Nursing Homes Worries Rise in Wake of “No Jab, No Job” and Pending CMS Rule

Nursing Homes Worries Rise in Wake of “No Jab, No Job” and Pending CMS Rule

President Joe Biden’s edict that nursing homes must ensure their workers are vaccinated against covid-19 presents a challenge for an industry struggling to entice its lowest-paid workers to get shots without driving them to seek employment elsewhere.Originally published in Kaiser Health News.

Although 83% of residents in the average nursing facility are vaccinated, only 61% of a home’s workers are likely to be, according to data submitted by homes and published  by the Centers for Medicare & Medicaid Services as of the week ending Aug. 8. More than 602,000 staff members have contracted covid and more than 2,000 have died from it.

That led Biden to declare Wednesday that the government would require employee vaccinations as a condition for nursing homes to receive Medicare and Medicaid reimbursements, which account for most of the industry’s income.

“More than 130,000 residents in nursing homes have, sadly, over the period of this virus, passed away,” Biden told reporters. “At the same time, vaccination rates among nursing home staff significantly trail the rest of the country.”

Nursing homes in Florida and Louisiana have the lowest average staff vaccination rates among states, with 46% of workers in a facility fully vaccinated. Rates are highest in Hawaii, with an average of 87% of workers vaccinated by facility, and California, with 81% vaccinated on average, the data shows.

The American Health Care Association, a nursing home lobby, said it appreciated the order but that the mandate should apply to other health care providers as well so that workers who refuse vaccination won’t have a reason to change jobs within the industry.

“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents,” Mark Parkinson, president and CEO of the association, said in a statement. “It will make an already difficult workforce shortage even worse.”

David Grabowski, a professor of health care policy at Harvard Medical School, said that, because many nursing home aides are paid only the minimum wage or slightly higher, they would be more likely to seek out work at retail establishments. “The risk isn’t that they go to the hospital down the street — the risk is they go to Starbucks or Target,” he said in an interview. “It’s great if you want to mandate the vaccine, but you also want to make sure these workers are making a living wage.”

Jon Green, CEO of Pinewood Manor Nursing and Rehabilitation in rural Hawkinsville, Georgia, said the “vaccines are necessary for control of the virus,” but “if we would have mandated it ourselves, it would have caused [many workers] to leave.’’ His facility, which is a nonprofit home, has about 85 employees.

Just over half of nursing home workers in Georgia, on average, are vaccinated.

Some facilities have already placed vaccination requirements on employees, including PruittHealth, a large Southern nursing home chain. The company set an Oct. 1 deadline for employees to have received at least an initial dose of vaccine. About 45% of its nursing home workforce has received a shot. PruittHealth said only medical and religious exemptions to its vaccine mandate will be considered on a case-by-case basis.

Lori Smetanka, executive director of Consumer Voice, a nonprofit that advocates for people receiving long-term care services, said that if nursing homes succeed in getting more employees to accept vaccinations, it might make it easier for them to retain and recruit others who have been fearful of catching covid at the homes.

“We did see that a number of workers fairly early on in the pandemic had quit because they were worried about their own safety,” Smetanka said. “This is one opportunity to attract people who have not been willing to work in the facilities.”

CMS said it would issue an emergency rule in the coming weeks that adds staff vaccination to the requirements for nursing homes to receive Medicare and Medicaid reimbursements. That rule would presumably spell out the criteria for compliance.

In practice, nursing homes rarely are thrown out of the Medicare and Medicaid programs for violating the government’s conditions of participation. The government generally gives facilities multiple opportunities to correct violations before proposing termination, even when facilities have repeatedly flouted the rules.

“Nope, LOL” — Over 40% of Long Term Care Workers are Unvaccinated

“Nope, LOL” — Over 40% of Long Term Care Workers are Unvaccinated

Amid a “pandemic of the unvaccinated,” more than 40% of the nation’s nursing home and long-term health care workers have yet to receive vaccinations.

They are two sisters in two states. Both are dedicated health care professionals who watched in horror as COVID-19 swept through the nation’s nursing homes, killing a staggering number of residents and staff alike.

One sister is now vaccinated. The other is not. 

Dude. Get vaccinated!” Heidi Lucas texted her sister Ashley in May from her home in Jefferson City, Missouri.

