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'They live and work in fear': Long-term care facilities face shortages amid pandemic
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'They live and work in fear': Long-term care facilities face shortages amid pandemic

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DES MOINES — Long-term care facilities were among those hardest-hit during COVID-19’s first surge this summer.

Now, with the virus raging through Iowa, those facilities are once again bearing the brunt of the pandemic.

So severe has the situation become that the state public health department has given its blessing — as a last resort in emergency situations — for long-term care workers with a confirmed COVID-19 infection to provide care to patients without the virus.

As of Friday night, there were COVID-19 outbreaks — defined as three or more confirmed cases in a facility — at more than a fourth of Iowa’s roughly 440 long-term care facilities. There have been nearly 1,000 deaths.

Nursing homes throughout the state are facing critical shortages of available workers and personal protective equipment like gloves, protective eye wear, gowns, and medical-grade face masks.

As of mid-October, 38% of Iowa nursing homes reported having less than a one-week supply PPE, and 43% of state nursing homes reported being short on staff, according to survey responses nursing homes send periodically to the federal Centers for Medicare and Medicaid Services.

While facilities across the country have been hit, Iowa is higher than the national average for nursing home resident cases and deaths per capita, and nursing home staff cases per capita, according to federal data compiled by AARP. The state also is worse than the national average in the percentage of nursing homes that say they are short on staff and personal protective equipment for that staff.

“It is serious,” said Di Findley, executive director of Iowa CareGivers, a nonprofit that works to address shortages among direct care workers like certified nurse aides and home care aides. “The people who work in these jobs, the nurse aides, social distancing isn’t really an option. You can’t give somebody a bath or assist somebody to the toilet or help them with oral hygiene from six feet apart. Because of that, (those workers) are a little higher risk of contracting and spreading the virus.

“So they live in fear. They love their jobs, but they still live and work in fear now.”

Findley said direct care workers worked in difficult conditions for years before the pandemic hit in March. There is high turnover and low pay. The median salary for a direct care worker in Iowa is $13.80 per hour.

“They’re putting their lives on the line for $13.80 per hour,” Findley said. “Things were not good before, so you can imagine now, in the midst of a pandemic, how challenging it is for those folks on the front line and their employers.”

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Anthony Carroll, advocacy director for the Iowa chapter of AARP, said the 38% of nursing homes with less than a one-week supply of PPE is “troublingly high,” particularly at the pandemic’s eight-month point.

“We’re halfway through November, and that is troubling,” Carroll said.

The state has a PPE stockpile, and Gov. Kim Reynolds last week urged nursing homes in need to request equipment. A spokesman later clarified that a facility must be dealing with an outbreak before it can tap the stockpile. Facilities not experiencing an outbreak will be evaluated on a case-by-case basis.

Carroll said the state should do what it can to make it easier to get the PPE they need.

“Iowa should streamline this process to make it easier to get PPE in the hands of long-term care facility staff and residents,” Carroll said. “For the sake of residents, families and staff, Iowa needs to do whatever it takes to ensure that we no longer have over 38% of Iowa nursing homes reporting that they don’t have a one week’s supply of PPE.”

On Thursday Reynolds announced she is dedicating $14 million in federal funding designated for COVID-19 response efforts to help long-term care facilities with staffing and testing. When asked if the funding can also be used to purchase PPE, she referred to the state stockpile.

She noted the state has worked on guidance for long-term care staffing. One of the new guidelines from the state public health department says workers with a confirmed COVID-19 infection may provide direct care to patients with a suspected infection, and “as a last resort in emergency staffing situations,” workers with a confirmed COVID-19 infection may provide direct care to patients without an infection.

Reynolds said she expects to announce an initiative next week to recruit nurses and other critical care workers to come to Iowa to bolster the state’s strained workforce. The governor’s spokesman said details will be available this week.

“Like our hospitals, it’s important that we also provide assistance to long-term care facilities at this time, and that every Iowan continues to do their part to protect the most vulnerable of our health care workforce,” Reynolds said.

Carroll and Findley both suggested Reynolds should consider deploying the Iowa National Guard to help with Iowa’s overwhelmed health care workers, and both proposed a state registry for direct care workers to help employers find workers when faced with shortages. Legislation to create such a registry was proposed during the 2020 session of the Legislature before the pandemic hit and derailed the session.

Findley would like to see some federal pandemic response funding put toward hazard pay and address increased child care needs for direct care workers.

“You hear a lot about doctors and nurses, and they are very, very important. But let’s not forget about these people (direct care workers),” Findley said. “They’re on the front line and they are an important piece of our ability to mitigate and fight this virus. And they need our support, too.”

Rod Boshart of the Gazette in Cedar Rapids contributed.

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