N.H.'s Long-Term Care Facilities Understaffed, Lack PPE
In a press conference Wednesday, April 1, state officials reported they are monitoring a handful of long-term care facilities in New Hampshire for clusters of COVID-19. Around the country, long-term care facilities have been some of the hardest hit by this virus due to communal living and high populations of people over the age of 65 with chronic medical conditions.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association. He spoke with NHPR’s Peter Biello on Thursday about what the state’s long-term care facilities are doing to prepare for a potential outbreak of COVID-19.
Editor’s note: This transcript has been lightly edited for clarity.
So can you tell us a little bit more about this "handful" of facilities the state is monitoring for clusters of COVID-19? How many facilities are we dealing with and where are they in the state?
I don't know which facilities in particular the state was making reference to beyond a couple of facilities. I know one in Manchester, and then obviously I know of the Crotched Mountain case, but I'm not sure. I'm as in the dark, I would say, as the general public as to where the other facilities might be.
And the state has declined to identify those as well. Do you think the state should be more transparent, given it's a matter of public health?
You know, that's really a decision for the state to make. I've talked with the state epidemiologist and we've kept in close contact with them and have facilitated webinars between them and between long-term care providers. You know, I think some states have chosen to, as we've seen in news reports, make that information available. New Hampshire has gone a different route. I don't know what the best approach is, frankly. I think that the only approach that we can guarantee is that facilities notify family members and residents and staff any time that there's an outbreak within the facility.
Aside from the monitoring of those places that may have clusters overall, what are the biggest challenges long-term care facilities are facing right now in the age of COVID-19?
Well, I think staffing is a huge issue. Staffing was a huge issue for us even prior to this. It was really hard to find licensed nursing assistants because the economy was robust while our Medicaid reimbursement for the roughly 63 percent of nursing home residents who are on Medicaid was extremely poor. And so if you're caring for the poor here in New Hampshire, it can make you poor. And so it's pretty appalling. I think that... you know, you have a front line workforce that's 92 percent women, the nursing assistants, who are being forced into poverty by Medicaid reimbursement. And now with the COVID-19 pandemic, a lot of those nursing assistants are moms who want to be at home with their kids, who are worried about their own health. And so we're going to need to see our state take some of the measures that other states have with respect to increased reimbursement to cover extra wage costs for those workers.
Another thing we keep hearing about is the lack of personal protective equipment, PPE. This conversation has been mainly focused on hospitals. Does it apply to New Hampshire's long-term care facilities? Do those places have enough PPE themselves?
No, we don't. And we have set up a dedicated website, which is protectcaregivers.com. And we've run ads encouraging people to donate personal protective equipment to facilities that need it. You know, we need N-95 masks. We need regular masks. We need isolation gowns. We need hand sanitizer. I've tried to work within the list of resources that the state has identified as to vendors to try to find connections for our members. There is, for example, a salon products supplier in Derry called Evolve that switched over from making shampoo to making sanitizer. And I'm aware of a number of facilities that placed orders through Evolve. So it requires a certain level of ingenuity. It's really hard to get the masks, as you know, for states and localities all competing with one another. We don't have the luxury here of having the New England Patriots owner truck in a bunch of masks to supply nursing homes. So we're kind of on our own.
Long-term care facilities are being told to prepare to take on more patients discharged from hospitals so that hospitals can free up beds if there's a surge in critical cases of people with COVID-19. Has this process started yet here in New Hampshire?
It has. I have been identifying for the state and the Hospital Association nursing homes that are able to take patients in. Some facilities are artificially constrained already because they've set aside beds for eventual isolation needs. And so they're just simply not running at full capacity in terms of their ability to take in admissions. We consider the hospitals to be our partners in health care, and so we're trying to do everything we can within reason to ease the burdens upon the hospital system.
(Do you or a loved one reside in a long-term care facility? Are you a healthcare worker or another support professional in this setting? NHPR wants to hear you've been affected by COVID-19. Please consider sharing your thoughts here. We will not publish your response without your permission.)