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Thomas D. Elias: Nursing homes face a new life-or-death crisis

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The COVID-19 crisis is over at California’s hundreds of nursing homes. Or is it?

Like nursing homes around the nation, this state’s skilled nursing facilities and the somewhat similar assisted living homes were the state’s most tragic dying grounds during the height of the pandemic.

They accounted for almost 48 percent of COVID deaths here and elsewhere, yet their residents make up just a small fraction of the overall populace. The advanced age of most nursing home residents put them at more risk from the virus than younger people and tens of thousands of them died at alarming rates.

But that’s largely over. The advent of vaccines from companies including Pfizer, Moderna and Johnson & Johnson and the government’s prioritizing immunizations for the elderly has cut the COVID-related death rate among nursing home denizens by 96 percent.

That did not relieve the other, ongoing crises still taking their toll in nursing homes and related facilities.

Visitation is still limited there (and in virtually all hospitals) to one guest per day in most locations. For many nursing home residents, this means seeing their grandchildren or their remaining friends either through ground-floor windows or electronic services like Skype or Facetime — a recipe for extreme loneliness and disorientation that has prevailed since Day 1 of the COVID lockdowns.

Plainly, the lack of visitation (almost absolutely banned through the worst of the pandemic) did not keep death out of the homes. While guests did not affect the residents, infected and contagious staff members did.

So it became urgent to hire solid staff willing to get vaccinated and maintain lifestyles featuring masking and social distancing. But the pay for these staffers — many of them compelled to work multiple jobs — did not rise appreciably.

A worker shortage results. Like many other businesses, nursing homes now find themselves short of help.

A national survey of more than 700 members of the American Health Care Assn. (AHCA) and the National Center for Assisted Living, trade groups for the homes, found that 94 percent of nursing homes have had a staffing shortage during the last month, with 81 percent of assisted living communities reporting the same.

Jobs are going begging. But for the most part, these are not extremely high-paying posts. That’s in part because the homes try to maintain healthy profit margins and in part because most homes cater to Medi-Cal or Medicaid patients, for whom payments lag far behind what most home-care companies or luxury retirement homes charge.

The AHCA says payments from those government-run programs cover just 70 percent to 80 percent of the actual cost of care.

As a result, most homes are short-staffed. For residents who are not ambulatory, this can mean multiple consecutive entire days spent in bed, often with no visitors and minimal outside human contact. That’s because staffers frequently are too overworked to do the hard physical labor of helping people out of their beds and into wheelchairs or getting them to seating in lobbies.

Says the AHCA, “Without a fully-funded Medicaid program (Medi-Cal is the California version of Medicaid), providers will continue to struggle to become competitive employers.”

That’s especially true in a dog-eat-dog labor market with hundreds of thousands of easier jobs available, from store clerks to Uber drivers.

As solutions, the AHCA recommends loan forgiveness for new college graduates who work in long-term care, tax credits for licensed nursing personnel in the homes, childcare assistance, and affordable housing for nursing home workers.

That’s a menu not among the highest priorities today in either Sacramento or Washington, D.C.

But lawmakers should make these kinds of incentives just as high a priority as they made getting nursing home residents vaccinated last winter when large cadres of health care workers were sent into the homes to administer shots.

If at least some of these tactics are not deployed, and soon, untold tens of thousands of nursing home residents will be doomed to unnecessarily dreary, lonely lives in a long-lasting but little-publicized side-effect of the pandemic.

Washington State fired football coach Nick Rolovich and four of his assistants on Monday for refusing a state mandate that all employees get vaccinated against COVID-19, making him the first major college coach to lose his job over vaccination status.Washington Gov. Jay Inslee, a Democrat, had set a deadline of Monday for thousands of state employees, including the Cougars coach, to be vaccinated. Rolovich applied for a religious exemption, which was denied Monday, Washington State athletic director Pat Chun said.Defensive coordinator Jake Dickert will be elevated to acting coach and his first game in charge will be Saturday at home against BYU.Also fired for refusing vaccination were assistant coaches Ricky Logo, John Richardson, Craig Stutzmann and Mark Weber. Chun said there may be no precedent for a team losing its head coach and so many assistants in the middle of a season.SEE MORE: Brooklyn Nets Won't Play Kyrie Irving Due To Vaccination RequirementThe 42-year-old Rolovich was the highest-paid state employee with an annual salary of more than $3 million in a contract that runs through 2025. He had said he wouldn't get vaccinated but wouldn't specify his reasons. He was the only unvaccinated head coach in the Pac-12 and had worn a mask during games.Rolovich was fired for cause, which means the university does not have to honor the rest of his contract, although lawsuits over the decision are likely. The Washington State athletic department is currently facing a shortfall of more than $30 million.Additional reporting by The Associated Press.

Thomas D. Elias writes the syndicated California Focus column. He is author of the book, “The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It.”

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