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PROVIDENCE — Health care workers continue to quit the industry due to burnout and low wages, leaving nursing homes in the state understaffed by as much as 20 percent.

According to a new survey conducted by the Rhode Island Health Care Association and LeadingAge Rhode Island, two organizations that together represent the state’s 77 nursing homes, there are about 1,920 open positions across the state’s nursing homes, including 983 openings for certified nursing assistants and 447 openings for registered and licensed practical nurses.

“The result of this survey quantifies what we already knew: Rhode Island nursing homes are facing the fight of their lives and the future of long-term care for Rhode Island’s most vulnerable citizens stands in the balance,” said John Gage, president of the RIHCA.

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As many as 28 facilities and units have shut down during the pandemic because they are unable to be properly staffed, according to the survey, and 23 facilities have closed new admissions over the last three months, even as vaccination rates among Rhode Island adults have soared to more than 84 percent.

The majority — 71 percent — of all long-term care facilities have limited the number of admissions they will accept.

James Nyberg, the executive director of LeadingAge Rhode Island, which represents nonprofit nursing homes and long-term care facilities, said that the crisis has not only affected operators and facilities but also the communities in which they are located.

“Without proper funding, adequate training, and available CNA testing sites in the state, the workforce challenges facing the industry will only get worse,” Nyberg said Wednesday. “With staff shortages, looming fines, payment freezes, admission bans, and potential closures, Rhode Island’s most frail residents will have no place to go.”

The staffing crisis has not been limited to nursing homes. The state’s hospitals and community clinics are feeling it as well.

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On Wednesday morning, Dr. Nicole Alexander-Scott, the state’s health department director, urged Rhode Islanders to avoid going to the emergency room unless they were experiencing a “true, medical emergency.”

“This is a public health concern and could become a patient safety concern,” said Alexander-Scott outside of Rhode Island Hospital.

Dr. Matthew Sarasin, the medical director of Landmark Medical Center in Woonsocket, said his facility is experiencing an increase in the number of patients visiting the emergency department who are sick and not just with COVID-19.

“But what we are also seeing, in addition to our sick medical patients, is an increase in the number of behavioral health patients, including behavioral health pediatric patients and that’s because of a lack of beds for them — not just at Landmark,” Sarasin said. “And they’re staying in the emergency department longer.”

Sarasin said the emergency department may be a suitable location for initial intake, where they can stabilize a mental health patient and rule out any other underlying medical issues while being evaluated, because not every behavioral health patient is undergoing a crisis and needs an inpatient psychiatric bed.

Matthew Sarasin, medical director of Landmark Medical Center in Woonsocket, R.I.
Matthew Sarasin, medical director of Landmark Medical Center in Woonsocket, R.I. MARK STOCKWELL FOR THE BOSTON GLOBE

But once the initial assessment is done, “we need to get them to definitive care (an inpatient psychiatric bed) so we can get them the treatment they need.”

Instead, he said, there are pediatric behavioral health patients who are staying in the emergency room for days at a time, and sometimes up to a week.

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“Right now, Landmark has a job fair going on, trying to recruit workers. But all at the same time, experienced nurses around Rhode Island all reached retirement age and left the industry. Younger nurses are taking traveling jobs where they can make just as much money as an attending physician,” Sarasin said.

One of the largest issues, he explained, is that the Medicaid reimbursement rates are much lower in Rhode Island than they are in surrounding states, which trickles down to affect wages. Many nurses, he said, will cross the border to Massachusetts and Connecticut for higher-paying jobs.

When asked if the state’s staffing crisis was linked to the vaccine mandate that required all health care workers to be vaccinated against COVID-19, Alexander-Scott said the mandate was meant to “stabilize the existing workforce” but that it’s a “contributing factor.”

“We can be confident that 98 percent of our health care workforce will not need to be isolated or quarantined multiple times or disrupt their ability to provide high-quality care to patients,” she said. “The staffing crisis throughout the nation is because of burnout, and it’s a challenge everywhere.”

“Health care workers have been working for 20-months straight. There’s a lot of burnout,” said Dr. Paari Gopalakrishnan, the interim president and chief operating officer of Kent Hospital in Warwick, which is owned by Care New England. “And there’s a lot of opportunity to work elsewhere.”

State Senator Sam Bell, a Providence progressive said the solution is “really quite simple” for the state to fix.

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“Raise wages and Medicaid reimbursement rates,” he said. He said burnout is linked to the low staffing levels that state leaders and hospital CEOs are warning Rhode Islanders about, which comes down to “inadequate wages.”


Alexa Gagosz can be reached at alexa.gagosz@globe.com. Follow her on Twitter @alexagagosz.