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Where is the care? Nursing home, assisted living facility staffing shortage hits Clark County

By , Columbian staff writer
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The long-term care industry is facing the worst staffing shortages among all health care providers nationwide, and Clark County is being impacted.

According to the Bureau of Labor Statistics November employment data, hospitals, physicians’ offices, outpatient care centers and other health care facilities have reached or surpassed pre-pandemic staffing levels, but nursing homes and assisted living communities are still experiencing substantial job losses.

Nursing homes alone have seen a 14 percent drop in employment — 234,000 jobs — since the pandemic began. Assisted living facilities have seen an 8.4 percent decrease, or 39,000 jobs.

The number of people needing care, however, is steadily increasing.

The workforce challenges could be attributed to many factors. Nursing homes were notoriously hard-hit at the beginning of the pandemic, which led to high levels of burnout. Low pay throughout the industry has also led many to seek employment in higher-paying health care sectors.

The long-term care industry was experiencing staffing woes even before the pandemic. Now, it is a crisis. Multiple states, including Minnesota and New York, recently announced that the National Guard would be activated to help staff nursing homes.

By the Numbers

Down 14%: Nursing homes employment since the pandemic began.

Down 8.4%: Assisted living facilities employment since the pandemic began.

— Source: Bureau of Labor Statistics

63.3% of Washington’s 4,300 licensed long-term care facilities are experiencing staffing shortages.

78% nursing homes and 61% assisted living communities are concerned that workforce challenges might force them to close, according to a national survey released by the American Healthcare Association and the National Center for Assisted Living.

According to a survey released by the American Healthcare Association and the National Center for Assisted Living, 78 percent of nursing homes and 61 percent of assisted living communities are concerned that workforce challenges might force them to close, and more than one-third of nursing homes are very concerned about having to shut down their facilities.

In Washington, 63.3 percent of the state’s 4,300 licensed long-term care facilities are experiencing staffing shortages, making it one of the hardest-hit states in the nation, behind only Alaska, Maine, Minnesota and Wyoming, according to data released by the AARP Public Policy Institute.

The National Guard has not been activated in Washington to help at nursing homes. But the Washington State Department of Social and Health Services has deployed Rapid Response Staffing teams — which include registered nurses — to facilities across the state, including in Clark County. Funding for the teams comes from the Coronavirus Aid Relief and Economic Security Act.

“Staffing shortages at long-term care facilities during omicron are an issue throughout the state and we expect that to continue during this surge,” Washington State Department of Social and Health Services spokesperson Chris Wright wrote in an email. “DSHS is monitoring them to see if any reach crisis level and need to temporarily close or transfer residents to a different facility. That has not happened anywhere yet.”

Clark County

In Clark County, staffing at long-term care facilities is bad, but not as bad as in other areas of Washington, according to data from the Centers for Medicare and Medicaid services. Most of Clark County’s long-term care facilities are at average staffing levels, both nationally and locally.

Adult family home finder

Nursing homes and assisted living facilities aren’t the only option for people in need of long-term care. For people who can’t age in place but want to live somewhere smaller and more affordable than an assisted living facility, there are adult family homes, a house run by a licensed mom-or-pop that provides low-medical, long-term care for up to six residents.

One Clark County resident, Selihom Gobeze, learned about adult family homes after a friend of his lost her grandmother while she was living in an assisted living facility that was understaffed, Gobeze said. He thinks that his friend’s grandmother would have received better care in an adult family home, and that it ultimately could have extended her life.

“She wasn’t getting the care she needed, and because of that, she passed away,” he said.

Gobeze, a Washington and Lee University student, started doing research. He learned that the average caregiver-to-patient ratio was higher at adult family homes and that the cost was lower. He also learned that they are more COVID safe; in Washington, only 16 percent of adult family homes have had a case of COVID-19, compared with 100 percent of nursing homes and 88 percent of assisted living facilities, according to the Centers for Medicare and Medicaid Services.

Gobeze was surprised that more people didn’t know about adult family homes, especially because they are recommended by the AARP and many senior care liaisons. He wanted more seniors seeking long-term care to know about adult family homes and their benefits, so he decided to take a gap year from school to design a website that could help people locate quality adult family homes in their area.

He interviewed adult family home owners, social workers and senior care liaisons in Southwest Washington as he crafted the website, findadultfamilyhomes.com, which launched in November. So far, it covers only Clark County, but he hopes to expand it in the future.

“I think Vancouver is a good place to start,” Gobeze said. “I didn’t want to just make it available everywhere. I want it to be a really good website. I wanted to start small. I don’t want to list every home there is. I want this website to direct people to great homes. I want people to find important information about homes, see reviews, the owner’s profile, important information, and also things like whether the owners are vaccinated, whether there’s smoking, whether there’s pets, fresh-cooked meals, stuff like that. I want it to be as consumer friendly as possible.”

