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As COVID surges, New Hampshire's health care system is left shaken

photo of empty nursing home bed
Maplewood Nursing Home

Construction took longer than expected, but workers are now finally finishing the newly-renovated Maplewood Nursing Home, a county-run facility in Westmoreland.

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But rather than accepting patients from a waiting list that runs more than two-dozen names deep, the recently spruced up Maplewood is doing the opposite: A shortage of workers, from nurses to janitors to food service, forced Maplewood to shut down a portion of its building. Despite having the space to care for 150 patients, just 95 currently live there.

“We made the horrible, difficult decision that it was time to close a whole floor,” Kathryn Kindopp, the nursing home’s top administrator since 2007, said.

Health care officials in New Hampshire, from critical access hospitals to safety net nursing homes, have long warned of a looming shortage of workers needed to take care of an aging population. Now, as COVID-19 cases and hospitalizations surge to their highest level ever in the state, the workforce issue is at a breaking point.

This week, the state approved spending millions of federal dollars to bring in temporary medical personnel from out of state. FEMA is sending dozens of emergency response workers to bolster some facilities, and on Wednesday, Gov. Chris Sununu announcedhe would call up members of the New Hampshire National Guard to assist health care providers. The governor also said he anticipates the spike to go on for at least a few more weeks.

The surge in COVID-19 patients at hospitals — more than 460 people as of Thursday — combined with the lack of workforce at some nursing homes, is creating a bottleneck. Patients who are ready to be discharged but can’t yet go home are languishing inside hospitals while they wait for a room to open at a long-term care facility or skilled rehabilitation center. Delays in processing Medicaid applications for some of these patients further compounds the problem.

On Wednesday, DHHS Commissioner Lori Shibinette told the Executive Council there are approximately 30-50 hospitalized patients stuck in this limbo at the moment, during which time they are occupying beds needed for newly arriving COVID-19 and other critical patients.

empty dining area
Courtesy of Maplewood Nursing Home
Despite a recent renovation, Maplewood recently closed an entire floor of its building due to staffing limitations.

“Right now, we just need to get people out of the hospital and into long-term care facilities or assisted living or wherever they need to go, so that we have beds for our critical care patients,” Shibinette said.

The council voted to spend nearly $90 million in federal funds, with some of that money going to long-term care facilities and ambulatory surgical centers that have space and the workforce available for new patients. Another $6 million will be spent on temporarily hiring 32 -35 traveling nurses from out of state, who will be assigned to long-term care facilities.

“They did the same thing in the southern states when they had the surge there,” Dr. Jonathan Ballard, chief medical officer for the state health department, said before the vote. “And a lot of the staff members that may be coming to the northern part of the country are coming off their 13-week assignments in the southern part of the country.”

But a few dozen temporary nursing professionals, at a cost of $200-300 per hour, won’t fill the gaping holes in the state’s health care workforce. Dartmouth-Hitchcock, the largest health care system in the state, is currently advertising 1,129 job openings, including 500 nursing and nursing assistant posts, and more than 100 physician vacancies.

“This is having a huge physical and emotional toll on our staff. From our custodial staff through our nursing staff, our surgeons, and leadership,” Dr. Edward J. Merrens, chief clinical officer Dartmouth-Hitchcock Health said this week. “This is a preventable crisis.”

Regulatory officials are working to expedite licensing requests for nurses seeking credentials. In response to a recently signed executive order by Sununu, the Office of Professional Licensure and Certification has reached out to more than 750 people who have submitted applications in the past six months, but for a variety of reasons, have not completed all necessary paperwork.

In addition, the Board of Nursing recently passed an emergency rule that will allow applicants to begin working once they have an FBI fingerprint appointment scheduled, rather than waiting for the background check to be completed.

Lindsey Courtney, the Office of Professional Licensure and Certification’s executive director, said her office is able to process a completed application in less than 24 hours.

“We’re going to do what we can in order to speed up the process, to get people through the door, make sure that they are qualified,” Courtney said. “But I don’t think licensing is going to solve the workforce problem.”

The workforce problem doesn’t appear to be due to a lack of interest in health fields. The University of New Hampshire has seen its enrollment in nursing programs double in size during the past decade, with 540 students currently enrolled.

The challenge, according to Dr. Gene Harkless, the department’s chair of nursing and a family nurse practitioner, is that after nearly two years of a pandemic, seasoned health care workers are burning out.

“I am so grateful for every nurse that is still on the line and working hard,” Harkless said. “But I really want them to take care of themselves and make sure that they can continue to care for others.”

Early retirements, health care professionals leaving the field, or others forced to stop working because of a lack of childcare, have left the vacancy rate for the overnight shift at Maplewood Nursing Home at around 70 percent. Kindopp, the facility’s administrator, said she’s now scrambling to hire from the same limited pool of traveling nurses that every other hospital and long-term care center are also chasing.

Kindopp said the Biden administration’s vaccine mandate, which has been temporarily halted by a federal court, also prompted several employees at her facility to quit.

The result of this staffing shortage is more than 50 open beds at Maplewood, and managers, including top administrator Kindopp, picking up shifts in other departments. At 5 o'clock, Kindopp said she was headed to the facility’s kitchen.

“I will either be scrubbing pots and pans or disinfecting the surfaces we prepare the food on. And mopping, yes. All that.”

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.
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