Nursing home

Jill Jacques, right, and Beth Bean, center, escort resident John Richardson down a hallway at the Belknap County Nursing Home. (Jon Decker/The Laconia Daily Sun photo)

LACONIA — As fatigue among nurses has become more commonplace due to anxiety, exhaustion, and COVID fears, nursing homes are struggling to hold on to staff at a time when the need for quality elder care has become particularly critical.

The chronic shortage of nurses nationwide, coupled with the fears about catching the COVID virus have turned what was a chronic problem into an acute crisis.

“It’s a perfect storm,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association which represents most of the state’s private nursing homes and some assisted living facilities.

The state of affairs is especially alarming at the Belknap County Nursing home where the challenge to retain staff is further aggravated by its inability to offer pay comparable to that of other long-term care facilities in the area.

Currently the nursing home has job openings for 12 full-time nurses posted on its website — eight licensed nursing assistants, two licensed practical nurses, and two registered nurses.

For LNAs — the category with the most openings — the advertised salary starts at $12.76 an hour. By comparison the average pay for LNAs statewide is $19 an hour.

Both Nursing Home Director Shelley Richardson and County Administrator Debra Shackett have both said they have been unable to fill the vacancies despite all the advertising, including ads in the newspaper.

“No one is responding to our job offers,” Shackett told a recent county commissioners meeting.

The nursing home has been operating for months at two-thirds of its 94-resident capacity due to staff shortages.

Things may get worse, and soon.

Richardson is afraid of the impact that the federal COVID vaccine mandate will have on the home’s already-depleted staff. As of last Thursday there were 27 unvaccinated people working at the home, including 14 nurses. If those workers all refuse to get vaccinated by the Dec. 5 deadline they will be terminated unless they qualify for an exemption to the mandate on medical or religious grounds.

Shackett told commissioners last Thursday that she believed that peer pressure was a big reason for the number of staffers who have so far refused to get vaccinated against COVID.

St. Francis Rehabilitation and Nursing Center in Laconia implemented a mandate that its staff be vaccinated against the COVID in September and seven "very good employees" quit as a result, according to Brenda Buttrick, the home’s administrator.

"I feel very good that we took that step," Buttrick said about the mandate, which applies to all nursing facilities operated by Catholic Charities New Hampshire.

Richardson is afraid if staff numbers take another big hit she will be forced to take steps to shut down another wing of the nursing home, meaning the home would need to find new places for 19 residents.

Unfortunately the plight the Belknap County Home finds itself in is not unique, which begs the question where could these 19 residents go.

St. Francis, which has a capacity of 51 residents, currently has 39 residents, Buttrick said.

The Merrimack County Nursing home has closed down one wing. Meanwhile, the Hillsborough County Nursing Home has 68 empty beds because it is short-staffed. It is currently looking to hire people to fill the equivalent of 89 full-time positions, Williams said.

In 2019, nursing homes in the state were operating at 86% capacity, Williams noted. Today it’s 76%.

The nursing shortage began in 2012 and is expected to continue until 2030, according to the federal Bureau of Labor Statistics.

The reasons for the dwindling numbers are that nurses are retiring or choosing to leave the profession because of mental and physical demands, that the aging population means patients need increasing level of care, that there is a shortage of nursing faculty, and because of burnout, said Pamela DiNapoli, executive director of the New Hampshire Nurses Association.

But long-term care facilities face an even greater challenge in recruiting nurses, compared to hospitals, she pointed out.

“It’s especially hard working in long-term care,” DiNapoli said, “but it doesn’t have the adrenaline rush that you get in other fields of nursing.”

She said many students coming out of nursing school are more apt to be drawn to work in emergency rooms or intensive care units because they feel those settings will give them the greatest opportunity to use and enhance their nursing skills.

“There’s this idea that to work in nursing homes you just need to have fundamental skills,” she said.

DiNapoli said nursing schools need to make more of an effort to encourage students to go into the field of geriatric nursing.

“Nursing homes have always been difficult to staff. We have to change the perspective.”

In order to maintain the necessary staff-to-patient ratios, health-care facilities have increasingly been turning to staffing agencies who place traveling nurses to fill the gap.

DiNapoli said 21% of all health-care postings in New Hampshire were for traveling workers. The rate in Belknap County was the lowest at 12%, she said.

Some agencies bill at rates as high as $70, $80, or $90 an hour, a situation Williams called “price-gouging.”

Beyond the heavy cost, the presence of traveling nurses has the potential of undermining the team spirit that is so essential in health-care settings.

Acknowledging that agencies are paid a portion of the contracted rate (20% to 25%, according to the website, Williams said, “It’s demoralizing for permanent staff to know the traveling nurses are getting so much more.”

The Belknap County Nursing Home has two traveling nurses at present. They are working alongside permanent staff nurses who are paid close to $30 an hour.

Recently one of the home’s permanent nurses quit to take a job with an agency and is now working as a traveling nurse.

With the demand for nursing personnel being greater than the supply coupled with the ramifications COVID is having on health care, pay is an important factor to retaining staff.

At Taylor Community, staff turnover was in the range of 50% five to six years ago, according to Michael Flaherty, president and CEO of the retirement community, which has 35 residents in skilled-nursing care among the more than 400 residents in its three campuses in Laconia and Wolfeboro. That turnover is now down to 15%.

Flaherty would not give specifics about what Taylor pays, but said, “We’re toward the higher end of the wage scale, but not the highest.” Recently Taylor raised its minimum wage to $15 an hour.

But like other facilities, it has openings for nurses — nursing aides, licensed practical nurses, and registered nurses. It has not chosen to employ traveling nurses, Flaherty said.

The Belknap County Home has struggled to ride out the shortage by having staff work back-to-back shifts. In recent months they have in addition turned to offering pay incentives to get employees to work the long hours, or take shifts on nights, weekends, or holidays.

Williams said the Belknap County Home finds itself in its present predicament because of a failure to keep pace, pay-wise, with what similar facilities offer.

“It’s suffered from years of funding neglect,” he said, stressing he was not criticizing the facility itself. “This was already a disadvantage before this pandemic.”

Richardson has said members of the nursing staff often work 60 to 70 hours a week and are going to extraordinary lengths to maintain the quality of care for residents.

“I knew it was bleak,” Richardson told the county commissioners recently. “But I didn’t realize it was this bleak.”

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