“Nope lol,” Ashley Lucas texted back from Orbisonia, Pennsylvania.

“Don’t you work with old people?”


“What if you killed one of them? Get vaccinated,” Heidi wrote.

Neither sister is budging as the Delta variant brings a new spike in coronavirus numbers across the nation.

Originally published in ProPublica.
Originally Published in ProPublica

Their divide mirrors America’s larger one, where the vaccine to combat COVID-19 is eagerly embraced by some, yet eyed with suspicion and rejected by others. 

It is the refusal group, including a significant percentage who work in the nation’s nursing homes, that has confounded and alarmed health care officials who are at a loss as to how to sway them.

Nursing homes faced a shocking mortality rate during the pandemic. In the U.S., COVID-19 killed more than 133,000 residents and nearly 2,000 staff members between May 31, 2020 and this July 4, according to Centers for Medicare & Medicaid Services reports . The true toll is thought to be even higher as data gathering lagged in the early months of the crisis, health experts say.

Working in a nursing home became one of the “most dangerous jobs” in America in 2020, according to an analysis of work-related deaths by Scientific American.

Yet seven months after the first vaccines became available to medical professionals, only 59% of staff at the nation’s nursing homes and other long-term care facilities are fully or partially vaccinated — with eight states reporting an average rate of less than half, according to CMS data updated last week.

Twenty-three individual facilities had vaccination rates of under 1%, the data showed. 

Staff vaccinations have lagged even as the overall rate for residents climbed to 83%, according to the CMS data.

The strong vaccination percentage among nursing home residents is credited, in part, to an early campaign to bring the vaccine directly to facilities. That suggests availability is not necessarily the issue behind staff going without.

So, what is?

The question defies easy answers. Vaccine refusal is regional and often aligns not only with individuals’ political alignment but also with their preferred news sources and which social media they follow.

Last week, President Joe Biden took aim at Facebook and other social media giants for failing to police vaccine misinformation that amplifies conspiracy theories and discourages people from getting vaccinated. “They’re killing people,” he said, directly blaming the platforms. On Monday, he recast the accusation to say it was specific individuals posting dangerous information who are culpable.

On Tuesday, U.S. Sen. Mitch McConnell, R-Ky., pleaded to “anyone out there willing to listen: Get vaccinated.” While not mentioning skeptics specifically — including those in his own party — the Republican leader urged the unvaccinated to ignore “demonstrably bad advice.”COVID-19 cases are now surging in every state, with new hospitalizations and deaths almost entirely occurring among the unvaccinated. “This is becoming a pandemic of the unvaccinated,” Centers for Disease Control and Prevention Director Rochelle Walensky warned last week during a White House briefing.

In May, CMS began requiring weekly reports on vaccinations of residents and staff at nursing homes and other long-term care facilities. The emerging data confirms many health care experts’ worst fears, especially for Southern states.

Louisiana has the lowest statewide average: Just 44.5% of the staff at its long-term care facilities have been at least partially vaccinated, according to CMS data released last week.

Florida, the second lowest-vaccinated state, had a rate of just under 46% among its nursing home and long-term care staff, with Missouri, Oklahoma, Tennessee, Georgia, Mississippi and Wyoming all showing rates of less than 50 percent, according to the data.

Vaccination rates in assisted living facilities are not included in the data.

A separate American Association of Retired Persons analysis, released last week, showed that only one in five of the nation’s more than 15,000 nursing homes were able to hit a goal, set by two industry trade groups, of vaccinating 75% of their staff by the end of June.

While cases in nursing homes have recently slowed, and most of the new COVID-19 infections are among younger people, some experts still worry of a return to darker days.

The CDC recently launched an investigation into deaths of residents at several western Colorado senior facilities possibly linked to unvaccinated staff, the Associated Press reported Wednesday.

“We need to sound the alarm,” said Susan Reinhard, senior vice president of AARP and director of its Public Policy Institute. “Nursing homes were devastated by COVID-19, and many residents remain highly vulnerable to the virus.”

Nationally, more than 89% of people 65 or older have received at least partial vaccination, the CDC reported this week. Still, public health experts have warned that even if fully vaccinated, the elderly may be vulnerable to “breakthrough” coronavirus infection because of compromised immune systems and other underlying health problems.

