In Rhode Island nursing homes, a staffing crisis made worse by COVID-19

Low wages and a high risk of catching the coronavirus may make meeting minimum staffing standards difficult for many nursing homes and assisted care facilities.

Registered Nurse Nancy Green administers the Moderna COVID-19 Vaccine to Matthew Lubera in the hallway outside his home at Forand Manor in Central Falls, R.I. on Dec. 30, 2020.Craig F. Walker/Globe Staff

PROVIDENCE — There’s a sense of desperation in the job postings for certified nursing assistants and nurses at nursing homes and senior care agencies all around Rhode Island.

Phrases like “Urgently hiring” and “$1,000 signing bonus” accompany ads for CNA jobs that pay people $14 to $17 an hour to work in settings where COVID-19 has infected more than 6,500 people over the last 11 months.

There are few takers.

The difficulty in finding workers for nursing homes has been a chronic problem for years nationally, not just in Rhode Island. And over the last year, the pandemic has only made the problem worse.

A recent analysis by AARP found that more than 41 percent of nursing homes in Rhode Island reported staffing shortages from Nov. 23 to Dec. 20, 2020 — up from 32.4 percent in the previous four weeks, according to data from the Centers for Medicare and Medicaid Services Nursing Home COVID-19 Public File. A new analysis is expected Feb. 11.

Local nursing home administrators say they are struggling to keep staff. Some quit when they become infected or leave out of fear of getting sick. Some leave for jobs in retail or fast-food that pay about the same but come with a far lower risk of contracting the coronavirus. Those who remain are sometimes subject to “lock-ins” when there aren’t enough people to work. Administrators end up relying on outside agencies to supply staff, at a higher price.

Many of these details came out during testimony recently on a Senate bill to set minimum standards for staffing, supported by the union for CNAs and nurses, and opposed by administrators for homes, who say it would be an unfunded mandate that they couldn’t afford to meet. They blamed cuts in Medicaid rates for strangling their budgets, and blamed COVID-19 — which has infected 95 percent of homes and assisted-living facilities in Rhode Island — for discouraging people from applying for jobs.

Jeff Roy, administrator at the Holiday Retirement Center in Lincoln, told the senators that his facility has tried to bring in more staff. “We use zip recruiter, ihirenurses.com, Facebook, The Valley Breeze, even a sandwich board out at the street,” Roy said. But, he said, for every four job openings, only one person applies.

“This was a problem prior to the pandemic, and trust me when I tell you, there’s not a lot of people lining up to work at nursing homes because of COVID and all the negative attention to nursing homes right now,” Liz DaRosa, of West Shore Health Center in Warwick, told the senators.

Later, in an interview Friday, DaRosa fought back tears as she talked about how the virus had swept through her nursing home last March. More than 100 elderly residents were infected, and she and the staff also got sick. “No one quit. When they had to be out (on quarantine), they were frustrated, and they came right back,” she said. “They wanted to be here. They wanted to help. They wanted to save as many as we could.”

But, they lost 53 residents to COVID-19, DaRosa said. “I’ll never be the same again,” she said, her voice catching. “What I saw and what I went through, I wouldn’t wish on anyone.”

And yet, she said, the staff has stayed on. They have opted to work extra hours rather than have an outside agency send in other nurses and CNAs, because they are dedicated to the residents.

She said she wishes she could pay them more. “If you really want us to have more workers here who will do justice (for residents), fund us properly so we can offer adequate wages and bring people in,” DaRosa said.

The full Senate passed the bill on Wednesday — as it has for the last three years — but companion legislation in the House hasn’t yet been heard. House Speaker K. Joseph Shekarchi, a Warwick Democrat, said through a spokesman that the House is studying the matter and “will have robust, transparent public hearings before we take any action on the issue.”

In the meantime, the short-staffed facilities continue to battle COVID-19 outbreaks. About 95 percent of all nursing homes and assisted living facilities in Rhode Island have had confirmed cases of COVID-19. So far, only six nursing homes and 13 assisted-living facilities have made it through the pandemic without any residents dying, according to the most recent data from the state Department of Health.

When the pandemic began, and staffing shortages became worse, the homes asked for help.

Scott Fraser, president and CEO of the Rhode Island Healthcare Association, which represents 64 of the state’s 81 nursing homes, said they had proposed using National Guard strike teams to fill in the gaps. Other states facing the same issues have used the National Guard.

“We were told that’s not their role,” Fraser said. “They had the support teams come into the homes, assess what the homes need, but not fill the shortages.”

“We’re hoping that vaccination will go a long way to keep residents and staff healthy, and keep them on the job,” Fraser said. “And we hope there will be full Medicaid funding in the upcoming budget.”

The loved ones of residents also feel the strain. During the lockdowns, the nurses and CNAs have been their only connection to knowing about the care of the residents, and that connection has been frayed.

“A lot of the staff is testing positive now, and they are scrambling to get people to fill in where they can if they have people quarantining,” said Roni Ferraro, whose husband, Louie, is a resident in the dementia ward at St. Elizabeth’s Home in East Greenwich. “Some have come back on, and others go out. It’s been a revolving door.”

In order to control COVID-19 outbreaks, many homes only allowed visitations outside — something that is impossible in the winter.

Although Governor Gina M. Raimondo decided in December to allow nursing homes and assisted living facilities to train designated relatives and close friends of residents to be essential caregivers, barely any of the homes are participating in the program.

And this has left families feeling helpless. “We don’t know, and we can’t see,” Ferraro said. “That’s the worst thing is not being able to see his condition the way we used to. ... Many times, I was the one to point out issues and changes.”

However, Ferraro said, she doesn’t believe the mandatory staffing bill will solve the complex problems of funding staffing and preventing shortages in care. The pandemic has exposed deep issues in long-term care, which without funding won’t be solved.

Until the pandemic subsides, and residents’ loved ones are once again allowed into the facilities, the CNAs and nurses are the residents’ only support.

“All those people who do those jobs are angels,” Ferraro said. “They should all go to heaven.”