Published December 29th, 2021 at 6:00 AM
Picture serenity and safety.
Manicured laws. Tidy rooms. Good meals. On-call nurses.
For seniors who need a little extra help as they age, they and their families turn to assisted living centers or nursing homes. But that system is in crisis, warns the American Health Care Association and National Center for Assisted Living.
The latest AHCA/NCAL report put it like this: “Long term care facilities are suffering from the worst labor crisis of any health care sector.” Email after email, subject lines underline the scarcity: “Nursing Homes Down 221,000 Jobs Since Start Of Pandemic.”
And Kansas City area centers are feeling the losses.
“If I start talking about it, I’ll cry,” said Carol Tsiames, executive director of Benton House of Lenexa. “It’s that bad.”
The surge in the omicron variant combined with the staffing shortage crisis is mounting pressure on an already delicate – and overburdened – system. These centers were already short-staffed and stretched thin before the pandemic.
But in the past year, the rate of nursing aides, nurses and other health care professionals leaving the profession is on the rise, the American Health Care Association warned. Nursing centers and assisted living centers were already among the most vulnerable.
Departures accelerated when the first variant of the coronavirus hit. Then another variant emerged. Then another.
Cases sky-rocketed. Certainty plummeted. And the roller coaster still hasn’t come to a full stop, warned Kansas City area chief medical officers on Dec. 17. It’s about to hit another peak.
In another stomach-curling twist, COVID exhaustion and the rise in the omicron variant are colliding with the newest surge.
Health care administrators such as Tsiames say staff members are leaving for reasons such as burnout, illness and fear. Others needed child care but couldn’t find it.
Kansas City area chief medical officers see that too.
And when centers try to fill vacancies, nobody applies.
This leaves center administrators scrambling to attend to residents who need round-the-clock care.
For instance, Benton House didn’t really begin to feel the effects of the staffing crisis until about six months ago, but the first couple of waves of the virus hit fairly hard. And while the Lenexa facility didn’t mandate vaccines, some staff feared returning to work.
Tsiames is feeling the whiplash of the past two years.
Without staff to call in, she sometimes works 90 hours a week. She’s been forced to step in for staff who have left. A workforce survey by the AHCA reveals that 99% of nursing homes and 100% of assisted living centers asked current staff to work extra hours and take on more shifts.
At the same time, folks are leaving the health care field at unprecedented rates, according to the AHCA. For a small center like Benton House, it’s devastating. But she thinks people are leaving for two reasons: fear and money.
“We have Amazon now,” she said. “That’s one of our competitors.”
On average Amazon workers are paid $20 per hour. In contrast, certified medication aides get paid $14.82 an hour, according to the Bureau of Labor Statistics.
Admittedly, Tsiames said, her company cannot match other higher, more competitive salaries. With a sigh, she punctuated the need for staff.
“With a smaller building, we don’t typically have a lot of extra hands,” she said. “It’s just the way assisted living runs.”
At the height of the pandemic, she began to call in students to fill in when nurses or medication aides leave. Students like Felicia Honey, a 21-year-old student at the University of Kansas, stepped up to the plate for several late-night shifts.
She typically helps as a medication assistant and has had to sub in for nursing duties as well.
The most recent was a 3 a.m. overnight shift.
“I did a lot of COVID care because I was one of the few workers there who already had COVID,” Honey said. “Also being one of the younger people who don’t have kids, I felt like I should be one of the people taking care of them.”
Caring for dementia and Alzheimer’s patients reminds her of her grandfather, who had Alzheimer’s so that personal connection has kept her going when she felt stressed.
But the extra responsibility has been tough on her as a student.
“It’s kind of irritating when I’m at school, and having texts constantly like, ‘Can anyone work Saturday night?’ or ‘Can someone come in at this time and what-not?’” she explained.
She also highlighted fellow health care workers’ dedication and waning tenacity, one of whom trained her. Honey came in for a 3 a.m. shift, only to learn her trainer had been there since 8 a.m. the day before.
Her trainer, she learned, had been there almost 24 hours.
Turnover has been so bad since Honey started last year that she hardly knows any of the staff anymore.
Tsiames is aware of the toll this takes on her workers because she feels it too.
“I know I’m not alone,” she said. “There are many executive directors out there, or licensed nursing home administrators, (who) are in the same boat I am. We’re all working a lot of hours.”
She added: “The only reason why I think they stay is because it’s a calling.”
Laura Benefiel, executive director of Cross Creek, says that’s why she sticks around.
Her center has also seen turnover lately and some of her staff has even been poached by other assisted living centers.
“Nothing’s been normal,” Benefield said, but she added that Cross Creek is private pay so there’s more funding flexibility.
“The good thing with us is that we have little higher functioning residents and the rest of the regulations aren’t as tight for us as far as how we staffed,” she added. “Of course for nursing homes, it’s a little more stringent and of course, they have lower functioning (residents) and need a little bit more hands-on (care).”
But if nursing homes close, those residents will be diverted to assisted living or remain in homes with poor care.
The scary thing is that she’s heard that some families are leaning toward assisted living centers, fearful of the COVID surges at nursing homes that hit early on in the pandemic. Her message?
“You know, staffing is a huge barrier, but we do the best we can with what we have,” Benefiel said. “It’s kind of an uphill battle.”
Across the metro, hospital systems are also feeling the weight of staffing loss.
Dr. Jackie Highland, chief medical officer at the University of Kansas St. Francis campus in Topeka, Kansas, rattled off how the surge in recent COVID cases has caused a domino effect on discharging patients. They’re also short-staffed and are seeing retired nurses coming back to help pick up the slack.
But there’s something else causing a revolving door of issues.
“The other thing that we’re seeing in Topeka, is difficulty discharging patients back to the nursing home due to their staffing shortages as well,” Highland said. “It causes a back-up all the way through to our emergency room, and holding (ER) patients there, preventing them from getting admitted to a hospital bed.”
She painted a picture of what that looks like. As of late, they’ve had five to 15 patients held in the emergency department limbo.
“(It) is very unusual,” she added.
Her hospital is so overwhelmed that surgeries have been canceled. With the recent surge in cases and a new variant having emerged, there are not enough nurses and too many patients.
“We know people are tired, tired, tired,” said Dr. Steve Stites, chief medical officer at the University of Kansas Health System. “These are hard days.”
Some Kansas City area nursing centers are bracing themselves for whatever comes next.
“To be honest, it’s a challenge that we really don’t see going away,” said Anthony Columbatto, vice president of community services at John Knox Village, which runs several assisted living and nursing care facilities in the area.
Columbatto said during the pandemic, working in health care became more and more difficult. He wouldn’t classify staff leaving as a mass exodus but rather “a slow trickle.”
“These are people we’re trying to serve and take care of and make their last days their best days, but we need people to take care of them,” he said.
Another compounding issue, he underscored, has been the pending Build Back Better Act, which requires nursing centers to have a registered nurse on the floor 24 hours, seven days a week. John Knox Village is able to meet those requirements, but other centers might not.
“They’re basically raising the amount of staff that nursing homes have to have,” he said. “But there isn’t a reimbursement model to support that.”
This leaves smaller senior care centers, many of which are in rural areas or are underfunded, in the dark.
People in the industry are voicing these concerns with legislators in the hope they can add more funding to the senior care pot to continue caring for their aging community members.
Ultimately, workers in assisted living and nursing centers have a plea for the public:
“Have compassion for those people who are working,” Honey said. “I understand everyone wants the best care for their loved ones, which I do as well. It is just really hard when you’re so rundown.”
Vicky Diaz-Camacho covers community affairs for Kansas City PBS.