Quality of care can be affected as nursing homes struggle to maintain workers

Oct. 29--Quality of care can be affected as nursing homes struggle to maintain workers

By ROBERTA BAKER

New Hampshire Union Leader

October 29. 2018 12:21AM

During the summer, Adriana Vasquez, a licensed nursing assistant, worked overnight with one registered nurse in the skilled nursing unit at Bedford Hills Center, where she cared for 36 to 38 patients -- many with IVs and feeding tubes, recovering from hip fractures and knee surgeries -- changing soiled bed linens and clothing, responding to call lights, and helping them navigate safely.

"The buzzers are ringing all night. The tube feeds go off. The IVs go off. They're needy patients who need assistance," said Vasquez, who's worked at Bedford Hills Center for three years as a per-diem aide from a staffing agency.

One woman who couldn't walk kept trying to get out of her wheelchair and fell, breaking an arm and leg, she said. A mechanical lift requires two people to transfer a patient from a bed to a wheelchair. "You can't boost or roll large people alone. When they're not staffing properly it's impossible to get anything done," Vasquez said.

Bedford Hills Center recently added an overnight nurse, making patients safer and her job more manageable, Vasquez said.

Tom Duffett, a physical therapist for Genesis HealthCare for 20 years, who worked at the corporation's Bedford Hills Center from 2011 to 2014, says staffing shortages there are primarily due to management decisions to shave costs.

But a deficit of trained and available staff, especially licensed nursing assistants who provide most of the direct care to patients, is increasingly becoming a problem for New Hampshire's nursing homes -- not just Bedford Hills Center, where the dining room was closed four nights a week during the summer because of a lack of staff.

Statewide, nursing homes struggle to maintain enough workers to provide sufficient care while earning enough to stay solvent, according to health care advocates.

"All administrators and staff are doing the best they can in challenging circumstances," said Lisa Henderson, executive director of Leading Age Maine New Hampshire, which represents the state's non-profit nursing homes. "Everyone is struggling to attract staff, and it can be a wage war between neighboring nursing homes. There aren't enough trained workers who are interested in the field. It's rewarding work but it's hard work."

In New Hampshire, state statutes mandate that nursing homes keep sufficient personnel to meet the care needs of each patient, without specifying exact numbers of caregivers required.

Licensed nursing assistants, LNAs, also known as certified nurse assistants, help residents with activities of daily living, including eating, bathing, dressing and moving, assisting eight to ten patients on average, depending on the shift, the unit and facility where they work.

The profession is not attracting as many entrants as in past decades, experts say, for reasons ranging from competition from other industries to inadequate training opportunities and wages that have been stagnant for years -- resulting in a deficit of caregivers for a growing population of seniors.

LNAs statewide earn $10 to $13 an hour on average compared to $13 to $14 in Massachusetts and southern Maine -- leading to an exodus of trained workers lured away by better pay and benefits elsewhere.

Solutions proposed by state health care advocates include raising LNA wages by increasing New Hampshire's Medicaid reimbursement rate to health care providers -- which would enable nursing homes to boost pay to nursing assistants, they say.

Massachusetts recently delegated $100 million to raising wages for low-paid health care workers; the Maine legislature voted to increase nursing home worker wages by 10 percent. Vermont's statutes tie rate increases to inflation.

"Nursing assistants need to make a living wage by providers being paid enough to care for residents 24-7," said Lynda Goldwaithe, a nursing home administrator and nursing vice-chair for the New Hampshire Health Care Association.

Elders on Medicaid, including many who have exhausted their assets paying for long-term care, account for 63 percent of nursing home residents. Brendan Williams, the health care association's president, said Granite State facilities struggle to cover the 25 percent shortfall between the actual costs of treating people who are living longer with increasingly complex medical conditions and Medicaid's payments to nursing homes, averaging $168.48 per patient per day in New Hampshire. Nursing homes have historically made up the difference by borrowing from Medicare insurance payments, Williams said.

Williams said he hopes legislators will consider raising the reimbursement rate by five percent, devoting 2.5 percent from the state's surplus and an equal amount from local and county taxes -- or tapping another income stream. For two years the state's surplus has gone to fighting the opioid crisis or into a rainy-day fund, he said. "Right now it's pouring on health care. We need to maintain very fragile infrastructure."

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at rbaker@unionleader.com or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.

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