By Damien Fisher
Granite State News Collaborative
The COVID-19 pandemic is exacerbating a longstanding problem for most nursing homes and assisted living facilities: not enough nurses in New Hampshire.
County nursing home officials say, and a state official confirms, that even before the spread of the novel coronavirus which causes COVID-19 they were struggling to fill positions in their facilities. Now they also have to contend with the staff contracting the virus and potential employees shying away out of fear they might get it.
“There’s been a staffing shortage long before COVID 19 came to us, we’ve been dealing with a staffing crunch,” said Craig Labore, the administrator at the Grafton County Nursing Home.
New Hampshire has about 20,000 registered nurses and 4,000 licensed practical nurses, but it is not enough to fill the jobs many nursing homes have.
“There has been a longstanding shortage of nurses and nursing aides,” said Joan Widmer, executive director of the New Hampshire Nurses Association. “The COVID-19 situation has exacerbated that shortage.”
Adding to the existing staffing challenge is the fact that many long term care staff are also contracting the disease, said Jake Leon, communications director for the New Hampshire Department of Health and Human Services in an email. “That is why DHHS has been so actively engaged with both nursing facilities and staffing agencies on implementing plans to limit potential exposure through consistent assignments.”
The spread of COVID-19 into nursing homes and long-term care facilities has resulted in 299 of New Hampshire’s 367 deaths. That means that more than 8o percent of the deaths from COVID-19 have been in nursing homes, one of the highest nursing home fatality rates in the country. The Center for Disease Control states that nursing homes are more at risk for respiratory infections like COVID-19, due to the age and medical fragility of many residents and the manner in which the homes are typically laid out.
Federal standards for nursing homes recommend there be at least one direct caregiver per five residents during the day, and one caregiver per 10 residents at night. The same guidelines recommend one licensed nurse per 15 residents during the day, one licensed nurse per 25 residents in the evening, and one licensed nurse per 35 residents overnight.
Ray Bower, administrator at the Riverside Rest Home for Strafford County said that even before COVID, a lot of nurses and nurse’s aides would take a pass on working in nursing homes, preferring jobs in hospitals.
“This profession didn’t really attract a large number of people,” Bower said.
Many people who get into nursing are not attracted to caring for the elderly, Bower said, and seek work in hospitals instead. Now that COVID-19 is a factor, it can be even more difficult to attract nursing staff due to fear of the illness, he said.
Many nursing homes have been using per diem staff, or nurses to take day-to-day assignments rather than work regular shifts, as well as temporary staff from nursing agencies. Per diem nurses are nurses who sign up for shifts on a basis similar to substitute teachers. Howard Chandler, the administrator at the Mountain View Nursing Home for Carroll County, said nursing homes use per diem and agency staff because they cannot find enough full-time staff.
“You’re using agency nurses when your back is against the wall,” Chandler said. “When you have to fill the slot, you’re taking any port in the storm.”
David Ross, the administrator at the Hillsborough Nursing Home in Goffstown, said his facility has stopped a lot of its use of agency nurses, in part because it’s been hard to attract them. Hillsborough’s facility has had 48 residents test positive, and 10 staff members, Ross said
“Folks are not so comfortable working in a COVID positive building,” Ross said.
Bower said he’d love to not have to use any agency nurses, but there are not enough nurses willing to work full-time.
Agency, or traveling nurses, typically get paid a higher hourly wage, with a portion going to their employment agency.
In Hillsborough County, LPNs can make between $22 and $29 per hour depending on seniority, while RNs can earn between $25 and $38 per hour. Per diem LNAs earn a flat $27 an hour rate, and per diem RNs earn $29 per hour. Agencies charge between $40 and $50 an hour, with the agency taking a cut of the wages from the nurse.
Per diem nurses generally work for one facility, but can get work at any facility. Widmer, who spent a good deal of her career working as a per diem nurse for one hospital, said many nurses make careers out of working on a per diem basis in part because they enjoy the freedom of being able to pick their schedules. According to Bower, per diem nurses also have the advantage that they don’t have to work weekends if they don’t want to.
Ted Purdy at the Sullivan County HealthCare nursing home said about 25 percent of his staffing hours are covered by per diem workers. He’d like to bring that down and have more full-time regular staff, but it’s balance.
“It would be more expensive because of benefits and New Hampshire state retirement,” Purdy said.
Though per diem nurses can work anywhere, the nursing home administrators interviewed said their per diem nurses agreed to stick to one facility.
“Because of the COVID-19 issues we’ve really worked hard to make sure people only work for us. That’s been important to us,” Purdy said.
Leon said the state’s recent COVID-19 guidelines for nursing homes and long-term care facilities include directives to make sure that staff stays at one facility, and even one area of the facility in order to keep the virus from potentially spreading. Purdy said all of his per diem staff have agreed to only work at Sullivan County.
Many facilities that still use agency nurses first screen the nurses to make sure that they have not come from a facility where there are infections, and then have the nurses quarantine for 14 days before they start their contracts, which can run for 13-weeks.
“We do have a concern about people being in multiple facilities,” said Tiffany McCary, the nursing director for the Rockingham County Nursing Home. “We are very careful with the facilities where they have been.”
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