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'They’re spending money they don’t have:' Nursing homes are suffering from dramatic workforce shortages

Nursing homes and assisted living facilities across the state are experiencing a workforce shortage of nearly all positions available within their facilities. The COVID-19 pandemic exacerbated the issues, and the Grand Forks region has been no exception.

Sally Rude, RNA/CNA at Valley Senior Living on Columbia, cares for resident Daniel Kosmatka. (Jacob Holley/ Grand Forks Herald)
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Half of Edgewood Memory Care interviewees don’t show up to their interview, and quarter of those hired don’t show up for their first day.

Sally Kovarik, clinical service director at Edgewood Memory Care in Grand Forks, has had difficulty finding anyone to fill vacant positions at the facility, let alone applicants with experience in the industry.

“A lot of times, we’re calling people and asking about an interview with them, and they don’t even know they applied to Edgewood,” Kovarik said.

Nursing homes and assisted living facilities across the state are experiencing a workforce shortage of nearly all positions available within their facilities. The COVID-19 pandemic exacerbated the issues, and the Grand Forks region has been no exception.

As of now, Edgewood is not offering any incentives or sign-on bonuses to those who apply. It has yet to have to stop admissions in order to deal with the shortage, and neither has Valley Senior Living, which has begun offering $10,000 signing bonuses for full-time RNs, LPSn and CNAs at its locations in Grand Forks.

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“I am incredibly proud of our team for that accomplishment this year,” Garth Rydland, president and CEO of Valley Senior Living, said. “Yes, there have been days where staffing has been less than optimal, but they have continued to pick up extra shifts to make sure the residents receive the care they deserve.”

Grand Forks is just the tip of the iceberg. According to the NDLTCA, 60% of its 211 members have stopped taking admissions in the past few months, while 30% of nursing homes and assisted living facilities in urban areas such as Grand Forks, Fargo, Bismarck and Minot have reported needing to stop admissions. However, in rural areas such as Devils Lake, Dickinson and Williston, 83% of facilities have stopped admissions.

Carrie Carney, vice president of marketing and communications for Eventide Senior Living Communities, said its locations in Devils Lake haven’t had to resort to any drastic measures yet.

“We haven’t stopped taking admissions, but that’s not to say we won’t get to that point,” Carney said.

Shelly Peterson, president of the NDLTCA, is speaking at a special legislative session beginning Nov. 8 to decide how to use $1 billion in federal funds from the American Rescue Act. In October, six meetings were held between the House Appropriations Committee and the Senate Appropriations Committee to receive proposals on how to spend the money. The committees have already received about $10 billion in requests for the $1 billion available.

Peterson hopes the ARA funds will be used to cover a one-time infusion of $45.8 million into nursing homes across the state, including the NDLTCA’s members, 57.6% of which are operating at a deficit.

“Cash reserves are depleted, lines of credit are running low and we were hit hard with occupancy levels going down during the pandemic, and we’ve had a hard time recovering that,” Peterson said. “People are hesitant to come into long-term care because of the issue of visitations, and then concerns of the high number of guests we had initially. Thank goodness the vaccine came out, because that has drastically changed.”

Those operating at a deficit are having to find ways to pay employees. According to NDLTCA data, 96% of its members have asked staff to work overtime. The positions most commonly vacant for NDLTCA members are CNAs and direct caregivers, of which 88% of facilities need new hires, dietary staff, RNs and LPNs. Carney said Eventide’s Devils Lake locations have had to make do in the meantime.

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“We just simply don’t have enough staff,” Carney said. “Some of our staff are working longer hours than we want them to or than would normally be expected when we aren’t in this big of a challenge, and we have travel staff come in and help us.”

Traveling contract nursing services can be used to ease the burden. The state also has a pool of what Peterson called “emergency nurses” it can send to facilities with the most desperate situations, but there are only about 60 of them.

“We had two facilities that literally had half of their staff at a testing event test positive for COVID, and then the next testing event the other half tested positive,” Peterson said. “How do you deliver care and services when half your staff are out or all of your staff?”

OSHA requires facilities to pay anyone that goes out on leave with COVID symptoms even if they haven’t tested positive for the virus. During the week of Oct. 18, 60 NDLTCA facilities had staff cases of COVID-19 and had to temporarily shut down to do immediate testing.

The hardships form a cycle; facilities can’t hire enough staff, or the staff they have are home with COVID-19 symptoms, and then they either pay contract staff to step in or for their employees to work overtime, which keeps them operating at a deficit.

“They’re spending money they don’t have,” Peterson said. “That’s why our request of the $45.8 million is to help them financially recover, because there’s only so long that you can spend money you don’t have. What they’re doing is they’re spending lines of credit, they’re going into reserves they don’t have and they’re just spending those down.”

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Crosby Long Term Care Center in Crosby, North Dakota, closed Sept. 1, and three more NDLTCA facilities are currently in danger of closing permanently. Peterson said more will follow if something isn’t done soon.

“Our payment system was never designed to withstand a pandemic and all the money you spend on contract staff, the overtime or the quarantine time,” Peterson said.

Valley Senior Living 1.jpeg
Registered Nurse Arlene Ulness inputs data into a computer at Valley Senior Living on Columbia. (Jacob Holley/Grand Forks Herald)

Valley Senior Living 1.jpeg
Registered Nurse Arlene Ulness inputs data into a computer at Valley Senior Living on Columbia. (Jacob Holley/Grand Forks Herald)

Jacob Holley joined the Grand Forks Herald as its business reporter in June 2021.

Holley's beat at the Grand Forks Herald is broad and includes a variety of topics, including small business, national trends and more.

Readers can reach Holley at jholley@gfherald.com.Follow him on Twitter @JakeHolleyMedia.
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