CORONAVIRUS

Iowa's long-term care facilities face shortages in pandemic

Scores of facilities report staffing and equipment needs

Nate Sternat of Cedar Rapids holds a sign April 24 in support of care providers including his mother at Heritage Special
Nate Sternat of Cedar Rapids holds a sign April 24 in support of care providers including his mother at Heritage Specialty Care in Cedar Rapids. At the time, Heritage was the scene of the worst COVID-19 outbreak in the state. It is no longer on the state’s list of outbreaks at long-term care facilities. (Andy Abeyta/The Gazette)

DES MOINES — Long-term care facilities were among the hardest-hit this past summer during COVID-19’s first surge.

Now, with the coronavirus spreading through Iowa exponentially worse than ever before, those facilities are once again bearing the brunt of the pandemic.

So severe has the situation become that the state public health department has given its blessing — as a last resort in emergency situations — for those facility workers who have confirmed COVID-19 infections to continue providing care to patients who do not have the virus.

As of Friday evening there were COVID-19 outbreaks — defined as three or more confirmed cases in a facility — at more than a fourth of Iowa’s roughly 440 long-term care facilities. Nearly 1,000 Iowans at long-term care facilities have died as a result of the disease.

Many nursing homes throughout the state say they are facing critical shortages of available workers and the personal protective equipment that shields them from the virus — gloves, eyewear, gowns and medical-grade masks.

As of mid-October, 38 percent of Iowa nursing homes reported having less than a one-week supply of personal protective equipment, or PPE; and 43 percent of nursing homes in the reported being short of staff, according to survey responses nursing homes send periodically to the federal Centers for Medicare and Medicaid Services.

While long-term care facilities across the country have been hit hard by COVID-19, Iowa is higher than the national average for nursing home resident cases and deaths per capita, and nursing home staff cases per capita, according to federal data compiled by AARP.

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The state also is worse than the national average in the percentage of nursing homes that say they are short on staff and personal protective equipment for that staff.

“It is serious,” said Di Findley, executive director of Iowa CareGivers, a nonprofit that works to address shortages among direct care workers like certified nurse aides and home care aides. “The people who work in these jobs, the nurse aides, social distancing isn’t really an option. You can’t give somebody a bath or assist somebody to the toilet or help them with oral hygiene from 6 feet apart. Because of that, (those workers) are a little higher risk of contracting and spreading the virus.

“So they live in fear. They love their jobs, but they still live and work in fear now.”

Findley said direct care workers had been working in difficult conditions for years, before the pandemic hit in March. She said the positions are high-turnover, and low-paying: she said the median salary for a direct care worker in Iowa is $13.80 per hour.

“They’re putting their lives on the line for $13.80 per hour,” Findley said. “Things were not good before, so you can imagine now, in the midst of a pandemic, how challenging it is for those folks on the front line, and their employers.”

Anthony Carroll, advocacy director for the Iowa chapter of AARP, said the 38 percent of nursing homes with less than a one-week supply of PPE is “troublingly high,” particularly at the pandemic’s eight-month point in the state.

“We’re halfway through November, and that is troubling,” Carroll said.

The state has a PPE stockpile, however, and Gov. Kim Reynolds last week urged nursing homes facing shortages to request equipment from the stockpile.

Reynolds’ spokesman later clarified that a facility must be dealing with an outbreak before it can request PPE from the state’s stockpile. The spokesman said facilities not experiencing an outbreak may be considered eligible, but those will be evaluated case-by-case.

Carroll said the state should do what it can to make it easier for facilities to get PPE they need.

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“Iowa should streamline this process to make it easier to get PPE in the hands of long-term care facility staff and residents,” Carroll said. “For the sake of residents, families and staff, Iowa needs to do whatever it takes to ensure that we no longer have over 38 percent of Iowa nursing homes reporting that they don’t have a one week’s supply of PPE.”

Reynolds last week also announced she is dedicating $14 million in federal funding designated for COVID-19 response efforts to help long-term care facilities with staffing and testing. When asked if the funding can also be used to purchase PPE, Reynolds referred to the stockpile.

Reynolds also noted her office and the state public health department have worked on guidance for long-term care staffing. One of the new guidelines, published in the state public health department’s November update says workers with confirmed COVID-19 infections may provide direct care to patients with suspected infections and — “as a last resort in emergency staffing situations” — workers with confirmed infections may provide direct care to patients without infections.

Reynolds also said she expects to announce this week an initiative to recruit more nurses and other critical health care workers to come to Iowa to help bolster the strained workforce. The governor’s spokesman said a plan to bring more health care resources to Iowa is being developed, but details were not yet available.

“Like our hospitals, it’s important that we also provide assistance to long-term care facilities at this time, and that every Iowan continues to do their part to protect the most vulnerable of our health care workforce,” Reynolds said.

Carroll and Findley both suggested Reynolds should consider deploying the Iowa National Guard to help with Iowa’s overwhelmed health care workers, and both proposed a state registry for direct care workers, which could be used by employers to more easily find workers when faced with staffing shortages. Legislation to create a state direct care worker registry was proposed during the 2020 session of the Iowa Legislature and was being considered before the pandemic hit and derailed the session.

Findley said she would like to see some of the federal pandemic funding be put toward hazard pay and other financial issues like increased child care needs for direct care workers.

“You hear a lot about doctors and nurses, and they are very, very important. But let’s not forget about these people,” Findley said. “They’re on the front line and they are an important piece of our ability to mitigate and fight this virus. And they need our support, too.”

Rod Boshart of The Gazette Des Moines Bureau contributed.

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