Georgia Army National Guard Soldiers, of Company C, 2nd Battalion, 121st Infantry Regiment, disinfect common areas in a long-term care facility in Dawson, Ga. April 2, 2020. The Georgia National Guard is sending infection-control teams to nursing homes around the state to help limit the spread of COVID-19.  April 2020 (Photo by 2nd Lt. George Peagler)

By: Sophie Quinton

To fix staffing problems over the long term, however, worker advocates say direct care workers need better pay. And that, industry groups and labor unions say, will require more state and federal dollars for long-term care.

“Post-pandemic, I think there needs to be a real conversation about valuing the roles of caregivers,” said Marlishia Aho, regional communications manager for 1199 SEIU United Healthcare Workers East, a union that represents roughly 2,000 nursing home workers in Massachusetts, including Bondah. “And that requires wages that reflect the work that they are doing.”

Not Enough Nurses

Most U.S. nursing homes don’t have enough staff to provide the 4.1 hours of daily nursing care experts recommend, said Charlene Harrington, an emeritus professor of nursing and sociology at the University of California, San Francisco, who studies long-term care staffing.

“Seventy-five percent of all nursing homes did not meet the professional staffing standards that experts believed they should have before the virus hit,” Harrington said. “So that made them very vulnerable.” 

Care is mostly provided by nursing assistants, who have at least 75 hours of training and do everything from feeding residents and giving them medication to helping them move from a bed to a wheelchair. 

Instead of employing one nursing assistant for every seven residents — the minimum recommended by experts — some facilities employ one nursing assistant for every 10 or even 15 residents, Harrington said. 

There’s no standard federal ratio of staff to residents. A 1987 law requires nursing homes to have a registered nurse on duty eight hours a day, seven days a week; a licensed nurse on duty in the evenings and overnight; and staff “sufficient to meet nursing needs of its residents.” 

There’s no national data on nursing home staffing during the pandemic, because the federal government has suspended staff reporting requirements to give businesses a break from paperwork. Before the pandemic, the average nursing home could provide 3.9 hours a day of nursing care per patient, according to the most recent federal data.

But workers, union leaders and industry groups say many workers are taking time off because they’ve contracted the virus, have caregiving responsibilities at home, or because they or a family member have a medical condition that makes them vulnerable to a deadly infection.

“Many people are afraid to bring this home to their families,” said Aho of the SEIU. 

Before the pandemic began, 1 in 7 direct care or nursing jobs at Massachusetts long-term care facilities were vacant, said Jennifer Chen, director of membership and engagement for the Massachusetts Senior Care Association, a trade association for long-term care facilities.

“We’ve seen this shortage of these nursing staff prior to COVID-19,” Chen said, “but the pandemic has really exacerbated the shortages.”

Despite the Massachusetts job website, the state hasn’t attracted enough applicants to meet demand, Chen said.

Some states also are allowing employers to hire temporary unskilled workers to support nurse aides.

Illinois regulators require “temporary nursing assistants” hired during the pandemic to complete 16 hours of instruction and training. Massachusetts workforce development officials are promoting “resident care assistant” jobs that don’t require any prior training or a high school diploma.

Using entry-level hires to perform simple tasks, such as holding up an iPad so isolated residents can video chat with loved ones, isn’t a bad idea, Harrington said. But it doesn’t fix the fundamental problem. 

“That would not, in any way, replace the needs for registered nurses or certified nursing assistants,” she said.

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