Cindy Roden left retirement to work on the COVID-19 unit in a nursing home near her home in Aitkin as health care facilities struggle with crisis-level staffing shortages and a new wave of illness. Photo by Max Nesterak/Minnesota Reformer.
After working for nearly 50 years as a nurse, Cindy Roden was ready to enjoy retirement after leaving her job last March at a nursing home in Aitkin. She had the summer and fall to spend gardening and fishing with her grandkids in the lake just outside her house.
Then she got a call from her former employer at Aicota Health Care Center, asking her to come back. The nursing home had to reopen a COVID-19 unit but couldn’t find anyone to staff it.
Despite being 70 years old and having diabetes, both of which make her more vulnerable to serious illness from COVID-19, Roden agreed.
“I just have to take my chances,” Roden said during a recent interview. “If they could call me after this amount of time and ask for me to come in, obviously, they need it bad.”
Aicota also coaxed one of Roden’s friends to come out of retirement to work as the other nurse on the COVID-19 unit. Roden works the 12-hour day shift, and her friend works the nights.
“There’s always been a nurse shortage, but this … this is way beyond a shortage,” Roden said.
Long-term care facilities are reaching new levels of desperation for workers as the highly contagious omicron variant creates yet another surge in COVID-19 patients.
Roden said it was grueling working through the first surge of COVID-19, before there was a vaccine and when about two-thirds of COVID-19 deaths were in long-term care facilities. Nearly half of the roughly 60 residents where she worked died of the virus.
“Once it’s in your building, there is no stopping it. It’s like wildfire,” said Roden, who miraculously was never infected.
About half of the nurses at Aicota left since the start of the pandemic. And while the number of residents has since rebounded, its staffing levels haven’t.
There were 23,000 vacant positions in long-term care facilities across the state last fall, which amounts to about a fifth of the workforce, according to the most recent survey conducted by Care Providers of Minnesota and Leading Age Minnesota, industry trade groups.
That’s led more than 70% of long-term care facilities across the state to limit how many residents they admit. In rural areas of the state like Aitkin, more than 90% of providers are capping admissions.
Long-term care facilities are typically full or nearly full, but now are just over 74% occupied on average because there isn’t enough staff to care for residents.
“If you can’t take care of them, you can’t take them,” said Patti Cullen, CEO and president of Care Providers of Minnesota.
The exodus of workers was driven by low wages, burnout, the fear of getting sick with COVID-19 and a lack of child care.
“We have a lot of single moms working in our settings. If you think about the unemployment benefits and the pressure they are under when daycares are closed or kids are being sent home every time there’s an outbreak, that was pretty stressful,” Cullen said.
Exacerbating the problem was that some training programs shut down early in the pandemic, disrupting the pipeline of new health care workers. While those training programs have resumed, Cullen fears the federal vaccine mandate for health care workers, which takes effect on Thursday will further exacerbate the shortage.
Across the state about 80% of long-term care workers are vaccinated, but that rate varies greatly from facility to facility.
Roden says many in her rural, central Minnesota community are skeptical of the vaccine and refuse to get it. Sixty percent of residents old enough to get the vaccine have done so compared with 71% statewide.
“People up here are not afraid of COVID for Pete’s sake. They don’t believe it,” Roden said. “To me, it’s an easy choice. Do you want to live or do you want to die? I happen to want to live, so I got the vaccinations and on we go.”
The shortage is felt across the health care system
The lack of nurses and nurses aides in long-term care facilities has created a bottleneck throughout the health care system, as hospitals can’t discharge patients who have nowhere to go.
“That’s when you get ambulances circling and circling trying to find a place for somebody with a heart attack or a stroke. And it’s just pure chaos,” said Mary Turner, an ICU nurse at North Memorial Hospital and president of the Minnesota Nurses Association.
“It starts when you can’t get that normal amount of discharges whether they go to nursing homes or wherever,” she said.
The crisis level staffing shortage led Gov. Tim Walz to call in the National Guard in November to form “nursing response teams” in long-term care facilities. He also directed $50 million in federal COVID-19 relief funding to long-term care facilities to hire and retain workers.
In December, Walz also directed $3.5 million to recruit and train 1,000 nursing assistants by the end of January and so far at least 500 are enrolled, according to a spokeswoman for the governor.
But those efforts continue to be dwarfed by the problem, which has been percolating for years. National Guard soldiers and airmen are currently serving in seven long-term care facilities, but the state has some 365 nursing homes, nearly all of which have vacant positions. And even if Walz is able to recruit 1,000 new nursing assistants in two months, the state needs thousands more just as quickly.
Cullen, with Care Providers of Minnesota, said the underlying cause of the chronic shortage of workers lies with the legislature.
Nurses can make tens of thousands of more dollars a year working in hospitals than in nursing homes, a function in part of a state law aimed at controlling long-term care costs by requiring nursing homes to charge private patients the same rate it charges patients on Medicaid.
Senate Republicans criticized Walz for not proposing more funding for long-term care facilities in his supplemental budget released on Wednesday. Sen. Jim Abeler, R-Anoka, called the governor’s proposal “woefully inadequate,” saying the historic $7.7 billion surplus “is likely our only opportunity to address this massive problem.”
Recently Senate Republicans put forward a $150 million proposal that would temporarily suspend pay caps for nurses and nursing assistants in nursing homes as well as temporarily allow nurses licensed in other states to work in nursing homes. The proposal also includes loan forgiveness and training funds for nursing assistants.
Nurses can earn even more now given the steep demand if they’re willing to travel across state lines. Minnesota is paying a staffing agency $275 an hour plus $345 a day for food and lodging per nurse for out-of-state nurses to work in hospitals overrun with COVID-19 patients. The company hasn’t disclosed what the nurses take-home pay is.
The state is paying for the nurses and other health care workers with $40 million Walz recently allocated from federal aid to try to shore up staffing shortages in hospitals.
Roden is being paid a premium to come back to work her old job. She knows she could make even more in a hospital and as a traveling nurse.
But she says she’s always loved long-term care, and at age 70, she’s not up for more. Currently, she works only when there are patients in the COVID-19 unit. Once the pandemic is over, she plans to go back to full-time retirement.
”This is what I can manage right now,” Roden said.
This story has been updated to clarify that the state is paying a staffing agency $275 per hour per nurse for out-of-state nurses.
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