Texas nursing homes, grappling with a pandemic that has ravaged their residents and decimated their workforce, are asking the state for $ 400 million in federal coronavirus assistance to deal with a crisis of staff in the system that supports the oldest and most fragile residents of the state.
The fact that 40% of the state’s 100,000 nursing home workers are not vaccinated against COVID-19 and they could face a federal ultimatum to do so later this month, adds to the urgency.
Industry advocates fear the federal vaccination mandate could mean the potential exodus of tens of thousands of facility workers across the state before Halloween.
âWe know we’re going to lose additional staff when this vaccine mandate is released,â said Becky Anderson, clinical operations manager for Focused Post Acute Care Partners, which manages 31 nursing homes and employs approximately 2,500 workers in Texas. . “We just have a few staff members who are very adamant that they will not get the vaccine.”
The federal rule comes at a time when the industry is already grappling with a shrinking workforce due to burnout, low wages, increased pandemic-related spending and the competition from other health care providers, according to administrators.
Governor Greg Abbott has pledged to fight any vaccination mandate in Texas.
According to recent polls from the Texas Health Care Association and LeadingAge Texas, two groups in the nursing home industry in Texas, facilities across the state have seen their workforce shrink by 12% in the past year. At least a third of survey respondents refuse new admissions due to understaffing, according to the survey.
For facilities, staff shortages mean higher costs for overtime and an inability to increase or maintain patient population levels. Facility operators also face an urgent need for higher wages and more money for recruiting tools, industry advocates have said.
âThe environment in which suppliers operate today is not sustainable,â said George Linial, President and CEO of LeadingAge Texas. âTexas cannot keep throwing this box on the road. Strong commitment and investment by lawmakers will pay huge dividends to the people we serve. “
However, it does not appear that help from the Texan authorities, either with emergency funding or personnel, is imminent.
There is no bill tabled in the current special session of the legislature, which ends in just over two weeks, that would funnel relief funds to nursing homes.
Texas has about $ 16.7 billion in money under the American Rescue Plan Act, and about $ 7.2 billion is written into legislation to bolster the state’s unemployment fund, which was overloaded last year with record requests.
The nursing home funding request includes $ 400 million to help recruit and retain workers, and an additional $ 350 million to pay for new infection control measures and maintain them permanently for future crises.
For the remaining $ 8.5 billion available, demands from everyone outside of the nursing home industry are nearly eight times more, according to budget officials.
Efforts by nursing homes to secure this funding have not gone very far, prompting industry concerns that nursing homes will begin to close.
Already, the nursing home workforce shortage is imposing admission caps, which is having a ripple effect on hospitals that are already at full capacity with COVID-19 patients. With nowhere to transport patients well enough to leave the hospital but still too sick to return home, hospitals are now often forced to house patients longer than they would have if they had. had a retirement home space available, said Kevin Warren, President and CEO. from the Texas Health Care Association.
It has also placed more burdens on families who may not be equipped to care for a much longer aging parent or older Texans whose medical needs are better met in a skilled nursing facility rather than by nurses. expensive home care, he said.
âI am concerned that without the additional funds needed to recruit and retain current staff and develop opportunities to bring new employees into the profession, we will see increasingly serious access to care issues with increasing restrictions on health care. ‘admission, closings, small independent owners forced to sell and bankruptcies,’ Warren said.
Meanwhile, New York state lawmakers are considering sending medically trained National Guard members to fill vacancies in struggling nursing homes. So far, there is no similar plan underway in Texas to use the military branch to supplement staff at any of the state’s 1,200 nursing homes.
A spokesperson for the Texas Emergency Management Division, which oversees state custody, referred questions about potential nursing home help to the Texas State Department Health Services.
A DSHS spokesperson said nursing homes with staff sick with COVID-19 or overwhelmed with COVID patients can seek help from the state, but facilities are not reporting a high number of active cases.
While Texas paid thousands of rescue workers this summer to send to hospitals struggling with a similar staffing crisis, Abbott has not announced a similar program for nursing homes.
Texas nursing homes have been devastated by the coronavirus, which has had a particularly high death rate among the elderly population and killed 10% of nursing home residents in the state in its first year.
In an effort to reduce the deadly impact of the virus, state and federal governments have imposed strict safety mandates on nursing homes that have changed daily, sometimes hourly, during the height of the pandemic. last year.
Homes have struggled to provide testing and personal protective equipment to staff members at their own expense, and some have made significant changes to their air filtration systems, building layouts and their staffing plans to respond to the health crisis.
Meanwhile, the cost of running a nursing home in Texas has increased dramatically during the pandemic. Safety protocols and ongoing staffing issues have caused Texas nursing home budgets to increase 25% in the past 18 months, according to the survey released Tuesday.
And even more problems lie ahead. About 75 percent of Texas nursing homes are operating at a loss, according to the THCA / LeadingAge survey.
These nursing home staffing challenges are not limited to lower paying or entry level positions. Each of the 31 facilities managed by Focused Care in Texas has openings, and the vacancies are going all the way to the top, Anderson said. Three facilities do not have an administrator and another handful do not have a nursing director, she said.
Bonuses for recommending new hires and extra shifts can help attract and retain staff, but about 90% of nursing home residents use Medicaid or Medicare, which helps keep budgets down and pay for it. most entry-level positions between $ 10 and $ 15 an hour.
There is also a shortage of applicants for a job that was already difficult and now that job comes with additional safety requirements and equipment needed to deal with a population susceptible to COVID-19. Any new worker finds themselves working more overtime due to lack of hiring and all of this contributes to employees quitting within a month or two of being hired, she said. The problem has become so serious that the company is updating its orientation program to find a way to better prepare new hires for the harsh environment, Anderson said.
The high turnover rate, especially among new hires, “is quite alarming,” she said. “It’s always been hard work, but it’s even harder now with everything that’s going on, and just the exhaustion.”
According to the US Centers for Medicare and Medicaid Services, about 65 percent of nursing home staff are currently vaccinated nationwide. A recent increase in cases among nursing home residents, both in Texas and across the country, driven by the highly contagious delta variant, prompted the federal agency to announce in August that all nursing home workers. Nurses would be vaccinated so that their facilities continued to participate in the Medicare and Medicaid program.
These rules are expected to be released later this month.
Anderson takes an anxious look at this time, when potentially 40 percent of his workforce could become ineligible for employment.
About 62% of staff and 81% of residents at Texas targeted care facilities are vaccinated, Anderson said.
But while resident vaccination rates are quite high system-wide, they vary widely among staff depending on the facility, according to state figures.
Statewide, the vast majority of nursing homes with less than 40% of their staff fully immunized are located in rural areas – primarily east Texas, where counties have some of the highest immunization rates. bottom of the state.
In contrast, most nursing homes with more than 90 percent of staff vaccinated are in the Rio Grande Valley and El Paso, which have some of the highest vaccination rates in the state.
Warren, the leader of the THCA nursing home advocacy group, said that while administrators work every day to convince their staff to get vaccinated, it is nearly impossible to distance them from the belief system that causes them to reject or reject. fear the vaccine. although it is free and widely available.
Much, he said, has to do with where they live.
âThere is this relationship between vaccination rates within the community and within the facility,â said Warren. âWhen people in these establishments work 8, 10, 12 hours a day, on their days off, they spend time with family and friends in the community. So if this same prevalence of vaccine worry and mistrust is present in this community, it only reinforces their own reluctance. “