US National Guard soldiers empty bedpans and clip toenails to ease nursing home's staff shortage

NEW HOPE, MINNESOTA (NYTIMES) - Private Shina Vang and his fellow soldiers in the Minnesota National Guard have had an exceptionally busy year. They helped process Afghan refugees fleeing Kabul for the United States, provided security at US military bases across the Horn of Africa and stood sentinel in Washington following the Jan 6 attacks on the US Capitol.

Closer to home, they have been deployed across Minnesota during the civil unrest prompted by the police killings of Mr George Floyd in Minneapolis and Mr Daunte Wright in nearby Brooklyn Centre.

But none of those experiences prepared Private Vang and his fellow Guard members for their latest deployment: collecting bedpans, clipping toenails and feeding residents at North Ridge Health and Rehab, a sprawling nursing home in suburban Minneapolis that is the largest in the state.

"I've had protesters throw apples and water bottles at me, but that doesn't compare with the challenge of giving someone a bed bath," he said.

Over the past two weeks, 30 Guard members have been working as certified nursing assistants at North Ridge, which has been so badly hobbled by an exodus of employees that administrators have been forced to mothball entire wings, severely limiting new admissions.

As a result, hospitals cannot send patients to long-term care centres such as North Ridge, creating a backlog that is eroding Minnesota's capacity to treat people with Covid-19 and other medical emergencies.

Similar backlogs - hospital patients well enough to be discharged but too fragile to go home - are choking health systems across the country.

"It's beyond a crisis," said Ms Katie Smith Sloan, president of LeadingAge, an association of non-profit long-term care facilities. "For many providers across the country, it's a collapse."

On Tuesday, President Joe Biden announced that 1,000 military medical professionals would be dispatched to hospitals across the country this winter to help overwhelmed doctors and nurses.

Public health experts fear the worst is yet to come as the highly transmissible Omicron variant spreads to communities where healthcare workers are already straining to handle the surge of patients sickened by Delta.

Maine, New Hampshire, Indiana and New York have deployed the National Guard to overburdened hospitals and nursing homes in recent weeks, but Minnesota's initiative may be the most ambitious, with 400 guard members who have no previous nursing experience going through rapid-fire training before being sent to long-term care facilities across the state.

Last week, chief executives from nine of the state's largest hospital networks took out advertisements in Minnesota newspapers beseeching residents to get vaccinated and take other steps to limit transmission of the coronavirus. "We're overwhelmed," the ads said.

Governor Tim Walz, a Democrat and National Guard veteran whose mother was a nursing assistant, said he conceived of the programme as a stop-gap measure.

"Our healthcare workforce is heartbroken and fatigued," Mr Walz said in an interview on Tuesday, not long after learning that he and his wife and son had tested positive for the coronavirus. "Having the Guard provide a bit of a respite is a godsend, but just to be clear, looking to the horizon, we don't see an end to the surge right now."

Staffing shortages have long been a problem for nursing homes in the US, but the coronavirus has pushed many to the brink as low-wage aides retire early or quit for jobs that are better paid and less taxing.

"The pandemic has underscored the system's fragility and the need for fundamental change," said Dr R. Tamara Konetzka, an expert at the University of Chicago in the economics of long-term care.

In Minnesota, that means 23,000 nursing home positions were unfilled in October, up from 8,000 in March, according to a survey of providers.

North Ridge has been hit especially hard by the pandemic, with more than 592 cases and 52 Covid-19 deaths among its residents since March 2020, according to the Centres for Medicare and Medicaid Services, although the vast majority of those cases - 472 - were among patients already sickened by Covid-19 when they arrived.

Over the past four years, North Ridge has been fined more than US$180,000 (S$246,000) by federal inspectors and cited for a number of health and safety violations. It has received two out of five stars for overall care from CMS, a "below average" rating.

Mr Austin Blilie, vice-president of operations, said that the two-star rating was based on surveys from 2018 and that North Ridge had greatly improved the quality of care since then.

He noted that the most recent rating from earlier this year gave the facility five stars for staffing quality. The 8.5 per cent mortality rate for Covid-19 patients at North Ridge, he added, was less than half the state average for patients in congregate care settings.