In Missouri’s southern region, the overall rate of full vaccination in some rural counties is less than 20%, according to state health department and CDC tracking. The latest surge of the delta variant has turned the area into a “tinderbox,” Steven Edwards, CEO of the CoxHealth hospital system in Springfield, recently told reporters.

On Thursday, 160 patients were being treated for COVID-19 at CoxHealth, a spokesperson told ProPublica. On May 14, there were 18.

Heidi Lucas
Heidi Lucas, president, Missouri Nurses Association

Heidi Lucas directs the Missouri Nurses Association. She is pro-vaccine and has been pushing hard for nurses to get vaccinated, especially those on the front lines of patient care. Lucas said it is impossible to separate the lack of vaccination among staff from the lack of vaccinations in individual communities. “Nurses are people too,” she said. “They are on social media and are inundated with false information. How do you fight it?”

Her sister, Ashley Lucas, lives 900 miles away in Orbisonia, a small town of around 500 people about an hour south of State College. She’s a traveling certified nursing assistant at area nursing homes and chose to skip the vaccine.

Her fiance and her children, ages 12 and 13, are also unvaccinated. “I don’t consider myself an anti-vaxxer,” she told ProPublica, bristling that some might see her as reckless or ill-informed.

Instead, she said her decision was carefully considered. It never made sense to her, she said, that the virus seemed to strike randomly, with some residents getting sick while others did not. She said she is not convinced the vaccine would change the odds.

She’s also concerned after hearing that the vaccine could interfere with fertility — a contention that has been deemed false by the Centers for Disease Control and Prevention and the World Health Organization. It all leads her to believe more research is needed into the vaccines’ long-term effects.

“This is just a personal choice and I feel it should be a free choice,” she said. “I think it’s been forced on us way too much.”

CNA Ashley Lucas refuses to be vaccinate.
Heidi’s sister, CNA Ashley Lucas.

Certified nursing assistants make up the largest group of employees working in nursing homes and other long-term care facilities, providing roughly 90 percent of direct patient care. They are typically overworked and underpaid, most earning about $13 per hour and receiving no paid sick leave or other benefits, said Lori Porter, co-founder and CEO of the National Association of Health Care Assistants.

Porter said she is not completely surprised by the low vaccination rate. It comes down to trust, she said, both of the vaccines and of facility administrators who now say staff must get vaccinated. Refusal may feel like empowerment. “It’s the first time ever they have had the ball in their court,” Porter said.

On March 31, Houston Methodist Hospital mandated that all of its 26,000 employees be vaccinated by June 7 or lose their jobs. Jennifer Bridges, a nurse, sued along with 116 other employees, claiming the health care system had overstepped its rights and that she and the others refused to be “human guinea pigs,” evoking the Nuremberg Code, a set of ethical standards established in response to Nazi medical experimentation in concentration camps.

On June 12, U.S. District Judge Lynn N. Hughes dismissed the closely watched case, taking offense to likening the vaccine to the Holocaust, which he called “reprehensible.” Ten days later, 153 Houston Methodist employees either were fired or quit after refusing the vaccine. The judge’s ruling has been appealed.

A handful of long-term care chains have similarly sought to mandate worker vaccines, but such action is far from widespread in the industry. One sticking point has been whether vaccination can legally be required, since all three available vaccines have only emergency use authorization, not full approval from the U.S. Food and Drug Administration.The thornier issue, though, is whether the facilities can risk losing staff when they’re already short-handed. Many workers have vowed to quit rather than be forced into vaccinations.

Aegis Living, a long-term senior care provider in three Western states, made vaccines mandatory for its roughly 2,600 employees on July 1. Dwayne Clark, founder and CEO, said initially 400 employees refused but when the deadline arrived, only about 100 left rather than be vaccinated.

“We lost some staff that we didn’t want to lose,” Clark told ProPublica, “but it felt like the right moral protocol to impose.”

Recently the U.S. Equal Employment Opportunity Commission issued guidelines stating that employers can require workers to be vaccinated as long as medical or religious exemptions are permitted.

