Government Leaders Update
from the Health Facilities Association of Maryland
Thank you for your continued leadership and partnership as we navigate the evolving COVID-19 pandemic. We appreciate all that you do and we look forward to our continued work together to protect quality care for Marylanders in skilled nursing and rehabilitation centers and on assisted living campuses.
Today there are just a very small number single COVID-19 outbreaks in Maryland skilled nursing and rehabilitation centers and assisted living communities. Long-term and post-acute care teams are doing all they can as they keep up the fight against COVID-19 and the Delta variant. Early reports of the Delta variant surge indicate that ninety-nine percent of those infected are unvaccinated. Therefore, it remains critically important that we all continue to promote vaccination.
In my many conversations with leadership and staff of skilled nursing and rehabilitation centers, colleagues across healthcare, and other associations, the biggest concern and threat to the sector remains to be workforce and staffing issues. In addition to workforce and staffing, we remain focused on quality care, reimbursements, and navigation of ongoing change. Here is a brief fact sheet that outlines our top priorities.
Interestingly, an article in McKnight’s was recently published regarding a study on staffing during the pandemic. This study found that conventional measures of staffing quality, such as direct care staff-to-resident ratios, did not significantly predict COVID-19 outcomes. Rather, the number of unique staff providing care is associated with COVID-19 outcomes.
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According to a recent study published in Health Affairs, staff size is strongly associated with COVID-19 outcomes at skilled nursing and rehabilitation centers.
- Researchers from the University of Rochester examined the correlation between staff size, including staff not involved in direct resident care, with COVID-19 outcomes among skilled nursing and rehabilitation centers in the United States that did not have confirmed COVID-19 cases by June 2020.
- Detailed staffing data were used to examine the relationship between the unique number of employees working daily, conventional measures of staffing quality, and COVID-19 outcomes.
- Sample centers with the lowest staff size had 6.2 resident cases and 0.9 deaths per 100 beds, while those with the largest staff size had 11.9 resident cases and 2.1 deaths per 100 beds.
- Even when accounting for the size of the center, there was still a strong correlation between the number of staff and COVID-19 outcomes.
- In the study, conventional measures of staffing quality, such as direct care staff-to-resident ratios and acuity, did not significantly predict COVID-19 deaths or cases.
- The study's authors note that reducing the number of unique staff members without decreasing direct care hours (such as relying more on full-time rather than part-time staff) could help prevent outbreaks.
Workforce recruitment and retention have long been a concern and the pandemic has magnified the importance of finding solutions to ensure that long-term and post-acute care centers have the resources needed to recruit, train, and retain qualified staff and that they have appropriate Medicare and Medicaid rate funding.
From nurses and nursing assistants, dietary workers, maintenance and janitorial crews, to admissions and activities personnel, staff in nursing homes and assisted living centers are healthcare heroes who have been on the front lines since the very beginning of the COVID-19 pandemic. Despite the fact that these teams have saved many more lives than were lost, there have been times throughout the pandemic when the sector has been vilified. This causes morale to drop, makes it difficult to recruit new staff, and causes dissatisfaction among tenured employees.
Again, workforce recruitment and retention issues are not new; they existed before the pandemic and remain an issue now. It is not solely about education, training, the day-to-day job, or even wages. It is a combination of factors that must be addressed to fix this workforce crisis.
There have been employees who left the workforce, and fewer workers seeking employment in general. The workforce needs to be available, and given that the sector is reliant on Medicare and Medicaid rates, funding needs to be adequate enough to cover appropriate wages for quality care.
HFAM continues to work with our partners to address workforce and other priority issues. Currently, skilled nursing and rehabilitation centers are lending their insight, expertise, and recommendations as the Maryland Department of Health (MDH) produces a COVID-19 pandemic after-action report. HFAM and other healthcare leaders are assisting in outreach to providers to collect information needed to compile this report.
We have also been working closely in partnership with the Maryland Board of Nursing (MBON) on a variety of related issues. As you may know, during the State of Emergency Governor Hogan extended the expiration dates for licenses held by professionals certified by Maryland Health Occupations Boards. The deadline to renew licenses is August 15, 2021. Since early June we have been working to assist with licensure renewals of nurses and nursing assistants and we have been collecting information from individuals so that MDH and MBON can better assist with potential issues and communicate more effectively.
During the pandemic, temporary nursing assistants have been allowed to work in our setting and we have been advocating to ensure these much-needed staff can continue working once the emergency ends. We are glad to report that MBON will honor the federal state of emergency and CMS waiver allowing emergency temporary nursing assistants to practice in Maryland for up to 120 after the federal emergency ends. We continue to encourage those working as temporary nursing assistants to enroll ASAP in a permanent full training program and pass the certification exam to remain on the job. The HFAM team has been assisting those who need guidance on such training programs and requirements.
We still have a long road to recovery, and in light of the surge of the Delta variant especially among unvaccinated individuals, we must all remain vigilant to ensure we continue to move forward and not back. As our healthcare hero teams go above and beyond to provide quality care to Marylanders in need, we must together ensure that they too are cared for and protected.
Again, thank you for that you do. We look forward to our continued conversations, meetings, and partnership to find solutions on workforce issues and to protect quality care. Should you have any questions, please do not hesitate to reach out to Joe DeMattos at jdemattos@hfam.org or Hope Morris at hmorris@hfam.org.