"Every time I look at the numbers of those who we lost, I am struck anew by the fact that every one represents an individual person, with a life and a history and connections to other people," he said. "Please know that we never lose sight of that here."

A low-slung collection of brown-and-tan brick buildings, North Ridge has 320 beds, but 100 of those are empty at the moment because of staff shortages.

The employees who remain have been running ragged as they work overtime, and on some days, administrators, dietitians and physical therapists are forced to help with making beds and filling water pitchers.

"We do what we can because the show must go on," said Ms Liz Ellenz, 37, director of dining, who often works weekends and stays until 9pm washing dishes. "Some days are really dark."

But last Thursday, Ms Ellenz was positively giddy as five Guard members zipped around the kitchen with soldierly purpose and precision. They hosed down food carts, bagged trash and helped prepare the day's lunch: ham and macaroni au gratin, stir-fried snow peas and citrus gelatin cubes.

One of them, Staff Sergeant Nathan Madden, 47, whose civilian job is an assistant manager at a home improvement store, said the past two weeks had given him a newfound appreciation for those who care for the sick and the elderly.

His past deployments have taken him to Kuwait, Croatia and, more recently, the Minneapolis courthouse where Derek Chauvin was on trial for Mr Floyd's murder.

"This kind of work is humbling for sure," Mr Madden said, adjusting the hairnet on his head. "It's great to help out in the community, but I have older parents, so in a way, this is preparing me for what I might have to do one day."

Certified nursing assistants, the workhorses of long-term care facilities, normally go through five weeks of training before taking final exams, but nursing school leaders condensed the programme to eight 10-hour days.

"It feels like we're supporting a natural disaster," said Ms Traci Krause, director of nursing at Minneapolis Community & Technical College, as a group of students practised pulse taking and face washing on bed-bound mannequins.

Besides gestures such as providing free pizzas and ice cream, there is not much North Ridge's administrators can do to stem the exodus of staff members; the number of employees at the nursing home has dropped to 450 from 590 since the start of the pandemic.

Although burnout and fears of infection have spurred some nursing assistants to quit, the root of the problem is money, employees and administrator said.

North Ridge and other long-term care facilities in Minnesota that serve mostly patients on Medicaid pay around US$16 (S$22) an hour for newly hired nursing assistants.

That is comparable with what some fast food outlets in and around New Hope have been offering. Kitchen staff at North Ridge are paid even less: US$11.25 an hour.

Such low wages are essentially tied to the state's reimbursement rate for nursing home patients, which averages about US$270 a day, according to the Minnesota Department of Human Services.

Efforts by Mr Walz to raise reimbursement rates have stalled in the state's politically divided Legislature, as has his push to use some of the US$1.2 billion in unspent Recovery Act funds on bonuses and raises for nursing aides.

Ms Fatimate Massquoi, a nursing manager at North Ridge, said meagre pay coupled with the physical demands of the job, the anxieties of treating Covid-19 patients and the unending loss inevitably take a toll.

"People don't know what it's like to hold the hand of someone dying alone because their family isn't allowed to be here," she said. "Sometimes after a patient dies, I have to go into the bathroom to cry so no one will see me because I have to stay tough."

With Omicron racing across the country, staff and administrators worry about the weeks ahead.

Only 60 per cent of residents have received their booster shots, slightly higher than the national average, and a federal appeals court ruling last week means that North Ridge may have to fire the 10 per cent of employees who remain unvaccinated.

But last Thursday, Ms Massquoi and her colleagues were feeling buoyant after learning that the National Guard would be staying an extra week, including 18 soldiers who had volunteered to work over the Christmas holiday. Having extra hands available does not mean North Ridge can increase its number of admissions, but it does allow exhausted workers to take a few days off.

"The Guard has really given us the opportunity to take a breather and allow people to spend time with their families and try to deal with the emotional burnout of the last 18 months," said Mr Blilie, vice-president of operations. "Hopefully, they'll come back feeling a bit refreshed and ready to go back at it."