Kentucky nursing homes plagued by nurse shortages during COVID-19 pandemic
Eight months into the COVID-19 pandemic, which has killed more than 870 residents and employees in Kentucky nursing homes, dozens of the long-term care facilities say they have experienced critical shortages of a vital resource: the licensed nurses who provide skilled care for residents.
During the period from late May through early October, 104 of Kentucky’s 285 nursing homes — 36 percent — reported a shortage of nursing staff at least once in a weekly survey by the U.S. Centers for Disease Control and Prevention.
It’s often a recurring problem. One in every six Kentucky nursing homes, or 47 facilities, reported having too few nurses for four or more weeks during this time. Some reported nurse shortages for up to 18 weeks.
In most instances, the same nursing homes that disclosed a shortage of registered nurses and licensed practical nurses also reported a shortage of nurse aides, the workers who give basic care to residents, such as feeding and bathing, usually for less than $14 an hour.
Since March, recognizing that close to half of COVID-19 deaths in the United States were occurring in nursing homes, the federal CARES Act has pumped billions of public dollars into the largely private, for-profit industry to subsidize the costs of staffing, testing and personal protective equipment and to replace lost revenue.
On average, Kentucky nursing homes had received $169,000 each in CARES Act funding by August, according to industry testimony.
But staff shortages persist as Kentucky heads into a third COVID-19 surge in the cold weather months.
‘We need qualified people in there’
“This is a very, very serious problem we’re discovering,” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, a national nonprofit that lobbies for better treatment of the elderly and disabled.
“The most important thing that determines the quality of any nursing home is its staffing, whether it has enough staff,” Edelman said.
In poorly staffed nursing homes, neglected residents lie in bed all day and get pressure sores, or they fall and hurt themselves, Edelman said. Rushed employees make careless medication errors. And they fail to prevent infections from spreading, she said.
The Herald-Leader reported in May that many Kentucky nursing homes failed at infection prevention and control before COVID-19 blazed through them this year, with employees violating hygiene rules as basic as washing their hands, changing their gloves and disinfecting medical equipment.
“I understand that facilities are losing a lot of workers right now. Staff are dying or getting sick or they’re home taking care of children or dependent family members. I get it. But we need qualified people in there caring for the residents or else you can be sure it’s not going to go well for anyone,” Edelman said.
Betsy Johnson, who lobbies for nursing homes in Frankfort as president of the Kentucky Association of Health Care Facilities, said her industry has sounded the alarm for years about a scarcity of qualified direct care workers.
The pandemic just made everything that much worse, Johnson said.
“We surveyed our membership,” Johnson said. Among the most frequent reasons facilities cited for their employees quitting this year are child care demands once daycare centers closed and schools went virtual; employees scared of getting sick; and employees worried about bringing the virus home to at-risk relatives they care for, she said.
Nursing homes must be able to pay more in order to recruit and retain the workers they need, Johnson said. But nursing homes aren’t reimbursed for their services as well as hospitals and private medical practices, she said.
“Since skilled nursing facilities are so dependent on Medicaid — the lowest payer for health care services in the United States — it is very difficult for skilled nursing facilities to compete for workforce against other health care providers who receive commercial insurance for payments,” Johnson said.
“The solution lies with government policymakers focusing on the broken payment models that support long-term care,” Johnson said.
Bringing in outside help to fill gaps
Many of the Kentucky nursing homes reporting nurse shortages have suffered terrible losses to COVID-19 this year as the virus sickened residents and staff alike, forcing employees into at-home quarantine and driving some to quit.
Pine Meadows Post Acute in Lexington, for example, has seen 160 infections among residents and staff, with 26 resident fatalities. From late May through early October, it reported 14 weeks of nurse shortages. It also reported having too few nurse aides for 11 weeks during that time.
Pine Meadows has brought in nurses from outside facilities and hired temporary workers in an attempt to fill the gaps, said Dan Kramer, spokesman for the facility’s owner, Providence Group Inc. of Farmington, Utah. And it has asked other employees to assist with patient care that doesn’t require specific licensing or training, Kramer said.
“Given the duration of the pandemic, many skilled nursing providers are having trouble retaining nursing staff,” Kramer said.
However, even before the pandemic, Pine Meadows offered its residents less registered nurse staff time per day than other Kentucky nursing homes on average. Pine Meadows is ranked “below average” on its overall quality of care and on its staffing by the U.S. Centers for Medicare and Medicaid Services.
Likewise, Landmark of Louisville Rehabilitation and Nursing and Cambridge Place of Lexington both have reported extended nurse shortages, and both have seen deadly novel coronavirus outbreaks within their walls. Those facilities are respectively rated “much below average” and “below average” by CMS for their quality of care.
Lower-rated facilities more likely to report shortages
A national study released in August found that the lower a nursing home’s quality of care rating going into the pandemic, the more likely it was to report a nurse shortage during the pandemic.
Overall, about 21 percent of the nation’s roughly 15,500 nursing homes reported nurse shortages during the two one-month windows covered in the study, one in late spring and the other in early summer.
But that number rose to 29 percent for nursing homes rated lowest by CMS in their quality of care. It fell to 16 percent for the facilities rated highest in quality.
The study’s results were published online Aug. 20 in the peer-reviewed medical journal Health Affairs.
Nursing homes that try to function at half-strength “put the health of their residents and staff at risk,” the researchers warned.
“The pandemic is straining an overstretched workforce that is already contending with low pay and demanding work environments,” wrote the researchers, Brian McGarry of the University of Rochester Medical Center, David Grabowski of the Harvard Medical School and Michael Barnett of the Harvard School of Public Health.
“Nurses and nurse aides are on the front lines of care delivery, with daily or even hourly contact with residents,” they wrote. “These shortages could have a major impact not just on nursing homes’ ability to adhere to standard infection control protocols but also on their capacity to provide necessary ongoing care not directly related to COVID-19.”
State officials: This is not a new problem
Gov. Andy Beshear’s administration says it’s aware of nurse shortages inside many Kentucky nursing homes. However, officials note, this is not a new problem.
“Before the onset of the global pandemic, three-fourths of U.S. nursing homes reported never meeting federal staffing expectations for registered nurse staffing. Kentucky was represented among these 35-plus states,” said Susan Dunlap, spokeswoman for the Kentucky Health and Family Services Cabinet.
The cabinet has taken steps this year to help, such as temporarily waiving some nurse aide training requirements so they can start on the job faster; boosting Medicaid payments for residents diagnosed with COVID-19; and creating a “strike team” of two nurses and four nurse aides assigned to pitch in at the most stressed facilities.
Johnson, the industry lobbyist, said the state’s strike team — funded through the federal CARES Act — is a good example of how hard it can be for anyone to hire direct care employees to work in a nursing home right now.
The state offered extremely generous pay packages, such as $65 an hour for registered nurses who might be paid $26 an hour by a Kentucky nursing home, Johnson said.
Yet there still were few takers, she said.
“My understanding is that the state wanted to hire three separate strike teams but was only successful in hiring enough staff for one strike team,” Johnson said. “The state couldn’t recruit RNs, LPNs and CNAs even though they were paying more than double what a typical nursing home would pay.”
The state ultimately hired two strike teams, deploying the first one in April, said Dunlap, the cabinet spokeswoman.
This story was originally published October 30, 2020 at 1:57 PM.
