COVID-era nursing home staff crunch hurting hospitals, too

Pennsylvania nursing homes say they are coping with dire staffing shortages that have forced many of them to stop accepting new residents, which in turn is preventing hospitals jammed with COVID-19 patients from discharging those who require lower levels of care.

Industry officials met with Gov. Tom Wolf's administration this week to ask for help, and to press their case for a $200 million infusion from the state's share of the federal coronavirus relief package signed by President Joe Biden in March. Long-term care facilities say the money would be spent on retention bonuses for current workers.

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"This is the worst workforce crisis I've ever seen, and there honestly seems to be no light at the end of the tunnel," said Anne Henry, senior vice president and chief government affairs officer at LeadingAge PA, a trade group.

The workforce crunch at skilled nursing homes and personal care facilities is having a spillover effect on hospitals, which are under strain from a 55% increase in COVID-19 patients since mid-November. Hospitals are treating more than 4,500 patients infected with the coronavirus, according to the state Department of Health, and are desperate to free up bed space and ease lengthy wait times in emergency rooms.

"Some of the skilled care facilities are having difficulty finding employees, and therefore it makes discharging from hospitals much more difficult," said Dr. Michael Seim, senior vice president and chief quality officer at WellSpan Health.

WellSpan, whose hospitals in south-central Pennsylvania have largely run out of beds because of the latest pandemic surge, typically cares for 30 to 50 patients who could otherwise be discharged to nursing homes if they had the staffing to care for them. Trying to gain bed space, WellSpan recently began sending its own nurses and aides to SpiriTrust Lutheran — which runs senior living facilities in WellSpan's service area — to help boost staffing levels.

Geisinger, a large health system in central and northeastern Pennsylvania that is also short on beds because of the COVID-19 surge, said gridlock at nursing homes, rehab centers and psychiatric facilities is contributing to its capacity woes. The average length of stay at Geisinger hospitals has nearly doubled to eight days, according to Dr. Jaewon Ryu, president and chief executive officer.

The worker shortage at nursing homes predated the pandemic, but has worsened over the past two years in a state with one of the nation's highest proportions of older people.

A recent survey of long-term care facilities found that 20% of the long-term care workforce — representing tens of thousands of people — has departed since early 2020, with the result that 85% of Pennsylvania nursing homes are now limiting new admissions. One nursing home operator in western Pennsylvania said it is declining 80% of resident referrals from hospitals, the survey said.

"It really has become a vicious cycle. When hospitals can't admit to nursing homes due to workforce shortages, it creates this backlog and it really has a negative impact both on acute and post-acute healthcare in Pennsylvania," said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, a nursing home trade group that conducted the survey of its members.

The group said it is pressing the Wolf administration for a "comprehensive plan" to address staffing shortages, and has offered to train National Guard members as temporary nurses aides in case a large-scale deployment is needed.

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The National Guard has done occasional, temporary stints at nursing homes. In October, a small Guard contingent spent a few days at Berks Heim, a county-run nursing home in Berks County, to maintain staffing levels. Currently, 21 service members are deployed to three personal care homes in northeastern and western Pennsylvania, said Capt. Travis Mueller.

GOP leaders in the House and Senate, meanwhile, asked the Wolf administration on Friday to shift the focus of the state's COVID-19 task force — which had been tackling statewide vaccine distribution — to capacity challenges at hospitals and health systems.

"The feedback we are hearing from our local hospitals in our communities is that most are operating at 110% capacity with lessening ICU beds and medical-surgical beds available by the day," the Republicans' letter said.

Wolf, a Democrat, responded in a letter that "the number one thing that the members (of the General Assembly) can do right now to help our hospitals is to urge all eligible constituents to get vaccinated."

Patients hospitalized with COVID-19 are overwhelmingly unvaccinated.