Long-term care needs to get creative to deal with coronavirus staffing impact


Originally published in McKnight’s

By Patrick McCormick

The coronavirus pandemic is undeniably going to have a major impact on U.S. long-term care operators in the coming months. The virus is an unwelcome addition to an already long list of headaches for an industry operating on thin margins amid falling demand, reimbursement pressures and new competition.

With a vaccine 12 to 18 months away and families likely to be more reluctant to admit loved ones, the overall impact could well be worse than that of the 2008 financial crisis.

Given the worryingly high mortality rate among elderly COVID-19 victims, some long-term care operators, especially independent ones, will be at risk of going under if the virus enters their populations. They could also be at risk if they make knee-jerk steps in responding to the health crisis that could push up their costs unnecessarily.

Now is the time to keep calm and think creatively. For operators, it’s important to take a step back and ask how you’re going to pay for any measures over the long term, while not skimping on sensible measures that could help reduce losses and prevent disruptions to operations.

Industry ‘relatively well-prepared’

The good news is that the long-term care industry is relatively well-prepared because it has long been required to have infection control plans in place and has the experience of dealing with other outbreaks of new viruses in recent years. The tragic situation at the nursing home in Kirkland, WA, has likely served as a wake-up call to the whole industry to put those practices in place without delay.

No one knows exactly how the pandemic will play out in the coming months, and long-term care operators need to make sure they have a plan in place that prepares for different scenarios. A worst-case scenario would be if frontline staff and  residents come down with the disease in large numbers, especially at the same time. Providers also need to consider how to support residents’ mental health as visits from relatives are increasingly restricted. On the other hand, one possibility is that there’ll be a surge in demand for beds from recovering or mild COVID-19 patients and overflow from overwhelmed hospitals.

The first priority for most long-term care facilities should probably be managing and protecting their frontline staff, who represent the biggest cost center and are essential to keeping operations running.

The first challenge that homes may face is making up for staff shortfalls as more employees call in sick or have to look after children who are out of school. A common response is to reach out to staffing agencies to fill gaps in the schedule, but that’s an expensive solution (often double the cost of regular staff) that also tends to be bad for maintaining quality of service.

A better plan is to get creative with how you manage, protect and support your existing staff, even if that comes with some extra costs.

Consider split shifts

Some options for keeping things running include introducing split shifts, identifying staff who are available for extended hours, and managing time off in a way that ensures proper rest. It’s also worth exploring opportunities to pool staff with other facilities in the same area, whether they’re part of the same group or not.

It’s equally important to think about ways to support staff in their daily lives. Most facilities, for example, have buses or vans that could be redirected to transporting staff to and from home, helping them avoid long commute times and public transport. Another option is to provide delivered meals at home or on site for staff who are juggling work with childcare, keeping them nourished while reducing their time pressures and the need to visit supermarkets and restaurants.

Some additional steps that we’ve heard operators are undertaking include giving staff hand sanitizers and soap for use at home and providing extra scrubs and shoe covers for staff to prevent contamination between home and work. Staff at some providers are also volunteering to provide childcare for colleagues who are on shift.

There may also be opportunities to lower the workload on frontline staff by assessing whether some tasks — such as bed-making and equipment-cleaning — could be carried out by non certified personnel.

Although different in its scale of disruption, the coronavirus is not an entirely new type of challenge for the industry and is one that they are mostly well equipped to handle. As well as thinking creatively about how to use their resources, providers should stay vigilant, follow CDC guidelines and work with local health departments to avoid panic while maintaining a sense of urgency.

Patrick McCormick, CPA, is a partner in Plante Moran’s senior care and living practice.