TOLEDO, Ohio — The first COVID-19 headlines that grabbed many Americans’ attention were attached to stories about an outbreak at the Life Care Center of Kirkland, Wash., two years ago.
Over a four-week period, more than 100 Life Care residents were infected and by mid-March, 2020, the virus was blamed for killing 39 residents.
No segment of society has been harder by the virus than the nation’s nursing homes. As of Tuesday, 148,612 of the United States’ 925,815 COVID deaths were in long-term care facilities. In Ohio, the number is more than 9,000 out of the state’s 35,372 deaths.
During a conversation with WTOL early in the pandemic, Sen. Rob Portman (R., Ohio) lamented the spread that was taking place in nursing homes between asymptomatic staff and residents.
On Aug. 18, President Biden took action to prevent that, saying the more than 15,000 nursing homes that participate in Medicare and Medicaid must only employ staff who are vaccinated against COVID-19.
"Now, if you visit, live or work at a nursing home, you should not be at a high risk of contracting COVID from unvaccinated employees," the President said.
Last month, the Supreme Court upheld that mandate, with the majority opinion stating: “ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm.”
But that decision set the conditions for a perfect storm in an industry that cares for our most vulnerable citizens. Yes, the vaccine helps these vulnerable citizens, but the mandate is pushing more caregivers from facilities that are running short on workers.
The case for the mandate
For several months, the Centers for Medicare and Medicaid Services has compiled vaccination data related to nursing homes. Ohio, which has the third-most nursing homes in the country, has one of the lowest nursing home staff vaccination rates – 68 percent.
11 Investigates broke down the data for nursing homes in Lucas County. As of the end of January, only seven nursing homes had staff vaccination rates of more than 80 percent and eight were 50 percent or lower. Some of the latter facilities have the highest number of resident COVID infections and deaths.
For example, Heatherdowns Rehab & Residential has 38 percent of staff vaccinated, the lowest rate in the area. It also has the highest COVID death rate per 1,000 – 392.
Close behind is Concord Care Center. It has a 50 percent vaccination rate and 282 deaths per 1,000.
Addison Heights in Maumee is at 45 percent. Its cases per 1,000 rate is actually higher than 1,000 - at 1,016 - meaning that some residents were likely infected more than once.
Contrast this with nursing homes with high vaccination numbers. The Franciscan Care Center has 93 percent of its staff vaccinated and has a death rate of 118. Lakes of Sylvania is also at 93 percent vaccination and case incidence is one of the lowest in the area – 333.
There seems to be clear evidence that the vaccine is needed in our nursing homes.
“Absolutely. I mean, there's no question,” said Pete Van Runkle, executive director of the Ohio Health Care Association, a lobbyist group that represents the interests of the state’s nursing homes. “But they’re Ohioans, and they tend to reflect the viewpoints of their community. … You might think, ‘Geez, they work in health care, that should overcome any of their other opinions,’ but it's really not taking into account human nature.”
Growing staffing crisis
The pandemic has dealt a crushing blow to the nursing home industry, not only because of the human death toll, but also because of staff flight.
According to the Bureau of Labor Statistics, U.S. nursing homes have lost 238,000 caregivers since the beginning of the pandemic – down to about 1.3 million.
“We did a survey of all the skilled nursing and assisted living facilities in Ohio back in the summer, and at that time - and I think it's only gotten worse since then, honestly - the average skilled nursing facility had 19 open positions,” Van Runkle said.
During the pandemic, a nursing home is a dangerous place to work. Yes, residents are infected by staff who bring the virus in from the outside, but staff are also infected by residents. Since April 15, 2000, more than 66,000 COVID infections have been reported among staff at nursing homes.
And that risk comes with much less incentive as facilities are limited by what they can pay because they accept federal money. Pay can’t just be raised to prevent poaching from competitors. A typical nurse’s aide makes around $20 an hour. Many are leaving health care all together and going to other industries that pay more.
“Yeah, that's right,” Van Runkle said. “And they aren’t required to be tested all the time or required to wear PPE and have federal surveyors.”
With the staff losses, nursing home administrators are forced to turn to agencies to bring staffing up to safe levels. And these agencies often charge twice what a permanent employee makes. It’s putting tremendous financial pressure on facilities that are already dealing with fewer numbers of patients.
The financial pressure is a serious issue, but Van Runkle said the lack of institutional knowledge from agency staff could possibly compromise care.
“I mean, these are folks that are not invested in that facility. They don't know the patients. They don't know the policies and procedures of the facility. You know, they don't know where to find things in the records. And that's not good for quality of care,” he said. “You need your own cadre of dedicated staff. It’s a huge concern.”
An uncertain future
According to the mandate, nursing home staff were required to have a first vaccine dose by Feb. 15. They are required to be fully vaccinated by April 15. At that point, facilities not at 100 percent could incur a range of penalties, including loss of Medicare and Medicaid payments.
It’s unlikely that will happen initially for fear of mass closures of nursing homes. But the looming vaccine deadline is likely to push more workers out of the industry, meaning that more agency workers will be needed, meaning more financial pressure on facilities.
It is a big enough concern that the U.S. Senate Subcommittee on Employment and Workplace Safety met last week and discussed potential anti-competitive practices by these nursing agencies.
“I’m concerned, however, that these agencies might be taking advantage of a very dangerous situation,” Sen. Tommy Tuberville (R.-Ala.) said. “They’re able to charge a high percentage cut for their services, and hospitals have no choice but to pay their prices.”
Despite the federal attention, Van Runkle said he’s bracing for some nursing homes to shut their doors. Maybe that isn’t a problem in Toledo, but it will be a major inconvenience for others in the area.
“Much of Ohio is rural, of course, and you have facilities that are scattered around that rural area,” he said. “One of them goes out of business, or they're impacted to the point where no one wants to use them, it may be 30 to 40 miles for people to drive to go see their loved one.”
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