The COVID-19 pandemic affected some areas of the population much more than others. Residents and staff at long-term care facilities were among those most affected by the virus and the resulting pandemic. A report in The New York Times revealed that, while people associated with skilled nursing facilities accounted for 4% of coronavirus cases, they accounted for nearly one-third of all COVID-19-related deaths.
Fortunately, the tide seems to be turning for long-term care facilities affected by the pandemic. The improvement can be linked to the vaccine rollout and to several aid programs designed to help facilities improve their staffing and increase protection against the virus. Learn more about the best stimulus investments for businesses affected by the pandemic and how your facility can take advantage of any available relief funding.
How COVID-19 Affected Long-Term Care Facilities
While not much was initially known about the novel coronavirus, one thing became evident almost right away: people who had chronic medical conditions, such as diabetes, heart disease and respiratory disease, had a higher risk of developing complications if they got infected. Older people were also more likely to have complications or more challenging cases of COVID-19. Older adults and people with chronic conditions are more common at long-term care facilities, leading to higher rates of death and severe illness.
Other factors also influenced the spread of COVID-19 at long-term care facilities and made the communities hot boxes for the virus:
- Understaffing: Even before the pandemic, understaffing was an issue at many long-term care facilities. In 2018, a report on PBS noted that many facilities had less staff than they reported. When a senior living facility doesn't have an adequate number of people working during a shift, it's more likely that residents won't get the care and attention they need.
- Close contact: Another factor that increased COVID-19 risk for people living and working at long-term care facilities is close contact. One of the first rules of the pandemic is to social distance, keeping at least 6 feet apart from others. At many long-term care facilities, maintaining 6 feet of space between others can be challenging, particularly for residents who need close attention from nursing staff. When residents share living quarters, social distancing is also difficult.
- Residents traveling from one location to another: While many residents at skilled nursing facilities stay there full-time, some occasionally need to travel to other places, such as a local hospital. Having residents return to a long-term care facility from a hospital in the midst of the pandemic increased the risk of exposure for other residents.
- Staff working at multiple places: Many people who work at long-term care facilities don't work at any one facility full-time. Instead, it's common for people to put together a patchwork of part-time jobs, spending a few days a week at one facility and other days at a different facility. Even during non-pandemic times, having staff who hop from one residence to another can increase the spread of infection. During the pandemic, employees who worked at multiple places amplified the risk and spread of the virus.
- Lack of personal protective equipment (PPE): During the early weeks and months of the pandemic, PPE shortages were common. Long-term care facilities had difficultly obtaining N95 masks, vinyl gloves and gowns to protect their employees throughout the pandemic. PPE shortages have persisted, with one out of nine skilled nursing facilities reporting a shortage in March 2021.
Staffing Issues at Long-Term Care Facilities During the COVID-19 Pandemic
Long-term care facilities experienced a range of staffing issues during the pandemic. In some instances, the issues were present before the pandemic began and were exacerbated by the situation. Some of the challenges facilities faced that contributed to the spread of the virus and the higher fatality rate included staffing shortages, limited resources and inadequate training.
There seems to be a direct connection between staffing rate and the spread of COVID-19 at long-term care facilities. One study of senior living facilities in Connecticut found that the fatality rate from COVID-19 dropped by 26% for every 20-minute increase in staffing of registered nurses. Additional studies found that the mortality rate decreased when a facility had more nursing and nursing aide hours.
One factor that contributed to staffing shortages during the pandemic was that many registered nurses found better-paying jobs at hospitals. Many hospitals pay higher salaries and offer nurses attractive signing bonuses.
Strict licensing standards also impeded staffing at many long-term care facilities. Traditionally, nurses and nurses aides need to pass credentialing exams to gain licensure and find employment. Credentialed nurses need to complete continuing education programs to maintain their licenses. Although licensing and credentialing standards are usually positive, they proved to be an impediment in a time of crisis.
PPE and other resources were in high demand and short supply, particularly at the start of the pandemic. Initially, some employees at long-term care facilities were concerned about returning home after working, potentially exposing family or roommates to the virus. Some staff members had difficulty obtaining childcare, as many daycare facilities shut down in the early weeks of the pandemic.
Many facilities struggled to obtain appropriate amounts of PPE and testing supplies to monitor for the virus.
At the start of the pandemic, some staff at long-term care facilities weren't adequately training on the best practices for reducing the spread of infection and keeping the virus under control. In some cases, the lack of training was due to a lack of general knowledge about the new virus. People weren't initially sure how it spread or how best to limit its spread.
COVID-19 Relief Bills and Their Impact on Long-Term Care Facilities
Throughout the pandemic, the U.S. government has introduced and passed several relief bills. The bills aim to protect the economy and offer aid and support to governments, businesses and individuals who need it most. Several of the relief bills included aid for long-term care facilities. The aid was intended to help facilities retain their staff and otherwise invest in their businesses to keep operations running.
CARES Act Paycheck Protection Program
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law in late March 2020. The Act introduced the Paycheck Protection Program (PPP), a forgivable loan that aimed to help small businesses cover their payroll and keep employees on staff during the shutdown. The first loans under the program were issued in early April 2020. Later relief bills extended the PPP, making loans available to eligible businesses through May 2021.