“Nursing home workers certainly have the right to make decisions about their own health and welfare, but they don’t have the right to place vulnerable residents at risk,” said Lawrence Gostin, a health law professor at Georgetown University. “Nursing homes don’t just have the power to require vaccinations, they have the duty.”

Still, the issue is far from resolved.

“America is a highly litigious country,” Gostin said, “I expect the courts to consistently uphold nursing home mandates, because they are entirely lawful and justified. But there will likely be lawsuits at least until it is quite clear they are futile.”

Diane Peters is a registered nurse in the Chicago suburbs who last year worked at a nursing home and is now working at a senior rehabilitation center. She does not trust the science behind the vaccine and is unvaccinated. So is her fiance.

Everything about the rollout felt like propaganda, she said. Development was too rushed. Clinical trials typically take years, she said, not months. “I don’t think it’s safe right now, it needs more time,” she said she tells patients if they ask.

Most don’t, she said. Neither do her co-workers. She has only been asked once by her employer if she was vaccinated, she said, declining to name the company.

Peters guesses about 40 percent of her colleagues are also unvaccinated, but said no one likes to talk about it because the divide surrounding the vaccine is “surreal.” Staff members are tested regularly and are required to wear masks, she said.

She is doubtful mandates would stick. “They can threaten,” she said, “but a lot of nurses would walk.”

She trusts her instincts and her own research for now. When asked what would change her mind, she had one word: “Nothing.”

Teen Volunteers Get a Foot in the Door for Nursing Home Careers

Teen Volunteers Get a Foot in the Door for Nursing Home Careers

Jasmine De Moya, 17, has dreamed for years of working in the medical field, and she yearned to spend time with older people, missing her grandparents, who live in the Dominican Republic. A program sponsored by the New Jewish Home health system in New York City that combines volunteering and free training for entry-level health jobs, career coaching and assistance on her college prep is helping make her hopes come alive.

Over the past three years, Jasmine has learned a lot about caring for older people, from the importance of speaking slowly and being gentle with frail residents who may have hearing or comprehension problems to how to brush their teeth or bathe them.

Originally published in Kaiser Health News.

“We practiced first with mannequins, so when we actually [worked on residents] I was in shock,” she said. “Cleaning a body and their private areas, I never expected I would do that. But then I got used to it.”

Last summer, Jasmine completed a certified nursing assistant training course. She has also researched and applied for colleges and student loans with help from an organization that the geriatrics career development program provides to volunteers like her. After graduating from high school last month, Jasmine will start nursing school at Lehman College in the Bronx in the fall. She’ll be the first in her family to attend college.

Since it launched in 2006, the geriatrics career development program  has helped more than 700 high school students from 10 underserved schools in New York City get hands-on experience with geriatric care at the New Jewish Home in Manhattan and the Harry and Jeanette Weinberg Gardens senior living facility in the Bronx. Ninety-nine percent of program participants graduate from high school, and more than 150 have gone on to college.

The advantages of the program are also evident for the New Jewish Home, which operates two nursing homes, senior housing and assisted living facilities and a home care business in the New York City area. By familiarizing young people with geriatric care careers, the system aims to address its growing need for workers as the tide of baby boomers enter their later years.

Six of the top 10 fastest-growing jobs in the decade leading up to 2029 are projected to be in health care, according to the federal Bureau of Labor Statistics, including home health and personal care aides.

“One of our biggest challenges is that there aren’t enough people who want to work in this industry,” said Dr. Jeffrey Farber, president and CEO of the New Jewish Home system. “People don’t want to work with older adults.”

The New Jewish Home began its career development program for teens 15 years ago with the idea of training and hiring them as nursing assistants, Farber said.

But it has become more than that. Working a few afternoons a week for three years with older adults, students gain insights into aging and develop relationships with residents, some of whom are assigned as mentors. It also gives students assistance with figuring out career goals and putting the pieces in place to get there.

“I think the students would be successful without us, but we provide the structure and resources to help them succeed,” said John Cruz, senior director of workforce initiatives at the New Jewish Home, who oversees the program.

Students generally must devote two afternoons after school every week and several weeks during the summer, said Cruz. The program curriculum, developed with Columbia University Teachers College, initially teaches students basics about patient privacy, Medicare/Medicaid and overcoming stereotypes about older people. By the time they’re seniors in high school, students can train as certified nursing assistants and work as paid interns supporting the residents on the days they spend at the facility.

