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US Coronavirus Hits Nursing Homes Hard, as Staff Combat Infections, Shortages

03:30  27 march  2020
03:30  27 march  2020 Source:   online.wsj.com

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For nursing homes, the new coronavirus is a double-whammy, hitting not just vulnerable elderly residents, but already-stretched staffs, putting heavy pressure on their operations as workers are forced to stay home because of potential infection.

St. Joseph’s Senior Home in Woodbridge Township, N.J., called the state for help because about a dozen staffers were sick and the facility couldn’t adequately care for residents. On Wednesday, the center was forced to bus 78 residents, escorted by state troopers, to a different facility more than 30 miles away.

At Life Care Center of Kirkland in Washington, an outbreak tied to at least 37 deaths spread widely through the employee ranks, compounding the crisis.

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“We lost a third of our staff within the first few days” as employees had to self-quarantine, said Tim Killian, a spokesman for Life Care.

The nursing home also lost its medical director, who self-quarantined but worked with the facility by phone, Mr. Killian said. Government employees had to parachute in to keep the center operating, according to the main federal agency that regulates nursing homes.

At the nonprofit Columbia Lutheran Home in Seattle, 14 residents with confirmed coronavirus were in isolation early Thursday as more were tested, along with several others also in isolation due to potential exposure, said Ellie Brown, director of community relations, emergency response and preparedness. Managing the outbreak has significantly boosted demands on staff, even as some have been sidelined with coronavirus infections and could be out for several weeks. They are eager to return but must test negative twice first, Ms. Brown said.

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“We’re already short-staffed and we have double the amount of work,” she said.

The novel virus is hitting an industry that was already struggling with staffing issues. Roughly 80% of the care work is done by nursing aides who make around $14 to $15 an hour and are “extremely underpaid for what they do,” said Nicholas Castle, a health-policy professor at West Virginia University. Industry officials say staffers often work more than one job. Nursing homes currently “are clearly having difficulty getting people into the facilities to work,” Dr. Castle said.

Covid-19, the respiratory illness caused by the new coronavirus, has been spreading rapidly among nursing homes, where residents’ age and underlying health conditions make them particularly vulnerable to the easily transmitted virus. The federal government has said there are cases in at least 147 nursing homes across 27 states, with large clusters and deaths reported in elder-living facilities from Louisiana to Vermont to Florida.

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Nursing-home officials have said that, like other health-care employers, they are struggling to secure enough masks and other protective equipment for staff, leaving them and residents potentially vulnerable to the virus if someone is unknowingly infected.

Federal regulators said they are aware of the pressure on nursing-home employees. “Right now we have a lot of health-care workers that are being quarantined,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. “We have a lot of health-care workers that can’t get to work because of child-care issues because the schools are closed. There’s already a lot of stress on the health-care system.”

The events at St. Joseph’s show how a coronavirus outbreak can spiral, rapidly knocking out a nursing home’s workforce.

The home, run by the Little Servant Sisters of the Immaculate Conception since 1981, has long been a fixture in Woodbridge Township, a community of about 100,000 people just west of Staten Island. The home had a five-star quality rating from Medicare, with four stars for staffing.

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Mayor John McCormac said he first learned of a half-dozen cases of Covid-19 at the nursing home on March 13. “Right away, everyone became alarmed,” he said.

Last Friday, St. Joseph’s reached out to state officials to warn of a crisis, according to Judith Persichilli, New Jersey’s health commissioner. St. Joseph’s referred questions to the state.

About a dozen staffers were out because of respiratory symptoms, Ms. Persichilli said during a press conference, and “the sisters were working around the clock to take care of almost 90 residents.” The nuns said they didn’t have enough staff to care for the residents, and asked for residents to be placed elsewhere, she said.

The state reached out to other nursing homes, and staffers from a facility owned by CareOne, a closely held company with operations in 11 states, filled in starting on the Sunday overnight shift, according to CareOne. State officials issued an emergency order shutting down St. Joseph’s.

By around midday Wednesday, six medical buses started heading north to a CareOne facility in Whippany, N.J., with more buses to transport staffers. CareOne said that it moved residents out of its Whippany facility to other locations. “CareOne and our team of dedicated professionals will comply with the [New Jersey Department of Health] Emergency Order, follow state directives, and continue to support the state,” said Daniel Straus, chief executive of CareOne.

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Nursing homes are screening employees for Covid-19 symptoms and blocking visitors to reduce the risk of infection. Ill employees are supposed to stay home. But nursing homes also have said they are having major problems obtaining masks and other protective equipment to protect workers, as well as prompt testing to confirm cases.

Many facilities are scrambling to fill in for absent staffers and for protective equipment.

At Columbia Lutheran Home in Seattle, staffers have been working long shifts and cross-training. Ms. Brown herself has donned protective gear—including donated Seattle Seahawks pullovers amid the shortage of medical-grade gear—to care for residents.

Researchers and patient advocates have long called for tougher staffing standards for nursing homes. Charlene Harrington, an emerita professor at the University of California, San Francisco, said that around 75% of nursing homes fail to staff at an adequate level. The coronavirus crisis “makes it just that much worse,” she said.

Industry executives say that staffing and wages reflect the rates they are paid by government programs, particularly Medicaid. “This public health crisis exacerbates the well-documented workforce shortage” faced by nursing homes, said Katie Smith Sloan, the CEO of LeadingAge, which represents nonprofit aging-services providers. The group had long called for government action to help, she said, and “now we are at five star alarm levels.”

Write to Anna Wilde Mathews at anna.mathews@wsj.com and Jon Kamp at jon.kamp@wsj.com

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