Omicron forces nursing homes to freeze admissions, strands more Ohioans at hospitals – The Columbus Dispatch
Typically, when patients are ready to move to a less-intensive setting, hospitals will discharge them to nursing homes or other places for rehabilitation or long-term care.
But the more contagious omicron variant of COVID-19 – infectious even among the vaccinated – has severely limited that process.
As a result, some nursing homes are halting admissions in Ohio and nationwide and people are getting stranded at already-overwhelmed hospitals waiting for spots to open up.
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There seems to be no end in sight, with both sides ravaged by the pandemic. Ohio hospitals are dealing with record levels of COVID-19 hospitalizations, while nursing homes are too understaffed to accept new patients, especially COVID-positive ones.
“It’s just a very overworked health care system at the moment,” said Erin Pettegrew, the deputy state long-term care ombudsman.
Nursing homes face severe staffing shortages
Many long-term care facilities have had to halt or limit new admissions due to the omicron variant causing more outbreaks and staff shortages, said Pete Van Runkle, head of the Ohio Health Care Association, representing for-profit nursing homes.
Some nursing homes have even had to lean on members of the Ohio National Guard (deployed by the governor to mainly assist hospitals) to help take care of patients.
“Things are really bad and I think members are under more pressure than they’ve ever been,” Van Runkle said.
Ohio Eastern Star Home, a nonprofit facility in Mount Vernon, usually can accommodate 24 guests in its rehabilitation section. Three months ago, the facility capped it at half that amount.
There were multiple reasons: nursing classes delayed by COVID-19 that would usually provide working students who would stay on for a job, and President Joe Biden’s vaccine mandate for health workers causing people to leave.
Those events coincided with the omicron wave, which really began to exacerbate the staffing shortage, said Ohio Eastern Star’s CEO, Michele Engelbach. Her home went from 180 full-time staff members before omicron to 150 currently — not all of the individuals are always available to work their shifts.
“We have a lot of staff members that are vaccinated and also received a booster, but because this variant is so contagious, it is getting to them,” she said. “They’re certainly not as sick, but they still have to be out for five days. And that poses a huge problem for us when we’re already short-staffed.”
For the first time during this pandemic, Engelbach has had to pick up patient-care shifts herself.
Omicron’s effects on staffing are also reflected in the complaints by nursing home residents to the state long-term care ombudsman’s office. The top type of complaint during the pandemic has shifted from visitation issues to staffing-related ones.
“It’s almost a direct tie between the number of staff you have available in the building and the number of residents going with delayed or missed care,” Pettegrew said.
Hospital patients ready for discharge have no place to go
Multiple hospital systems have reached out to ombudsman’s offices to see if any facilities have open spaces, Pettegrew said, especially for COVID-positive ones who don’t need hospital level of care.
“We’ve had to search far afield,” she said. “I know personally several residents who’ve had to go dozens, if not hundreds, of miles away from their … hometown to find a nursing home.”
Even before the pandemic, hospitals were one of the largest referral services for long-term care facilities. So many facilities don’t want to let hospitals down by telling them no, even if they’re forced to because of COVID, Van Runkle said.
But taking in COVID-positive patients puts disproportionate pressure on staffing.
“We have to separate them from everybody else. And then that takes a dedicated staff member, while we already don’t have staff members to care for the population that we have some days,” Engelbach said.
The dearth of nursing home space means more ready-to-be-discharged patients waiting inside hospitals. The Ohio Hospital Association isn’t tracking the backlog of patients, but the association’s spokesman John Palmer said he’s heard anecdotally it’s an issue facing hospitals throughout Ohio.
At Columbus-based OhioHealth, the number of COVID-19 patients waiting for a bed to open up in a skilled nursing facility in recent weeks has more than tripled since October, said spokeswoman Katie Logan. That’s more than at any time since the pandemic started in March 2020.
As a result, hospitals have had to get creative to accommodate the additional pressure.
The holdup forced Dr. Todd Weihl, vice president of medical affairs at OhioHealth’s Doctors Hospital, and his staff to postpone some elective procedures. They instead use an outpatient operation wing of the hospital for patients waiting for a spot at a nursing facility.
Weihl and his team created the makeshift nursing unit in a matter of two days. Since the unit was usually used for people having a brief stay at the hospital, Weihl and his team had to bring in more comfortable beds, figure out how to best provide patients with meal service and entertainment, such as a TV.
The unit also needed to be able to operate 24 hours a day and be staffed with physical therapists and nurses from other areas of the hospital, he said.
“We essentially became experts in supply chain in real time,” Weihl said. “It really took a village to do it all.”
Will vaccine mandate help or hurt nursing home staffing?
One potential solution that could help, said Pettegrew, is increasing vaccination rates among nursing home staff members and residents. This could lead to fewer outbreaks and more employees on duty.
As of early January, roughly 69% of nursing home workers in Ohio and 84% of residents are fully vaccinated against COVID-19. That’s expected to increase after the U.S. Supreme Court gave the green light to resume Biden’s vaccine mandate for health care workers.
That same mandate, however, could lead to more employees quitting, industry leaders warn. Ultimately, the root of the problem is not enough people wanting to work in health care amid the pandemic and the staff burnout and prolonged stress it’s created, said Engelbach.
The only thing hospitals and nursing facilities can do now, she said, is to grind it out.
“The motto that we have right now is we are living 24 hours at a time,” Engelbach said. “And if we get through that, then we’ll go to the next 24 hours.”
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.
