Some South Jersey nursing homes dealing with decreases in staff due to COVID-19

GALLOWAY TOWNSHIP — Rita Trotter, a certified nursing assistant, misses the co-workers she used to see at the Simon & Sylvia Zisman Seashore Gardens Living Center before the COVID-19 pandemic.

Trotter, 51, has been employed at Seashore Gardens for nearly 22 years.

She works the 7 a.m. to 3 p.m. shift and helps residents with showering in the morning and eating breakfast. She talks with residents and keeps their spirits up. She had more fun when there were more co-workers around.

“The change is not good,” said Trotter, of Mays Landing. “There is less excitement.”

Even before the pandemic, thin staffing was a hallmark of nursing homes around the country.

Now, staffing is even thinner, with about one-third of nursing homes in the United States reporting fewer nurses and aides than before the pandemic, an Associated Press analysis of federal data found.

The American Health Care Association, which lobbies for care facilities, said 99% of nursing homes and 96% of assisted-living facilities reported staffing shortages in a September survey.

The skilled nursing industry across the country, including Genesis HealthCare-affiliated facilities in South Jersey, has faced health care worker staffing challenges since before the pandemic, said Lori Mayer, a Genesis spokesperson.

Genesis offers assisted and senior living and long-term care in nearly 400 centers across the country, including the Southern Ocean Center in Manahawkin, the Millville Center in Millville and Genesis-affiliated centers in Cape May County.

“In some cases, facilities have had to shut down units or hold admissions due to staffing shortages in skilled health care workers,” Mayer said in a statement.

Cape May County’s long-term care facility, the Crest Haven Nursing and Rehabilitation Center in Cape May Court House, also is feeling the effects of the pandemic on staffing, said Diane Wieland, a spokesperson for the county.

“Similar to what is happening nationwide, they have experienced some staffing issues and continue to address those issues,” Wieland said, adding a new director of nursing starts this month.

In the midst of these difficulties, nursing homes are trying a variety of things to entice workers and boost staffing.

The Hammonton Center for Rehabilitation and Nursing offers bonus days to its staff personnel who would have otherwise had the day off, but now can come to work and fill any gaps needed for extra pay, said Jeffrey Jacomowitz, director of corporate communications for Centers Health Care.

“It is common also for nurses to work double shifts, but with that said, Centers Health Care facilities continuously work to avoid the scenario. Generally speaking, nursing homes, who have been through a staffing shortage due to a number of reasons, mostly associated with COVID-19, will have a direct effect on patient care,” Jacomowitz said in a statement.

The state dictates the number of certified nursing assistants, or CNAs, in a nursing home that should be working during each eight-hour shift, said Martin H. Klein, president and CEO of Seashore Gardens.

Seashore Gardens is an independent, nonprofit facility licensed as both a home for the aged and for assisted living. It offers a range of services from assisted living to short- and long-term nursing care, Alzheimer’s care, respite care and rehabilitation.

The ratios are one certified nursing assistant for every eight residents for the 7 a.m. to 3 p.m. shift, one CNA for every 10 residents for the 3 to 11 p.m. shift and one CNA for every 14 residents for the 11 p.m. to 7 a.m. shift, Klein said.

The lack of CNAs during a shift can result in longer wait times when residents call for help, Klein said.

“Not too many people want to go into the field,” Klein said of CNAs. “The day shift has been a challenge for us.”

Along with problems hiring, Seashore Gardens has fewer residents than prior to when the pandemic started. Before the pandemic, occupancy was between 91% and 94%, Klein said. Currently, occupancy is between 80% and 82%.

Other facilities also may have experienced a decrease in residents, Klein said.

The American Health Care Association and the National Center for Assisted Living created an eight-hour course to recruit and train temporary nurse aides to help providers during the pandemic.

Temporary nurse aides can assist with things such as helping residents in the dining room, Klein said.

As the pandemic initially spread in New Jersey, the difficulty of attracting and keeping nurses and nurse’s aides in nursing homes increased. Some workers fled over fears of exposure to the virus. Others were lured to less stressful work at similar or higher pay in stores and restaurants. Some were laid off by homes as occupancy fell.

Trotter said it takes more than money to make a career as a CNA.

“It’s really tough. I have seen aides and CNAs that go above and beyond,” she said. “It’s physically and mentally straining.”

One of the keys to being a successful nurse or CNA is the ability to deal with a variety of personality types, Trotter said.

“It depends on your approach. I’ve dealt with the toughest and made them smile,” Trotter said. “You have to know how to talk. You don’t take anything to heart.”

South Jersey nursing homes are trying to hold onto their existing staff and recruit new nurses and CNAs despite the obstacles.

The Hammonton Center has always aggressively recruited staff, Jacomowitz said.

“In addition, from time to time, leadership at Hammonton Center incentivizes the staff through bonuses to pick up extra shifts as well as contracts out with nurse staffing agencies to ensure that our staffing levels remain sufficient enough to provide essential care for our residents,” Jacomowitz said.

The state could help more with the shortages of CNAs in nursing homes by loosening regulations, Klein said. For instance, neither a licensed practical nurse nor a registered nurse can fill in for a CNA during a day shift, Klein said.

In August, the state started requiring long-term care facilities to hire either a part-time or a full-time infection preventionist, a managerial employee, depending on how many beds the facility has.

The responsibilities of an infection preventionist, who reports directly to the administrator, include assessing the facility’s infection prevention and control program by conducting internal quality improvement audits and training all employees in infection prevention.

Every time a resident has a change of condition, a required form for which used to be two pages has grown to a 56 pages of information, and the condition of a very frail person can change from one hour to the next, Klein said.

There needs to be a broad campaign to interest more people in the CNA field that starts at the high school level, said Alysia Price, Seashore Gardens’ executive director.

The government also has to pay more of the actual costs to cover the expenses of people on Medicaid who are in nursing homes, Klein said.

The state has taken some steps to address the nursing home staff shortage.

Gov. Phil Murphy signed legislation requiring direct care workers in long-term care facilities be maintained at $3 above the state’s prevailing minimum wage, Dawn Thomas, a spokesperson for the state Department of Health, said in a statement.

“Additionally, several waivers were issued during the public health emergency that are still in effect that provide flexibility to nursing home administrators to hire certified nursing aides (CNA) in-training, allow for certified homemaker home health aides (CHHAs) to perform CNA duties, and to expand the scope of medication technician,” Thomas said.

The Associated Press contributed to this report.