As part of the program, students may also become certified in other jobs, including patient care technician, phlebotomist, EKG technician, and medical coding and billing staff.

The pandemic, however, changed things. The New Jewish Home in Manhattan was hit hard, with dozens of covid deaths at the 514-bed facility.

Since volunteers weren’t permitted inside the facility, the home instead hired many of them as part-time employees so they could continue to help seniors. This also gave students a chance to complete the clinical training portion of their certified nursing assistant coursework.

In addition to the program for high school students, the health system created a program in 2014 for people ages 18 to 24 who are unemployed and out of school, training them to become certified home health aides and nursing assistants. Nearly 200 have completed the program and the New Jewish Home has hired three-quarters of them, at a starting wage of $15 to $19 an hour.

Both programs are supported primarily by grants from foundations.

In February, the state announced that nursing homes could accept visitors again, following federal guidelines. But many nursing home residents still rely on virtual visits, and during the spring Jasmine spent her time helping them connect with their families and other loved ones by iPad or phone.

The isolation was hard on the residents, and students provided sorely missed company. Asked how the students helped her, resident Dominga Marquez, 78, said, “Just talk.”

“We are lonely,” said Marquez. “I have a lot of friends that used to come every week to visit but, with the pandemic, nobody came.”

Kennedy Johnson, 17, said helping seniors experience virtual visits with their families during the pandemic made him realize how much he takes for granted.

“With the pandemic and doing the virtual calls, seeing how these families don’t get to interact with their loved ones every day, that really opened my eyes,” he said.

Working at the New Jewish Home was the first time Kennedy had ever been in a nursing home or seen the kinds of work that staff members do.

In the fall, he will start at Morehouse College in Atlanta and plans to major in political science. His goal: “I want to be a health care attorney so I can represent people … like this.”

Published courtesy of KHN (Kaiser Health News) a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Covid Cases Drop 83% Among Nursing Home Staffers

Covid Cases Drop 83% Among Nursing Home Staffers

Joan Phillips, a certified nursing assistant in a Florida nursing home, loved her job but dreaded the danger of going to work in the pandemic. When vaccines became available in December, she jumped at the chance to get one.

Months later, it appears that danger has faded. After the rollout of covid vaccines, the number of new covid cases among nursing home staff members fell 83% — from 28,802 for the week ending Dec. 20 to 4,764 for the week ending Feb. 14, data from the Centers for Medicare & Medicaid Services shows.

New covid-19 infections among nursing home residents fell even more steeply, by 89%, in that period, compared with 58% in the general public, CMS and Johns Hopkins University data shows.

These numbers suggest that “the vaccine appears to be having a dramatic effect on reducing cases, which is extremely encouraging,” said Beth Martino, spokesperson for the American Health Care Association and National Center for Assisted Living, an industry group.

“It’s a big relief for me,” said Phillips, who works at the North Beach Rehabilitation Center outside Miami. Now, she said, she’s urging hesitant co-workers and anyone else who can to “go out and take the vaccination.”

After a brutal year in which the pandemic killed half a million Americans, despite unprecedented measures to curb its spread — including mask-wearing, physical distancing, school closures and economic shutdowns — the vaccines are giving hope that an end is in sight.

Noting that more than 3 million doses of vaccine have been doled out in nursing homes, CMS issued new guidelines  Wednesday allowing indoor visits in the facilities, even among unvaccinated residents and visitors, under most circumstances.

National figures on health care worker infections in other settings are hard to come by, but some statewide trends look promising. In California and Arkansas, health care worker covid cases have dropped faster than for the general public since December, and in Virginia the number of hospital staffers out of work for covid-related reasons has fallen dramatically.

Research in other countries suggests that vaccines have led to big drops in infection. A study of publicly funded hospitals in England indicated that a first dose was 72% effective at preventing covid among workers after 21 days and 86% effective seven days after the second shot. At Sheba Medical Center — Israel’s largest hospital, with over 9,600 workers — 170 staff members tested positive from Dec. 19, the first day the vaccine was offered, through Jan. 24. Of those who tested positive, only three had already received both doses of the vaccine, according to The Lancet.

