Staffing levels at Vermont’s long-term care facilities reached a crisis point even before a new Covid-19 variant sidelined a large number of health care workers, according to a recent Vermont Legal Aid report.

The report, published earlier this month, says staffing issues coincided with a precipitous decline in quality of care in the fiscal year that ended Sept. 30, 2021, well before Vermont’s first documented case of Omicron. The issue needed “immediate attention” even then, according to the report. 

“This was an issue before the pandemic and it’s only gotten worse,” said Sean Londergan, Vermont's long-term care ombudsman and author of the report. 

When nursing homes and other long-term care facilities don’t have enough staff, residents there suffer. Overworked staff have less time to monitor the health of residents and build relationships with families. With more patients to look after, it’s much easier for routine tasks like replacing an empty oxygen tank or bathing residents to fall by the wayside. 

Will Terry, spokesperson for the Agency of Human Services, acknowledged these issues and said the state has helped long-term care facilities with temporary staffing since the beginning of the pandemic. Gov. Phil Scott also has outlined in his recent budget address proposals for longer-term education and tax incentives to shore up Vermont’s nursing sector. 

Omicron, meanwhile, is setting new infection records in Vermont’s long-term care facilities. As of Tuesday, the state reported 25 outbreaks and a total of more than 300 cases. The peak for the Delta surge, by comparison, was roughly 200 infections and 17 outbreaks, according to state data.

Despite the explosion of cases, Omicron is causing milder infections and fewer deaths in long-term care, Health Commissioner Mark Levine said. 

The rapid spread of the highly contagious variant means that more staff members get sick at once, which shrinks the pool of available workers at any given time. As a result, long-term care facilities have vacancies at every level — from nursing and clinical staff to aids, housekeeping and cooks, Laura Pelosi, lobbyist for the Vermont Health Care Association, told lawmakers at a Jan. 6 meeting.

“We’re struggling to get drivers to take dialysis patients to their dialysis appointments,” she said. “The workforce shortages are that extreme in our long-term care facilities.”

The Legal Aid report had a litany of examples of the alarming implications to residents. In one instance, staff almost sent home a wheelchair-bound nursing home resident who had no one to care for her. The resident “was going to ask the bus driver to put her into bed” and had no other care plans beyond that, the report says.

In another instance, a hospitalized resident had to live in the hospital for “months” because her facility refused to take her back. The woman was transferred to another facility only after the ombudsman’s office intervened. 

In an email earlier this week, Pelosi attributed the gaps identified in the report to the lack of workers. Nursing homes have attempted to bridge the gap by leaning on costly temporary workers, but the economics of that approach are not sustainable in the long term. Pelosi estimates that nursing homes spent $37 million on travel staff in 2021, a three-fold increase from 2017. 

Nursing homes have attempted to minimize these costs by shutting down some 500 beds this month, compared with 279 beds this time last year, she said. 

“Even losing a few staff in any facility right now is a huge, huge challenge,” Pelosi told lawmakers on Jan. 6.

State officials, for their part, have repeatedly touted efforts to help long-term care facilities reopen beds that closed for lack of staff, but Londergan, the ombudsman, said that these measures don’t address the staffing issues associated with beds that are already filled. 

“I really don’t think it’s addressing the overall issue of the fact that long-term care facilities are short-staffed,” he said. “I think they’re addressing a different problem.”  

Wikipedia: Liora Engel-Smith covers health care for VTDigger. She previously covered rural health at NC Health News in North Carolina and the Keene Sentinel in New Hampshire. She...