A year of COVID: A grim milestone for nursing homes in New Hampshire

  • Matt Lagos, administrator at Merrimack County Nursing Home, looks over some of his staff member at the Boscawen facility on Tuesday, April 28, 2020. “Staffing has actually been pretty stable here,” said Lagos and he pointed out, there are no cases of COVID-19 at the nursing home with restrictions on getting into the facility. GEOFF FORESTER

Monitor staff
Published: 3/8/2021 7:02:50 PM

A little more than a year ago, the United States reported its first outbreak of COVID-19 at a nursing home at a suburban facility in Kirkland, Washington. Two-thirds of the residents tested positive for the virus and 35 people died.

Brendan Williams, the president of the New Hampshire Health Care Association, knew the facility intimately – years ago, he worked with the home during his tenure the Washington Health Care Association. The death toll set off red flags in his mind.

“I saw how it was ravaged,” he said. “It was a five star facility.”

He urgently emailed members of his board to tell them to brace themselves for the virus and soon after, five star facilities in New Hampshire reported outbreaks and rising numbers of deaths.

Over the past year, long term care facilities were ground zero for New Hampshire’s COVID-19 crisis — since March of last year, 840 people associated with these facilities have died from the virus, about 70% of the state’s total deaths.

The virus has emotionally and financially squeezed these facilities and the effects of that strain, Williams thinks, will be seen for years to come.

The income of nursing homes is tied to how many residents are in their care. During the pandemic, many facilities have had to take beds offline to make room for COVID units and free up staff for higher intensity care, cutting homes’ revenue substantially.

The reduced income, compounded with the additional costs of PPE and COVID testing has put homes in a precarious financial situation.

“Your electrical bill doesn’t go down because you’re operating at a lower census,” he said. “Facilities are going to have to consistently boost occupancy over a period of months, or face ruin.”

At Merrimack County Nursing Home, occupancy usually stays above 90%, said Matt Lagos, the nursing home administrator. This year, though, it’s hovered around 70%, putting a huge financial burden on the facility.

Health care giant, Genesis, facing billions of dollars in debt, announced last week it was preparing to sell control of 51 of its facilities around the country, including three of its 20 centers in New Hampshire. In Concord, Genesis owns The Harris Hill Center, Granite Ledges and the Pleasant View centers near the hospital.

Williams doesn’t see vaccines as the finish line many have made them out to be — there will always be some people who decline to get the shot and there’s always a slim chance someone fully inoculated could contract the virus. Already, some vaccinated residents have tested positive for COVID-19 and, though asymptomatic, have had to be quarantined in the empty beds that used to be occupied by revenue-generating residents.

The fact is, reduced occupancy may be the reality for a while, he said.

“I guess what scares me is that we need to come to terms with what a coexistence with COVID-19 looks like,” he said. “Because we hear a lot of talk about post-COVID and there’s not going to be a post-COVID, at least not in the foreseeable future.”

This is particularly frightening given that many nursing homes are on the brink of financial ruin right now. He said he hopes the state will use funding from the CARES Act to support struggling nursing homes.

If not, “They will go broke and close because they’re awfully close to that right now,” he said.

Most homes are simultaneously facing staffing crisis, brought on by burnout and lengthy, but necessary, quarantine requirements.

Shortage of staff in nursing homes has long been a problem in New Hampshire. Low Medicaid reimbursement rates in the state make it difficult for facilities to keep salaries competitive.

Williams said the pandemic has exacerbated the staffing shortage. When outbreaks of COVID-19 started appearing at homes across the state, many facilities had staff members quit out of fear.

Furthermore, the programs that train new nursing assistants were put on pause to limit the number of visitors to nursing homes, effectively cutting off the supply of new staff.

As of Dec. 6, about a third of nursing homes in the state reported having a shortage of aides and nearly a quarter of homes reported a shortage of nurses, according to a recent report from the U.S. PIRG Education Fund.

The staff that have remained during the pandemic have faced exhaustion from countless extra shifts and trauma from witnessing an unprecedented number of death.

“Everybody’s had burnout from COVID but it’s 24/7 that we’re living this,” Lagos said. “We’re all worried about if today is the day that more cases are going to occur.”

Williams said he isn’t sure how the workforce is going to recover from an experience like this.

“The emotional scars are going to be lasting for staff and residents alike,” he said. “I just don’t know what that looks like you know going into the future.”

Teddy Rosenbluth bio photo

Teddy Rosenbluth is a Report for America corps member covering health care issues for the Concord Monitor since spring 2020. She has covered science and health care for Los Angeles Magazine, the Santa Monica Daily Press and UCLA's Daily Bruin, where she was a health editor and later magazine director. Her investigative reporting has brought her everywhere from the streets of Los Angeles to the hospitals of New Delhi. Her work garnered first place for Best Enterprise News Story from the California Journalism Awards, and she was a national finalist for the Society of Professional Journalists Best Magazine Article. She graduated from UCLA with a bachelor’s degree in psychobiology.

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