Nursing Home Staff Shortage Hampers Coronavirus Response

Even as more than a million Texans collect unemployment benefits, critical jobs at the frontline of the coronavirus outbreak are being left unfilled, hampering efforts to protect the vulnerable.

Nursing homes, assisted living facilities, and long-term care facilities face chronic shortages of personnel — a problem that predates the crisis but now is being brought sharply into focus. 

The shortage “has to do with lack of funding to support staffing and a lack of general interest in the healthcare community in working in these facilities,” said Austin’s Interim Director of Public Health Dr. Mark Escott, on a video call April 22. 

“Quite honestly, infection control at nursing homes has been a challenge for us for years. And part of that has to do with this constant struggle for staffing.” He added, “It’s hard to have proper infection control if you have a substantially high level of residents and a substantially low number of nursing staff or support staff as compared to a hospital setting.” 

Some staffers at nursing homes with clusters of coronavirus cases work at other facilities, making them a vector for the spread of the disease. “That has been a factor in some of our outbreaks,” Escott acknowledged.

Yet authorities have taken no action to prevent workers from moving from one care home to another. Escott explained: “We’re certainly discouraging working at different facilities, particularly involving those facilities with COID-19 outbreaks. But quite honestly there’s some concern that if we completely restrict the ability to work at multiple facilities we will not have enough staff to staff facilities.” 

At least 67 staff at nursing homes and other long-term care facilities have tested positive for COVID-19, according to data released by the city on April 20. Approximately 96 residents have been infected, and 15 residents have died. 

National Guard Deployment?

If the situation gets even worse, state officials could deploy National Guard into senior homes in response to outbreaks, according to Escott. In some other states, National Guard have been deployed to nursing homes to carry out tests on staff and residents, but not to care for patients.

“The state is looking hard looking at state resources, and I’m sure they’re looking at federal resources including National Guard to perhaps fill those holes that are needed to be filled,” Escott said. (National Guard are a state-level military organization unless called into federal service).

However, a spokesperson for the Texas Military Department told Honest Austin that the Guardsmen don’t have any focus on that for now. “At this time that is not our current mission,” said TMD Press Secretary Brandon Jones. 

He instead pointed to the Texas Guard’s threefold mission of testing, logistics, and engineering, which it has had since being called up by the governor several weeks ago.

Jones said, “Texas National Guard units will leverage the military and civilian skillsets of our Guard members to support three missions: support the logistical needs of the state, expand communication capabilities for response operations and provide trained medical and engineering staff to increase the availability of hospital beds and healthcare throughout Texas.”

At least 1,200 Guardsmen have been mobilized as part of COVID-19 mobile testing teams.

Another option for emergency staffing could be surge teams made up of civilian medical personnel hired by either the state or the city. 

Austin has ‘strike teams’ of additional personnel and equipment as part of its Incident Command System and the Austin-Travis County Emergency Operations Center (EOC).

Escott says the state could provide similar personnel resources: “We’re asking the state for new staff, for staff who don’t normally work in nursing facilities, to help fill these gaps, so that we don’t have a domino effect into other facilities.”

In Williamson County, paramedic teams have been visiting senior homes to check in on staff, but haven’t embedded themselves at any single location. County Press Secretary Connie Odom explained, “Teams from the Williamson County EMS Community Health Paramedic unit have been visiting facilities to answer questions, check on PPE supplies, complete site assessments, and to be a point of contact for information and support in the event an outbreak occurs.”

Unlike Travis County, Williamson County has not yet seen any outbreaks in its senior care facilities. 

Who’s Going to Step Up?

Whatever emergency measures are taken now, the staffing shortage in long-term care facilities is structural and long-term. Some Austin homes have been paying as little as $14 an hour, though CBS Austin’s Jordan Bontke reports that they are hiking pay to $24 an hour.

Escott says that Austin Public Health has made recommendation to increase staffing “across-the-board” for nursing homes and long-term care facilities.

“We have to create some opportunities for career development and growth within this industry for staff, including nursing assistants and medical assistants. And we’ve got to look at pay options — it’s got to be attractive on the pay scale.”

Medical assistants, nursing assistants, and nurses are all in demand.