Lost on the Frontline, a yearlong data and reporting project by KHN and The Guardian, is investigating over 3,500 covid deaths of U.S. health care workers. The monthly number has been declining since December, but deaths often lag weeks or months behind infections.

Along with other health care workers, nursing home staffers and residents were first in line to get vaccines in December because elderly people in congregate settings are among the most vulnerable to infection: More than 125,000 residents have died of covid, CMS data shows, while over 550,000 nursing home staff members have tested positive and more than 1,600 have died.

Yet the vaccination rate among staffers is far lower than that of residents. When the first clinics ran from mid-December to mid-January, a median of 78% of nursing home residents took a dose, while the median for staff was only 38%, according to the Centers for Disease Control and Prevention. Now several nursing home associations say the rate of staff vaccination has been climbing, based on informal surveys.

While vaccines are “contributing to the observed declines in COVID-19 cases in nursing homes, other factors, like effective infection prevention and control programs/practices,” are also at play, CDC spokesperson Jade Fulce said.

Vaccine uptake by nursing home residents has been “very promising,” said Dr. Morgan Katz, a specialist in infectious diseases at Johns Hopkins University who is advising covid responses in nursing homes. “I do think this is a huge contributing factor” to the drop in staff cases.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Nursing Homes Worries Rise in Wake of “No Jab, No Job” and Pending CMS Rule

Short on Staff and PPE, Nursing Homes Prepare for a Hard Winter

COVID-19 hit nursing homes with a situation that they “were not equipped to handle,” according to David Coppins, CEO and co-founder of IntelyCare , a workforce management company specializing in post-acute care. In an interview with DailyNurse, Coppins discussed the battle that nursing homes have had to confront during the pandemic, and Pennsylvania CNA Christine Pepple offered a frontline perspective.

DailyNurse: Can you list the factors that make nursing homes so vulnerable to the pandemic?

“Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital.”

David Coppins, CEO, IntelyCare
David Coppins, CEO, IntelyCare

David Coppins: “Most healthcare workers would tell you that they were not adequately prepared to handle this virus. It has been traumatic across the board. But the nursing home community has experienced incredible loss during the pandemic, and it feels as if they have been wrongfully blamed for that loss. They were thrust into a situation they were not equipped to handle. 

Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital. Hospitals are designed with the assumption that everyone could have an infectious disease, and their workers also operate under that assumption. Nursing homes take what precautions they can, of course, but they do not have the equipment hospitals do, and their workers typically deal with the management of chronic conditions. 

In the first wave, when there was a desperate need to get healthcare heroes PPE, hospitals had the purchasing power to acquire PPE quickly. Nursing homes simply don’t have that same purchasing power, and were effectively left to scramble for what little PPE remained – often times at 10x the typical price. There was also widespread movement from the public to get all available PPE to hospitals – you had people buying up N95s and donating them to their local hospital. The nursing homes did not benefit from public support in the same way.  

It also is important to note that the nursing home population is the most at risk of all patients. It’s largely geriatric residents, or people living with chronic conditions. These folks have multiple risk factors for COVID-19. The care at nursing homes is also very touch-oriented. There are multiple CNAs in and out of rooms helping residents with teeth brushing, feeding and washing, and those CNAs, as I mentioned, were not afforded proper PPE, and were forced to use their PPE over and over again. 

Finally, it bears saying that nursing homes struggled with staffing prior to the pandemic. The pandemic only exacerbated their short-staffing problem. Hospitals were impacted as well, but in most cases, hospitals canceled elective procedures and were able to re-allocate staffing resources to COVID-19 dedicated floors. Nursing homes did not have this same pool of people to rely on – they’re only fall back was agency staff which was also severely taxed. 

While there was no ideal situation to be in during the pandemic, nursing homes found themselves in a uniquely unfortunate one – they didn’t have the financial resources, the PPE, or the workforce levels to cope.”

DN: What are the key lessons learned from the initial experience during the first wave of COVID-19? What measures are being taken to make nursing homes safer for nurses and residents? 

