Hidden Heroes: Staff In Long-Term Care Facilities Fight An Uphill Battle During COVID-19

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Hidden Heroes: Staff In Long-Term Care Facilities Fight An Uphill Battle During COVID-19

May 26, 2020

Staff in long-term care (LTC) facilities have experienced uneven and possibly unfair coverage during the COVID-19 pandemic. While much of the media has rightfully praised clinical staff in the acute care settings, the risk, conditions and sacrifices of workers in this setting have been under-reported. Staff in skilled nursing facilities (SNF), assisted living (ALF) and home health (HH) have embraced the challenge of working in settings that offer limited resources and a higher risk of infection and lower-wage roles.

Data from KFF.org and the CDC illustrate the reality facing-long term care facilities and its workers. It is estimated that long-term care facilities account for roughly 20% of all COVID-19 related deaths. A glance at Medicaid data released as of 4/23 provides further context.

  • In twenty-three states that report death data, over 10,000 reported deaths were due to COVID-19 in LTC facilities, accounting for 27 percent of the deaths in those states
  • 50,000 reported cases accounting for 11 percent of total cases in twenty-nine states
  • In six states COVID-19 is responsible for 50 percent of the deaths (Delaware, Massachusetts, Oregon, Pennsylvania, Colorado and Utah)
  • COVID-19 cases have been reported in over 4,000 facilities across the country
  • COVID-19 has had a disproportionate effect on those that live and work in LTC facilities
  • 53 percent of LTC workers (2.3 million) are aids and personal care workers
  • 6 in 10 LTC workers are low wage earners earning less than $30,000 in 2018
  • LTC workers are largely low-income females and 1 in 4 are Black
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Fighting An Uphill Battle

As illustrated, staff in LTC facilities are facing incredible risk while being compensated the least for it. This has led to staffing challenges in many of the LTC facilities most impacted by COVID-19.  A facility in southern California was forced to temporarily shut down as staff refused to show for work in early April. Absenteeism and a lack of adequate PPE and overall resources have compounded the challenge to operators. Federal government and Medicaid programs must act to address the deficiency in resources that will reduce the risk to staff and residents. Shortages in PPE have been a focus of policymakers for frontline inpatient facilities, however, extraordinarily little discussion has centered around increased support in the LTC setting.

The recently passed Coronavirus Aid, Relief and Economic Security (CARES) Act appropriates substantial federal funds to hospitals and other health care entities in order to offset the financial burden of the coronavirus pandemic, which could potentially be used to bolster PPE supplies. But, the law does not allocate such funds to LTC facilities. The needs of these programs will be largely at the doorstep of Medicaid waiver programs. Without delving too deeply into policy and process, more needs to be done.

The sacrifices and uphill nature of the battle in America’s nursing homes appear to be severely understated. Nurses, administrative staff, rehabilitation staff and nurse aid are fighting COVID-19 under challenging circumstances often with limited resources. The constant onslaught of negative media coverage only intensifies the challenge of maintaining morale of the staff in these settings.

Celebrate The Hidden Heroes

Now that we have a clearer picture of the state of COVID-19 in our LTC facilities, let us celebrate the staff that cares for our nation’s elderly around the clock. They too should be lauded as heroes a little more often as they are caring for our most fragile and most vulnerable members of the patient population. If the media remains slow in this area, join me in giving a collective “Thank you” to these hidden heroes in healthcare’s fight against COVID-19.


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