Only specific types of businesses are eligible for the PPP. People who are self-employed or are sole proprietors qualify, as do businesses that meet the size standards established by the Small Business Administration (SBA). Non-profits and certain other types of businesses can also qualify for a PPP loan if they have more than 500 employees.
A business can use the money it receives under the PPP for:
- Mortgage interest
- Cost of uninsured property damage resulting from vandalism or looting in 2020
- Worker protection costs due to COVID-19
- Particular operating expenses and supplier costs
The interest rate on PPP loans is 1%, and loans issued before June 2020 mature in two years. Loans issued after June 2020 mature after five years. Forgiveness is available if a business spent at least 60% of the loan on payroll costs.
CARES Act Provider Relief Fund
The CARES Act also established the CARES Act Provider Relief Fund. While the PPP was targeted at small businesses, the CARES Act Provider Relief Fund is intended for organizations that provide healthcare, support and services. Long-term care facilities often qualify as providers and can receive funding from the CARES Act Provider Relief Fund. Unlike the PPP, money received from the CARES Act Provider Relief Fund isn't a loan and doesn't need to be repaid or forgiven.
The main criteria a provider needs to meet to be eligible for the CARES Act Provider Relief Fund are being a state-licensed or certified long-term care facility or billing Medicare for health-related services between 2018 and 2020.
Additionally, a provider will need to have offered care to patients after the end of January 2020 and will need to have filed a tax return for 2017, 2018 or 2019, if it was in business before 2020. If operations began after January 2020, the provider would need to have filed quarterly tax returns for 2020.
Money received under the CARES Act Provider Relief Fund needs to be used to help a facility prevent, respond to or prepare for the coronavirus. The money can make up for any revenue lost due to the virus.
American Rescue Plan Employee Retention Credit
The American Rescue Plan (ARP) was signed into law in 2021, offering another $1.9 trillion in aid. The ARP included funding for local governments, direct payments to individuals and an employee retention credit for businesses.
The employee retention credit included in the ARP is an extension of a credit first included in the CARES Act. With the extension, the credit is now available through December 2021. It allows employers to offset employee costs by up to $28,000 per year, or $7,000 per quarter. It's a tax credit against payroll taxes. To qualify for the credit, your business will need to have had a drop in revenue due to the pandemic.
Is More Aid Coming?
While it's not clear if an additional relief bill will be passed, there is demand for more aid from many long-term care facilities. At the end of April 2021, U.S. lawmakers requested that the $23 billion remaining in the CARES Act Provider Relief Fund get distributed to facilities that need it most. How quickly the money gets distributed remains to be seen.
What Long-Term Care Facilities Can Do
If your facility received relief funding under the CARES Act or American Rescue Plan, you can use the money to help keep your facility afloat and protect residents and staff. Some ways to invest the business relief include:
Reduce Staffing Shortages
Your facility can use money received as part of a PPP loan to cover the cost of payroll and to increase the wages you offer nurses and other trained staff. Higher wages make working at a long-term care facility more attractive to nurses, potentially encouraging them to return from hospital jobs. Offering other forms of assistance, such as help with transportation and childcare, can also help to reduce staffing shortages during and after the pandemic.
Introducing software that makes it easier for employees to request time off or keep track of their paystubs can lead to higher rates of employee engagement, improving employee retention and reducing shortages.
Improve the Hiring Process
Making the right hire from the beginning can help improve your facility's retention rate and ensure that you always have the staff you need on the clock when you need them. Investing in an applicant tracking system is one of the best ways for businesses to use their government relief funds. These systems let you easily screen candidates, interview the most qualified and hire the best for the position. The software lets you schedule interviews and conduct video interviews.
Offer Support to Staff
Beyond increasing wages and hiring the right people from the start, your long-term care facility can improve operations, keep staffing levels up and protect residents by providing staff with the support they need. Some ways to do that include:
- Offer more paid sick time: When staff members don't feel well, they should be encouraged to stay home. Introducing more paid sick time incentivizes staying home, potentially saving the lives of residents.
- Increasing childcare options: Staff who have trouble finding childcare are more likely to call out or arrive late to work. Providing childcare on-site or otherwise subsidizing childcare for your employees will help reduce call-outs and improve the quality of your facility.
- Providing adequate PPE: PPE shortages persist, so a facility that can provide its staff with the right amount of protective gear will be a more attractive place to work than a facility that doesn't offer adequate protection.
- Encouraging vaccinations: Healthcare personnel and residents of long-term care facilities were among the first to get offered COVID-19 vaccines. As the supply of the vaccine has outstripped demand in the U.S., it has become even more critical to encourage people to get vaccinated. Medicare will soon make reporting vaccinations a requirement for long-term care facilities.
Request a Demo of SmartLinx
Keeping track of your employees and staffing needs will help your senior living facility weather the remaining pandemic and prepare it for future crises and emergencies. SmartLinx offers workforce management solutions designed with the needs of long-term care communities in mind. To see how our software can help you streamline the hiring process, improve employee engagement and reduce labor costs, request a free demo today.