— Dylan Jefferies

But the crisis is still being felt.

“There is a statewide staffing shortage that has impacted our region and county,” said Neil Degerstedt, regional long-term care ombudsman for Southwest Washington and a contracted employee for the Area Agency on Aging and Disabilities of Southwest Washington. “These shortages have impacted food preparation and service, calls for assistance and personal hygiene due to a lack of showers or bathing. More serious are those related to medicine administration, failure to note changing symptoms or, worse yet, neglect of a resident’s worsening pressure sores.”

“We see caregivers and staff working extra hard. But undeniably, staffing levels are low, and they can’t provide all the assistance, and therefore, resident care often suffers,” said Deawn Herrmann, assistant long-term care ombudsman for Southwest Washington, who spends a lot of her time visiting long-term care facilities in the area.

Low staffing levels at long-term care facilities increase wait times for incoming residents, which is impacting hospitals.

“Due to these low staffing issues, some facilities are responsibly not taking in new residents, which means we hear of more people who are waiting in hospitals for placement,” Herrmann said.

Breanne Swanson, Aging and Disability Resource Center supervisor with the Area Agency on Aging & Disabilities of Southwest Washington, agreed.

“My team reports that we are seeing an increase in calls from people reporting difficulty getting into a care facility,” she said. “Some were even waiting for room to open up in Oregon facilities. In general, we’re seeing increasing numbers of people who need help in general or who are looking for placement because they don’t have anyone to help them.”

According to Debra Carnes, a spokesperson for PeaceHealth Southwest Medical Center as of Jan. 4, there were 18 beds available at Clark and Cowlitz county nursing homes for people being discharged who require a higher level of care than is available at home.

The 18 beds serve all three Southwest Washington hospitals: PeaceHealth Southwest Medical Center, PeaceHealth St. John, and Legacy Salmon Creek. Pre-COVID, 60 to 70 beds were typically available, Carnes said.

“The lack of available beds in nursing homes and skilled nursing facilities is an ongoing issue and concern for our hospital,” she said. “We recognize these facilities are dealing with staffing challenges as a result of COVID. Every day, we have patients that are medically stable and have met discharge criteria, but they are waiting for placement to a higher level of care than home can provide. This directly impacts our patient length of stay and overall hospital capacity on a daily basis.”

Local long-term care facilities

Representatives from Clark County nursing homes say the omicron variant is making a bad situation worse.

“Our cases of COVID-19 usually reflect the community’s COVID status,” said Julie Beckert, a spokesperson for ProMedica Skilled Nursing and Rehabilitation, formerly known as ManorCare Health Services Salmon Creek. “Unfortunately, as the virus spreads locally after post-holiday get-togethers, we have seen an increase in positive cases.”

With additional staff out, the nursing home has had to bring in nurses from the Rapid Response Staffing team.

“In some cases, we may reduce the number of admissions so we can safely care for our patients,” she said.

Some local nursing homes are seeing positive results from their response to the crisis.

Prestige Care, a Vancouver-based senior living company with multiple long-term care facilities in Clark County, is also experiencing staffing shortages. But according to Blake Thiess, director of talent acquisition for Prestige Care, the company’s response to the issue gives him hope.

By raising wages for all employees, creating an employee loan-forgiveness program, starting a web- and app-based nursing assistant training program to bring on more certified nursing assistants and more, Thiess said, the company has positioned itself to grow in the coming years.

“We’re not immune to the staffing challenges impacting our industry,” he said. “But I’m very proud of the number of actions we have taken enterprise-wide, not only here in Southwest Washington but in the eight states in which we operate, to attract staff. While many operators in this space are struggling — some are closing their doors, there’s mass consolidation going on — I’m pretty proud to say that we’re positioned well to really grow and come out of the pandemic strong because of the strategic actions we have taken in the last 20 months.”

Many long-term care facilities don’t have the resources to implement those kinds of changes, and advocates are calling on lawmakers to address the staffing crisis before it gets worse.

At the federal level, the Build Back Better plan would have included improvements in protections for nursing home residents that. If it had passed, it could have been the most significant legislation impacting long-term care facilities in decades, according to Patricia Hunter, Washington State ombudsman for long-term care.

“Advocates would like to see the state improve staffing requirements in nursing homes in order to provide better-quality care and life for residents,” Hunter said.

Degerstedt, the Southwest Washington regional long-term care ombudsman, agreed.

“Long-term care workers are challenged by long work hours and low pay,” he said. “Caregivers need a decent wage, benefits and hazard pay when caring for COVID-positive residents.”

Residents or family members who feel they are being abused or neglected as a result of staffing shortages should call the Washington State Department of Social and Health Services at 1-800-562-6078.

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