“To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”

David Coppins, IntelyCare CEO

Coppins: “At the start, there was a rationing of supplies. The CDC recommended that nursing home staff refrain from using masks and gowns for every resident, and they also recommended the reuse of the same mask for long periods of time. And, nursing homes are very touch-oriented – which facilitated the spread of the virus from patient to provider. That was the first problem. 

Due to resourcing and staffing issues, some facilities struggled to maintain COVID-19 specific units. While facilities did have COVID-19 specific units, they were not always able to adequately isolate workers and residents to those units. And hospitals were also sending COVID-19 patients to nursing facilities, which, in some instances, introduced COVID-19 to previously unexposed populations. 

When we talk about measures to fix this problem, they’re expensive ones. We’re talking about the high cost to redesign facilities for infection control, and affording a higher capacity of PPE. Ultimately, the biggest takeaway is that the government should have stepped in faster to get necessary PPE to nursing homes. They simply did not have the purchasing power to compete with hospitals.  

To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”

DN: Have nursing homes started to benefit from the various state and federal funding efforts?

Coppins: “There are various state and federal funding efforts to help out nursing facilities – but those funds were exhausted through PPE price gouging, paying for agency staffing, and the high cost of testing. It was a short-term solution. Those funds are running out, and as far as anyone can tell, there is no second wave stimulus money on the horizon. These facilities are going to be scrambling for PPE and staffing again soon enough.”

DN: What are nursing homes doing to counteract the CNA staffing shortage? Can CNAs expect higher wages or bonuses?

Coppins: “Some pay rates have gone up. Right now, nursing homes simply don’t have the cash flow to put towards recruiting and staffing. And CMS reimbursement rates haven’t changed – they need to be reevaluated and updated to match the current demand. 

Staffing levels are still recovering from the unemployment act. It blew up CNA shortages. The indiscriminate application of the federal bonus had an unintended catastrophic effect on CNA staffing. Many CNAs stayed home and out of the workforce while there was a desperate need for people to work. 

We may see an increase in CNAs working in the coming months. Unfortunately, there have been massive layoffs in the service industry (restaurants, retail, entertainment, etc). So you have a large population of people in need of work. Nursing homes might be an appealing prospect for those populations, and there are plenty of programs out there trying to quickly recruit and train new CNAs. But I think it will be some time before we see if this has any impact on the staffing shortage.”

“Our Residents Need Us” — A CNA’s Perspective on Nursing Homes and Covid

DailyNurse also asked Pennsylvania CNA Christine Pepple for her first-hand view from the nursing home frontlines.

DailyNurse: How has the pandemic changed the working routine of CNAs? How has it changed the way they interact with nursing home residents?

Christine Pepple: “For me, it’s really just wearing the PPE and being aware of new protocols. If I have been working at a facility that has COVID-19 exposure, sometimes I will be restricted from working at other facilities. Now I am just wearing a mask and eyewear. Earlier in the pandemic, I was head-to-toe in PPE, including a plastic gown. It was so uncomfortable.

But as for how I’ve interacted with residents, not much has changed. I have a job to do. And the residents need my care. This has been so hard on them. Luckily, visitations are coming back, and we’re now able to take them to the dining room and they can get their hair done.”

DN: How have CNAs been coping with the hardships of working during the pandemic?

“Luckily, the facilities have our backs.”

Christina Pepple, CNA

Pepple: “The hardest thing for me was the stigma. I wasn’t really able to see friends and family because I was working with COVID-19 on a regular basis. It’s been hard. 

Luckily, the facilities have our backs. They have all gone above and beyond to make sure we were taken care of, and the residents were taken care of. It’s good to see some of the activities opening up and having the residents get to see each other again.”

DN: Do nursing home workers feel better prepared for the next wave of COVID?

“The facilities I have been working with have been so on top of it.”

Christine Pepple, CNA

Pepple: “We know what to expect now. We’re resilient. Nurses and nursing assistants are going to continue to do their jobs because our residents need us.  

We are more prepared now. It feels like we have a lot of PPE and we have more structure now than we did at the beginning. When they bring a resident in from the hospital they quarantine for two weeks on the COVID-19 wing. If you’re working there, you wear a gown, masks, and protective eyewear. And if you’re on a wing where there’s no COVID-19, we’re just wearing eyewear and masks. We’re also getting tested every week – the facilities I have been working with have been so on top of it.”