Last year, as the pandemic raged in New York City and sirens filled the air, a group of young travel nurses arrived to assist weary long-term care teams. They took over nursing stations that had been depleted due to positive COVID tests and allowed healthy staffers working doubles to get some rest. They gave us hope that after being ignored in the COVID-19 war zone, we were finally getting help.
There may not be sirens blaring outside today, but the need for staff reinforcements is even more dire now.
The current alarm bells are headlines about facilities closing or limiting admissions due to lack of staff, the McKnight’s Mood of the Market Survey results showing that directors of nursing and administrators would rather have more employees than more money, an AHCA/NCAL survey indicating that just 1% of nursing homes are fully staffed, and the level of burnout being experienced at all levels of the field.
Less visible alarms are the quiet complaints of exhausted workers telling their colleagues that “it’s too much,” the incessant ring of unanswered call bells and the flashing message lights of family phone calls that go unreturned.
The reality of the current short-staffing is probably even worse than the data indicate, due to an increase in acuity of the residents, greater numbers of residents with serious mental health problems and the level of burnout among workers who have been subject to cascading collective trauma due to COVID-19.
Nursing homes need immediate “boots on the ground” to ease the situation, followed by further steps to ensure adequate staffing.
Increasing the number of workers costs money, but there are costs to failing to increase the number of workers.
When teams are too busy to know their residents, changes in their clinical presentation are missed, so ailments that could have been treated in the nursing home require hospitalization instead.
Unanswered phone calls of family members impede the flow of essential information (such as a history of a bad reaction to a medication) and heighten the risks of care transitions (relatives are often the only ones accompanying a resident from one medical event to another). They also increase family frustration and the likelihood of lawsuits.
There are expenses for workers out on stress-related disability, pricey agencies used to temporarily fill open positions, and replacement costs for new hires to take on roles abandoned by burned-out old-timers.
Closed facilities lead to unemployment claims, add financial strain to unemployed workers’ families and can impact the economy of communities that relied on that employer. Human costs are great as well, such as a disintegration of long-time teams and the need for relatives to travel great distances to visit a loved one in a far-flung nursing home.
The healthcare situation in the U.S. is beyond frustrating, with consequences detached from behaviors. A company that regularly understaffs their units may turn a profit, but if understaffing leads to an increase in medical costs for their residents, Medicare, Medicaid and private insurance pick up the tab, with little to no ramifications for that company.
Sometimes individual staff members like myself can prevent cascading costs.
For instance, I began to see a frail nonagenarian for psychotherapy sessions. Her advanced directives indicated that she was full code. When I raised this issue with her, she told me firmly that in the event of a health crisis, she wanted the staff to “let [her] go.” Her social worker, who would normally have handled this situation, quit. A new social worker didn’t arrive for several weeks and was immediately inundated with more pressing tasks.
Soon after, the woman, who had virtually no social supports, mentioned a nephew. I pulled out my smartphone, searched for him online, miraculously reached him during our session, relayed her end-of-life wishes, and got him listed as a contact in her chart. A week later she was hospitalized and returned to the facility weakened, but with her updated advance directives in place. This eased her eventual passing, and, if she had been resuscitated but further disabled, potentially saved the system many thousands of dollars.
It shouldn’t take Google and divine intervention to take care of residents’ basic needs. It does, however, take a full team of workers. Every day without one is costing us money, and our humanity.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.