WORCESTER — Having borne the brunt of COVID-19, nursing homes say the financial help and guidance they have received from the state have prepared them to better address a second wave of the deadly virus should it strike this fall and winter.
Funding, staff recruitment efforts, and acquisition of personal protective equipment have significantly improved, but some advocates say more needs to be done to continue the fight against COVID-19 in nursing homes and to enhance the overall quality of care.
Nursing homes had already been struggling for decades before the pandemic because of inadequate funding, a shortage of staff due to low pay, inappropriate training and poor infectious disease control. The ravages of COVID-19 put a spotlight on all those deficiencies and prompted the state and federal governments to step up.
Ironically, last year, just months before the novel coronavirus was known to be in the country, the state established a nursing facility task force to look at MassHealth rates, staffing and occupancy challenges and other opportunities for reform.
During the state of emergency, the administration put measures in place early to address the inappropriate infection controls that plagued the majority of nursing homes a couple of years earlier.
The state assigned an infectious disease control expert to each nursing home. It also implemented a 28-point infectious disease control checklist on which each nursing home is graded. Any facility not in compliance receives targeted training and re-auditing.
Tara Gregorio, president of the Massachusetts Senior Care Association, said the state needs to continue what it has been doing and provide more funding to help nursing homes. There are about 380 nursing homes in the state.
“The state made significant and necessary financial and educational investments to enable nursing homes to combat COVID-19 and to protect their staff and residents. … However, this insidious virus is still with us,” Gregorio said via email. “To ensure we will be prepared for any resurgence, we need continued state investment to allow us to pay our courageous staff the higher wages they deserve, and we need the state to continue prioritizing PPE and access to timely testing for both symptomatic and asymptomatic nursing home residents and front-line staff.”
Since March, the coronavirus has robbed more than 5,600 nursing-home residents of their lives, which is 15% of all nursing home residents in the state, and nearly 66% of all of the state’s COVID-19 deaths, according to Dignity Alliance Massachusetts. The grassroots coalition of more than three dozen stakeholders was formed two weeks ago to address the decades-long structural and systemic deficiencies which have created this public health crisis.
During the outbreak, 68 residents at the 113-bed Holy Trinity Nursing and Rehabilitation Center on Barber Avenue in Worcester tested positive and 11 people died, including a woman who was transferred there after being treated for COVID-19 at St. Vincent Hospital. Twenty-eight of the approximately 160 staff also contracted the virus and all recovered.
Ellen Belanger, CEO at Holy Trinity, and director of nursing Ann Marie LeBoeuf said from what has been learned throughout the pandemic and guidelines provided by DPH and the governor, the facility has developed policies and procedures that will keep residents and staff safe.
“During the height of COVID-19, families and health care workers were concerned, scared and ill-prepared for the pandemic,” Belanger said. “We will be prepared come fall with precautions, full PPE, testing of workers and residents if need be and a full-fledged emergency preparedness plan.”
Holy Trinity and other nursing homes have protocols in place to regularly test staff and residents. Baseline testing has been completed and surveillance testing is underway.
Generally, only staff is allowed inside. Before entering, each worker’s temperature and in some cases their respiratory status are monitored. They are asked a list of COVID-related screening questions. The appropriate personal protection equipment is required to be worn at all times while inside the facility.
Family visits — which are monitored to make sure participants wear masks and social-distance — have been limited to areas outside the building. If anyone tests positive they are immediately isolated.
A positive staff member would be required to leave and contact their personal care physician to get tested and quarantined until recovery, if needed. Staff who visit high-risk COVID states are required to be tested before they return to work. New residents are generally quarantined for 14 days.
David Becker, interim administrator at St. Mary Health Care Center in Worcester, said having testing and PPE available sooner would have made a significant difference.
The Queen Street facility’s first positive case was in mid-March, but it was not detected until weeks later, when DPH started making testing available.
Eighty-five residents in the 124-bed facility tested positive and 30 died. The remaining infected residents and 34 staff who tested positive recovered.
“We’ve all learned. The whole industry has learned and everybody is prepared and doing well,” Becker said.
One tough lesson learned is to have a stockpile of PPE. Becker said in addition to what is being used currently, St. Mary has more than a 60-day supply stored. He said supply chains seem to have caught up with the demand.
State Rep. Ruth Balser, D-Newton, co-chair of the Joint Committee on Elder Affairs, has filed an amendment to the health care bill that the House passed in July that would require the state Executive Office of Health and Human Services to establish an exchange so nursing homes and other facilities can work together rather than compete to acquire PPE.
Staffing, however, appears to still be a problem. Before the pandemic, there were about 45,000 staff in nursing homes. State Sen. Patricia Jehlen, D-Newton, who also co-chairs the Joint Committee on Elders, said that by mid-April direct care jobs were 40% vacant. The state sent in National Guard at first to only conduct testing, but eventually the guard helped supplement staffing.
Because of the low pay, recruitment and retention of staff was challenging even before the COVID-19 emergency. Certified nursing assistants, who provide the day-to-day care to residents, make up the largest segment of nursing home staff. Some are paid the state minimum wage of $12 per hour, leaving them to have to work in multiple facilities to make ends meet. Many nursing homes encouraged staff to only work at one during the pandemic to help prevent transmission of the virus.
