It may be hard to recall that, in the memory of many Americans, the COVID pandemic seemed to begin in a Kirkland, Washington, nursing home. In early 2020, news reports began circulating about the coronavirus causing devastating illness and death among the vulnerable population in America’s long-term care facilities, beginning here in the Pacific Northwest. As the pandemic swept the country and the nation’s nursing homes went into full lockdown mode, the fearsome death toll continued. Based on recent statistics, about 140,000 of the nation’s one million COVID deaths were nursing home residents.
That means 0.5 percent of the U.S. population accounted for 14 percent of those dying from COVID-19. That’s an astounding number.
It may seem that the pandemic has largely subsided, but in fact the concern over another resurgence remains high. This time, if an outbreak were to occur, many long-term care facilities here in Washington State would find themselves dangerously short-staffed. In this recent article from the Seattle Times, staff reporter Paige Cornwell examines the condition of our state’s nursing homes and finds that, even though death rates are way down and isolation is over, many facilities are operating as if disaster is just around the corner.
A Blend of Normalcy and “Crisis Mode”
If it’s difficult for any of us to tell if the pandemic is “over”, it’s especially tough for staff and residents in nursing homes. Cornwell takes us into North Cascades Health and Rehabilitation Center in Bellingham, where the feeling of crisis mode still persists in the 122-bed facility.
“North Cascades Health and Rehabilitation Center is no longer on lockdown, so visitors can come inside and see their loved ones,” Cornwell writes. “Residents having a hard night can stay in the nurse’s station and do arts and crafts. There’s weekly coronavirus testing, and workers only have to wear surgical masks.”
But a nursing assistant at the facility, Shelly Hughes, notes a “frantic energy” that still lingers. Cornwell writes, “[Hughes] wonders: What if there’s another COVID-19 outbreak, like the brutal one they experienced this winter? With turnover so high, will there be enough staff for the week? What’s going to happen tomorrow?” These fears leave a deep, pervasive frustration felt by staff and residents alike.
Nursing Homes and Similar Facilities Hard-Hit
Cornwell paints a pretty devastating picture of the pandemic’s effect on Washington State’s 4,760 long-term care facilities: “Washington’s nursing homes, assisted-living facilities and adult family homes account for 30 percent of all COVID deaths over two years, but just 3 percent of total cases, according to the Washington State Department of Health. Because of visitor restrictions, even residents who survived the virus were still susceptible to the mental and physical effects of isolation. Workers experienced high rates of burnout amid low pay and an ongoing threat of illness.”
The relatively good news is that, thanks to steady vaccination rates, COVID cases and deaths are now “comparatively low”, although Cornwell notes that booster shot rates are increasingly sluggish among facility staff.
But the numbers are still startling. Cornwell writes, “As of mid-April, 3,779 people associated with a long-term care facility — a vast majority of them residents — had died of COVID complications, according to the DOH. There has been a total of 40,774 cases.”
Omicron Variant Caused Surge in New Cases
Cornwell credits widespread vaccinations for the significant drop in cases and deaths in January 2021 that lasted for nearly a year. Unfortunately, the omicron variant brought the numbers back up the following year, and 2022’s winter was extremely difficult for many facilities across Washington, including North Cascades Health and Rehabilitation.
The North Cascades outbreak—which included the deaths of several residents—was traced to a visitor. Nursing assistant Hughes said, “That was really brutal. It was as horrible as I’d imagined it would be.”
Thankfully, March of this year marked a turning point, and there have been fewer than 100 new cases and 10 new deaths associated with nursing homes reported per week. But while the number of cases has lessened, the “epidemic” of short staffing remains.
Percent of Short-Staff Facilities Tripled During Pandemic
Staffing shortages have become an increasing problem, between workers contracting COVID and needing to stay home, as well as complete burnout from long hours during the peak of the pandemic. Cornwell writes, “The omicron spike also forced many workers to stay home, causing widespread staffing shortages. The staffing situation in nursing homes has stabilized since the peak, but remains an issue at facilities throughout the state.”
The official numbers are worrying: “About half of the state’s nursing homes report being short staffed, according to CMS [Centers for Medicare and Medicaid Services] data, approximately three times more than the number reporting low staffing levels near the start of the pandemic.”
Patricia Hunter, ombudsman of the state’s long-term care facilities, hears constant complaints about safety concerns and poor-quality care linked to short staffing. “I’ve heard from nursing home staff who have been doing this work for many years that the quality of care and staffing levels are the worst they have seen in their long careers,” she said. “They say that staffing has always been bad but now it is so very bad.”
Vaccination Rates Exceed National Averages
Helping to keep further surges at bay, vaccination rates are steady. Cornwell writes, “In nursing homes, vaccination rates among residents and workers are higher than the national percentage, though the booster rate lags among workers. Among residents, 90 percent are fully vaccinated, compared with 88 percent nationally, according to CMS, which counts a person as fully vaccinated two or more weeks after they’ve received a two-dose Pfizer or Moderna vaccine or the one-dose Johnson & Johnson vaccine.”
She adds, “Among Washington’s nursing home staff, who are required to be fully vaccinated but not required to be boosted, 92 percent have received their shots, compared with 87 percent nationally. All residents and workers are eligible to receive booster shots, but 83 percent of residents and 47 percent of workers have done so.”
The fervent hope is that the worst is well and truly over for Washington’s long-term care facility residents, staff, and families. To keep this hope alive, CMS encourages everyone to consider further vaccination and boosters to keep us all as safe as possible, especially those most vulnerable.
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(originally reported at www.seattletimes.com)