Nursing homes fear coronavirus could aggravate severe staff shortages

Working to prevent an outbreak, long-term care facilities worry that exposure to the virus could keep staffers home during crisis.

Vietnam War veteran Leo Marchand, 71, made his way to the dining room for lunch at the South Shore Rehabilitation and Skilled Care Center on March 6 in Rockland, Mass. The retired truck driver has chronic obstructive pulmonary disease that makes it difficult for him to breathe. The possibility of contracting the coronavirus scares him. "It's a concern," Marchand said. "It really is."David Goldman/Associated Press

Long-term care facilities in Massachusetts, grappling with a severe shortage of direct care workers, fear coronavirus exposure could make a bad situation worse if sick staffers are sidelined during a crisis.

Nursing homes, assisted-living centers, and other senior living communities across the state are working overtime on precautions to prevent infections of residents and employees. Such facilities are on the front lines of the battle against the spreading coronavirus because many of their residents ― older folks with weaker immune and respiratory systems ― are at higher risk.

Should an outbreak occur, as happened at Life Care Center in Kirkland, Wash., operators worry it could tax a workforce that’s understaffed because of low wages and an economy that’s generated better-paying jobs. Massachusetts long-term care facilities currently have about 5,600 unfilled jobs. The vacancy rate is highest, 17.2 percent, for a category called certified nursing assistants, front-line care workers who help residents eat, bathe, and get in and out of bed.

Virus concerns "put stress on an already stressed system,” said Rich Bane, president of BaneCare Management in Braintree, which runs a dozen Massachusetts nursing homes and has reported 1 out of 6 positions are vacant at its homes in Berkshire County. "Everybody wants to do the right thing. Nursing homes are used to providing good infection control. But this could put another drop in a rain bucket that’s overflowing.”

Tara Gregorio, president of the Massachusetts Senior Care Association in Waltham, said the ratio of nursing staff hours devoted to long-term care residents daily in Massachusetts is lower than the national — or Washington state — ratios.

“We’re in the midst of a historic staffing crisis,” Gregorio said. "The concern is that, if we have to self-quarantine [staffers], we may not have the workers we need to meet the needs of residents.”

That concern was echoed by Dr. David Gifford, chief medical officer at the American Health Care Association and National Center for Assisted Living, in a conference call with reporters last Friday. He said many of the nation’s nursing homes and assisted living centers, which house about 2.5 million, face worker shortages even as they prepare their staff to handle a crisis.

The protocols are being modeled on those they use annually for influenza: isolating infected patients; restricting visits by sick family members; and requiring staffers to wear masks and gowns to care for infected residents. But the novel coronavirus is considered a more serious challenge because much about it remains unknown, and there are currently no vaccines or other treatments.

"Our top priority is making sure the virus does not get into any of our nursing homes or assisted living facilities because the people in these facilities are very susceptible” to Covid-19, the illness caused by coronavirus, Gifford said. As the virus continues to spread, the death toll has reached more than 4,000 worldwide, including 27 in the United States.

Life Care Center in Kirkland, across Lake Washington from Seattle, is considered the epicenter of the US coronavirus crisis. At least 13 nursing home residents who died after being taken to hospitals tested positive for Covid-19. More than two dozen residents have died in the acute care facility since mid-February, though it’s not known how many of the deaths were caused by the virus. Seventy Life Care employees, meanwhile, have shown symptoms of coronavirus and are self-quarantined at home.

"The situation in Seattle is extraordinarily scary,” said state Senator Pat Jehlen, Democrat of Somerville, who cochairs the Legislature’s Joint Committee on Elder Affairs. "Nursing facilities are not good places to be when viruses and infections are going around. And we have a very tight labor market and no good way to recruit people to work in these facilities.”

At a hearing of the elder affairs committee last month, front-line care workers and senior living officials attributed the labor shortage to low wages and a supply of better-paying jobs in the state. The average hourly wage in Massachusetts is $13.98 for personal care aides, $14.82 for home health aides, and $16.12 for certified nursing assistants, according to the most recent Bureau of Labor Statistics data.

Tom Grape, chief executive of Benchmark Senior Living, a Waltham company that manages 31 senior living residences in Massachusetts and a total of 62 in eight states, said the tight labor market is affecting some of his properties. In preparation for the coronavirus, he said, Benchmark is setting up a separate sick bank so employees staying home with Covid-19 symptoms don’t lose sick time. It’s also working on establishing day care for employees in the event their children’s schools are shut down.

"Sometimes [employees] who are dedicated to their jobs or don’t want to miss a paycheck will come to work when they’re feeling sick,” Grape said. "We don’t want them to do that now. We’re trying to reduce the exposure to our residents.”

Though most nursing facilities prefer to hire staffers, many have turned to temporary agencies when they haven’t been able to fill jobs, said Elissa Sherman, president of Leading Age Massachusetts, a Newton group that represents nonprofit housing and aging services for older adults. "I assume that if facilities face staff shortages due to staff being out sick, they will need to turn to staffing agencies in the short term to fill the gaps,” Sherman said.

As senior living facilities beef up their precautions, many are preparing to activate a mutual aid evacuation and supply plan to allow them to share supplies and vendors in the event of an emergency.

But the plan currently doesn’t cover the transfer of direct care workers from one employer or one part of the state to another if a coronavirus outbreak were to sideline a crew of employees, said Helen Magliozzi, director of regulatory affairs for the Massachusetts Senior Care Association, who manages the mutual aid plan in the state.

Extending the aid provision to staffers would require guidance by the state Department of Public Health, senior living officials said.

"This is uncharted territory,” Magliozzi said.