“We are working with the Baker administration to identify pools of workers and are offering as robust financial incentives as we can to existing staff, but many facilities still struggle to recruit and retain staff,” MSCA’s Gregorio said, adding that without continued state funding, most nursing homes will be not be able to offer incentives to increase staffing levels.
As of Friday afternoon, the DPH hadn’t replied to an email sent by a reporter Tuesday requesting information about what is being done to address the staffing shortages at nursing homes and to prevent residents from contracting COVID-19 this fall.
St. Mary, which pays CNAs $13 to $15 to start, higher than average, lost 25% of its staff, mostly CNAs, during the outbreak. Becker said the facility has been successful in hiring CNAs and nurses and expects to hire more after Labor Day, when kids begin some semblance of school, freeing up parents to go back to work.
There are fewer residents to provide care for after the virus took the lives of thousands. Before the pandemic there were approximately 38,000 residents in Massachusetts nursing homes. There are about 33,000 now.
Holy Trinity, which starts new CNA hires with no experience at minimum wage and evaluates them after three months, also lost several staff.
“We lost more than a dozen who were working at other centers. Many employers insisted that staff pick a building and stick with that building during the initial phase of the outbreak,” Belanger said. “We had about four who quit because they were afraid.”
Alison Weingartner, executive director of Massachusetts Advocates for Nursing Homes, said she still has concerns about the safety of nursing home residents. One of her main concerns is the state designating wings of some nursing homes — including many that were poor-performing — as isolation space for COVID-19 patients brought there from hospitals.
As an incentive, the state paid the nursing homes, not only for the COVID-19 positive patients they took in, but also provided additional funding toward the care of all the other patients in that nursing home.
Weingartner said two of the nursing homes had been designated “special focus facilities” by the Centers for Medicare and Medicaid Services, which meant they were “among the worst of the worst.”
Weingartner’s group complained when Beaumont in Worcester was designated a COVID-19 recovery center and relocated regular residents so it could take in COVID-19 patients from hospitals. The relocation plan was abandoned after some of the patients being moved were found to have the coronavirus.
“I have concerns,” Weingartner said. “If we have a surge, how does that affect these isolation homes that still exist today when we still haven’t sorted through the fact that some are low-care providers … and how they affect residents already living in the nursing home?”
The state has moved to terminate from MassHealth three historically-performing private nursing homes that did not meet expectations during the pandemic. Removal from the state-run Medicaid program could lead to the closing of Hermitage Healthcare on Mill Street in Worcester, Town and Country Health Care Center in Lowell, and Wareham Healthcare. Hermitage has said it plans to appeal.
Ed Blake, director of operations for Salmon Health and Retirement, which operates Beaumont Rehabilitation and Skilled Nursing Center on Plantation Street in Worcester as well as nursing centers in Westboro, Northboro, Northbridge and Natick, said the entire Worcester campus stopped being a recovery center for COVID-19 patients because there is no longer a need. Instead, 41 beds on one floor of the five-story Worcester facility are for COVID-19 positive patients from hospitals and the other Beaumont campuses. There were more than 140 COVID-19 deaths at the five campuses.
While seniors, particularly those with underlying health conditions, are especially vulnerable to the coronavirus, some countries with some of the largest senior populations have fared well during the pandemic. In addition, facilities in other states have also excelled. For example, Maryland Baptist Aged Home, a 29-bed, 100-year-old nursing home in a poor neighborhood in Baltimore, seems to have beaten the odds — no staff or residents at the facility contracted the coronavirus.
The Rev. Derrick DeWitt, director and CFO of Maryland Baptist Aged Home, said he moved quickly to keep the virus out. DeWitt said when President Donald Trump announced in late February that there were only 15 cases in the country, and that by the end of the week there would be none, he knew that couldn’t be true.
Being in an impoverished part of the city whose residents’ average annual income is roughly $23,000, DeWitt said he knew he could not wait for nor rely on government to take action, so he took steps.
Before there were shortages, the facility stocked up on PPE and other things it would need. People coming into the facility were limited to essential personnel. Residents received enhanced meals and activities in their rooms. They used Zoom or FaceTime to visit with family, and the building was sanitized around the clock.
The facility had already trained a nurse a few years earlier to be an infection control expert. The manual and guidelines the nurse had set up were effective. Staff and their families signed on to the plan and even agreed to social-distance as much as possible from each other in their homes. The facility also provided PPE for the families to take home.
Staff were asked not to work at other facilities or jobs and were rewarded with a bump in salary and periodic bonuses. Public transportation to and from work was paid. They also received free meals at work, $50 gift cards to a grocery store, and fresh fruit and vegetables to take home from a food distribution program at a church where DeWitt is pastor.
“We moved early. We were extremely excessive in our approach to the pandemic and it turned out to be effective,” DeWitt said by phone Thursday. “We now have a waiting list of people wanting to get into our facility.”
Contact Elaine Thompson at [email protected]. Follow her on Twitter @EThompsonTG