service

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