The older woman, who’s 74, sometimes slips trying to get out of bed or into her wheelchair. She can’t always remember that she needs help, so falling is a constant threat.

But the worst thing for Burgess and other family members is wondering what happens next.

“Unless she yells out, I’m sure they don’t know she’s fallen, and she may lie there for who knows how long,” the daughter said.

Burgess has been told the staff checks on residents, at least every 90 minutes to two hours. But she’s been there on Saturdays when there seems to be only one aide and one nurse tending to several dozen patients. If a resident is a “two-person assist,” as her mother is, two people have to help with tasks like getting in and out of the bathroom.

That means there’s no one else to look in on others, including a woman with dementia who needs help getting up off the floor. What adds insult to injury is that her mother is charged $8,400 per month for the room and care.

But Burgess, who lives in Culpeper County, doesn’t fault any of the health care workers at the facility, which isn’t being named because the problems described there probably are pervasive nationwide.

In the seven months her mother has lived there, Burgess said she hasn’t met any nurses or aides who gave the impression they wouldn’t do anything they could to help.

“There just aren’t enough of them,” she said. “It’s not a person issue at all, it’s simply the lack of workers.”

HORRIFIC SHORTAGES

Finding workers for long-term care facilities—whether they specialize in memory care or provide general treatment to older and disabled people—has always been a challenge, even before COVID-19.

Elderly patients tend to have the most chronic health problems and need the most hands-on treatment, but health care professionals say staff shortages in long-term care facilities have gotten progressively worse as the pandemic has worn on.

“The same crisis that we’ve had in the acute-care arena with ‘the great resignation,’ where 20% of professionals left health care, that same kind of crisis is being seen across all areas,” said Dr. M. Stephen Mandell Jr. “Nursing facilities are no different. It’s every bit as hard for them and maybe even more so sometimes.”

Mandell was the medical director at the Bowling Green Health and Rehabilitation Center in Caroline County about 11 years ago. More recently, he’s represented Mary Washington Healthcare on a community council that shares information on ways to improve a patient’s transition from the hospital to nursing facilities and vice versa.

When nursing homes have limited staff, they have to cut back on the number of beds they can fill and that action has a ripple effect, Mandell said. Patients leaving the hospital—but not well enough to go home—then face limited options in terms of where they can go for rehabilitation.

That’s already happening, according to the American Health Care Association, which represents 14,000 long-term care facilities nationwide. A recent AHCA survey noted that 6 of 10 nursing homes are limiting new patients because they don’t have enough workers to care for them.

Almost every survey respondent, or 98%, said it’s difficult to find staff, while 87% reported shortages between moderate and severe. While pandemic outcomes have improved this year to the point that fewer people are being hospitalized and dying—because of the availability of vaccines and more treatments—60% of nursing home providers said their workforce woes have worsened in 2022.

“I’m hearing about shortages that are horrific, truthfully, and it’s a bit of a perfect storm,” said Dr. Zoila Ortega, the founder and president of Career Nursing Academy in Locust Grove. Her academy trains certified nursing aides, or CNAs, for nursing homes, as well as personal care assistants, or PCAs, who work in assisted-living facilities or in homes with private patients.

‘STRAIN AND DRAIN’

The Free Lance–Star contacted spokespeople and workers at local long-term care facilities, but didn’t get any responses and reached out to people such as Ortega, who are familiar with the staff shortages. She said workers who remain are being taxed because they’re assuming more of the workload and facing physical and mental burnout.

Tracey Bilodeau, a licensed practical nurse who lives in Stafford County, knows the feeling. She’s a home health nurse who cares for a paralyzed patient and said nurses who work in private homes face some of the same “strain and drain” as those in facilities.

The work is constant, mundane and hard on a person’s body. She knows an LPN who worked in a long-term care facility in New York and was trained to do various maneuvers alone, in case no one else was available.

Bilodeau said the nurse can lower a bed, roll a 300-pound patient toward her and somehow rest their body against her knee while she does the necessary cleaning or treatments.

“God love her,” Bilodeau said. “That’s just a recipe for slipped discs and herniated discs and everything else. I’m 65 years old and in good physical condition, but I’m not 30 anymore. You have to be careful.”

During the first year of COVID, media reports cited a number of reasons for the decrease in nurses. Those nearing retirement age left careers earlier than planned and younger ones, with children at home, took different jobs so they wouldn’t expose their families to a mutating virus.

As the pandemic goes on and new issues surface, Bilodeau said she feels for her fellow nurses who still face the same grind.

“They’re worn out, they’re COVID weary, the world is COVID weary,” she said. “I’ve had it with masks and the idea of more vaccines and now monkeypox comes along. We were already dealing with so much stuff.”

MORE TRAINING

Ortega has heard about facility supervisors—administrators, directors of nursing and even human resource personnel with a background in health care—“going to work on the floor” to care for patients, especially on holidays and weekends.

“When you hear these people are leaving their offices, their desks, and they have to go out there and work as CNAs, you know things are bad,” she said.

Ortega believes the answer is training more candidates and finding more creative ways to recruit nurses and aides. Her academy in Orange County specializes in helping those for whom English is not a first language as well as people who have what she calls “a caregiving spirit” but don’t always perform well on written tests.

She believes retirees and those who’ve left the military would be good candidates for jobs as nursing aides and would like to see programs developed to reach them—and to cover their training while they work. The same could be done for 17-year-olds seeking summer jobs, Ortega said.

Germanna Community College has a goal to double the number of nurses and health care professionals it trains to more than 400 per year to help with the shortage. Earlier this year, Germanna and others in the Virginia Community College System asked the General Assembly to invest in efforts to boost nursing programs.

Without it, the VCCS won’t be able to fill high-demand nursing jobs by training more graduates who are ready for the workforce, said Dr. Patti Lisk, dean of Nursing & Health Technologies at Germanna.

“Simply put, this is a crisis that transcends geography, provider types and health care settings, leaving a nursing workforce that cannot meet Virginia’s needs,” VCCS spokesman Jeff Kraus said in February.

Ortega described it another way.

“If nothing changes and you have to go into a facility 10 years from now,” she said, “there won’t be people to take care of you.”