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Meager pay, benefits and low Medicaid reimbursement are driving staffing crisis in Virginia's nursing homes
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Meager pay, benefits and low Medicaid reimbursement are driving staffing crisis in Virginia's nursing homes

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Nursing homes in Virginia are cracking in the aftermath of a staffing crisis left unaddressed far before they became the epicenter of the state’s most severe coronavirus outbreaks.

Findings released Thursday from the Virginia Center for Assisted Living — which represents roughly 350 long-term care facilities statewide that largely rely on Medicaid — found almost all are reporting a workforce strain worse than “the height of the clinical nightmare of the COVID-19 pandemic.”

The majority of the 199 long-term care facilities that responded pointed toward a need for higher Medicaid reimbursements to offset mounting costs and noted how meager pay and poor benefits is a driver to being unable to recruit and retain staff. The vast majority of open jobs are for certified nursing assistants, who make about $29,000 a year in Virginia, according to federal data.

Three in four facilities had a shortage of staff across all shifts. Almost every facility had to ask staff to work overtime or take additional shifts, and two-thirds are still needing to turn toward more expensive agency staff to fill the holes.

It’s nowhere near enough. Then there’s the invisible risk.

In Virginia, 4,430 people linked to outbreaks inside long-term care facilities died. At least eight times that number have been infected.

Deaths among health care workers aren’t publicly tracked. Neither is the burnout and emotional toll that has wrecked those left to care for some of the state’s most vulnerable patients in a grueling, 19-month-long pandemic.

But a national April report from The Guardian and Kaiser Health News revealed lower-paid health care workers who were on the front lines daily were more likely to die than physicians.

Nursing home workers were twice as likely to die as those in hospitals.

Now, almost 40% of nursing homes in Virginia are operating well below capacity because there aren’t enough people to take care of residents. At least 29% are holding off on new admissions. More than a quarter have turned away hospital patients.

“The survey demonstrates the severe workforce challenges facing Virginia’s long-term care providers. Too many facilities are struggling to hire and retain staff that are needed to serve tens of thousands of vulnerable residents,” said Keith Hare, president and CEO of VHCA. “If nursing care is important to Virginia and the seniors who need it, it is well past time for Virginia to invest in it.”

Hare emphasized in a statement that the state’s nursing homes are doing what they can, but to fix the problem, they need policymakers to act.

Members of the General Assembly were made aware once again in early October, when a report submitted to Virginia’s Joint Commission on Health Care outlined the extensive challenges and risks resulting from understaffing.

Among them: low-quality care that impacts largely poor Virginians.

The people who are most likely to be in nursing homes struggling to retain staff — a rough indicator of quality of patient care — are Medicaid recipients and Black residents.

Kyu Kang, a health policy analyst for the commission, said Virginia has among the lowest staffing levels in the country, which influences patient care and, often, health inspection assessments.

The ratings are based on the hours needed to care for in-house patients and, statewide, 43% of nursing homes have fewer than three stars. The national average is 31%, according to the U.S. Centers for Medicare & Medicaid Services.

At one point in the pandemic, nursing homes accounted for a bulk of the state’s outbreaks and more than half of Virginia’s COVID deaths. With a growth in vaccinations, the severity of outbreaks within these homes has plateaued.

But a note on the Virginia Department of Health website on Thursday alerted a major discrepancy in reporting: Due to a data gap, 424 COVID outbreaks haven’t been posted to the public dashboards .

Of those, 38 will show up on the “COVID-19 Outbreaks by Selected Exposure Settings” updated every Friday. This is slightly less than 9%, reiterating the persistent pattern of how available virus data is a fraction of what the current spread looks like.

On Thursday, the state health department awarded a $6 million grant to VCU Health for a statewide infection prevention training center that will work with health care facilities and public health agencies to help train frontline providers.

“The COVID-19 pandemic exposed major gaps in knowledge around infection prevention nationally, particularly in nursing homes and other long-term care settings,” said Dr. Michael Stevens, interim hospital epidemiologist at VCU Medical Center, in a news release. “Our goal is to give practitioners in Virginia the knowledge and skills to prevent as many infections as possible.”

smoreno@timesdispatch.com

(804) 649-6103

Twitter: @sabrinaamorenoo

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