To say it’s been a rough year for nursing homes is to state the obvious.
As COVID-19 swept the nation, the pandemic seemed to hone in on long-term care facilities like tornadoes targeting trailer parks.
Despite an aggressive expansion of sanitation and infection-control measures, the coronavirus devastated facility after facility, infecting more than 85,000 residents and staff in Pennsylvania alone and claiming more than 13,000 residents – half of the state’s COVID-19 deaths.
“Once it was in the building, it was almost impossible to keep it from spreading,” said Timothy Mock, CEO of Laurel View Village in Davidsville.
Although Laurel View was not hit as early as other facilities, Mock said it became clear very early that few would be spared.
“It was not a matter of ‘if;’ it was a matter of ‘when?’ ” he said.
The local area’s homes were passed over during the initial spring 2020 surge.
By the end of October, there were only 84 resident cases and one death for all nursing and personal care homes across Cambria and Somerset counties.
And then came November.
Case counts began rising early in the month and deaths began to follow. By early January, 1,364 residents of the Cambria and Somerset homes had been infected and 145 had died from the virus.
“Once it hit, there was no stopping it,” Administrator Rick Wilson said from Arbutus Park Retirement Community in Richland. “It was just rampant.”
‘There to hold the hand’
With all visitors, including residents’ relatives, barred from entering facilities, nursing home staff became a surrogate family for residents in their final hours, said Mark Fox, president of Grane Healthcare. The company operates a dozen Pennsylvania nursing homes, including Cambria Care Center in Ebensburg, Laurelwood Care Center in Upper Yoder Township, Altoona Care Center and Greensburg Care Center.
“They became the extended family at the end,” Fox said. “They were there to hold the hand at the end.”
The situation was devastating for residents, families and the staff, he said.
“Staff is used to seeing end-of-life, but when there is no family and they become the family, it’s hard,” Fox said. “We had to do emotional counseling. That was offered to our staff.”
Mock echoed that observation, saying, “We are used to people we know and love passing away, but when it happens all at once, it takes an enormous toll.”
Families dealt with the separation, but the stress was telling, Wilson said. For the first time in his memory, a family took a resident out of Arbutus and hired home health workers to help care for the individual at home just so they wouldn’t be separated.
Fox said a few family members took jobs at some Grane homes just to be able to see their loved ones.
“Families understand that some of it was necessary, but at the same time they are heartbroken,” Wilson said. “We feel like we’ve been stealing the last few months or years of these people’s lives away from family members.”
Costs and revenue
In addition to the human toll and the emotional toll, COVID-19 has taken a huge financial toll on nursing homes. The American Health Care Association and National Center for Assisted Living estimates the industry will lose $94 billion due to the increased costs needed to fight the pandemic and declining revenues. Last year, nursing homes spent roughly $30 billion on personal protective equipment and additional staffing, the organization says.
Meanwhile, nursing home occupancy dropped more than 16% to 68.5% occupancy.
“Heads in beds equals revenue,” Wilson said, explaining that the Arbutus nursing home census is about 65% and its budget requires 80-85% occupancy to cover margins.
Arbutus and Laurel View are both associated with the LeadingAge PA organization of independent non-profit homes.
LeadingAge PA, the Pennsylvania Health Care Association and the Pennsylvania Coalition of Affiliated Healthcare & Living Communities filed a lawsuit in December to demand Wolf administration officials reallocate more than $150 million in federal dollars the lawsuit claims was mandated to be directed to Pennsylvania’s nursing home residents and their providers of care.
“The reason that those dollars are so dire is the result of – an outgrowth of – chronic under-funding,” LeadingAge President Adam Marles said. “It’s been nearly a decade since the medical assistance program for nursing homes has received a rate increase.”
The situation made it hard to hire staff, even before the pandemic because it’s too hard to offer competitive wages, the local homes’ leaders said.
“We want to pay our staff more,” Mock said. “We think the work they do is more valuable than what we are able to pay.”
Staffing and care
The nonprofits pride themselves on providing higher staffing levels than some for-profit homes, Wilson said.
“More staffing is better quality care,” he said “No doubt about that.”
It’s not just Pennsylvania. Homes across the country are asking federal and state governments to send more money.
“The consequences of inaction will have a devastating impact on the industry,” the AHCA/NCAL said in a press release.
“Financial challenges could lead to more than 1,600 nursing homes permanently closing their doors this year, which hurt residents, their families and staff alike.”
Mock and Wilson said their viability depends on Medical Assistance and other government sources and families can’t afford to pay more for their services.
“We do need to look to the government for help,” Wilson said. “There’s no private sector help out there.”
Randy Griffith is a multimedia reporter for The Tribune-Democrat. Follow him on Twitter @PhotoGriffer57.