Congregate and long-term care facilities across Maine and the United States are grappling with a perfect storm of challenges: high case counts, ongoing staffing shortages and the risk of a resurgent flu season.

Health professionals say the staffing challenges that existed even before the pandemic are the worst they have ever seen and show no signs of abating. Dealing with the omicron variant and staffing shortages have been the primary challenges, but officials say adding influenza back into the mix makes a terrible situation worse.

There are currently 70 COVID-19 outbreaks among long-term care facilities in Maine and 10 flu outbreaks, out of 14 total statewide, according to the Maine Center for Disease Control and Prevention.

John F. Murphy Homes is averaging six new COVID-19 cases per day, mostly among staff. That’s more than at any other point during the pandemic.

Employees are stretched thin, frequently working 80 to 100 hours per week to pick up the slack as the recent omicron variant of coronavirus causes more of their co-workers to call out sick.

Todd Goodwin, the facility’s CEO, said he’s never seen anything like it.

“It’s a mess,” he said. 

‘STRESSFUL AND DIFFICULT’

Angela Westhoff is executive director of the Maine Health Care Association, a trade group that represents nursing homes and long-term care facilities. Roughly 95 percent of her organization’s members say they are experiencing staffing shortages, with direct care professionals and certified nursing assistants being the most difficult positions to fill.

“I’ve been talking with people and everyone is saying that they’ve never seen it this bad,” Westhoff said. “And the fact is, the pandemic is not over. Cases are still surging, (transmission) rates are really high. … It’s so stressful and difficult.”

Even before the pandemic, long-term care facilities struggled to meet their staffing needs, and the situation has only grown more dire over the past two years, Westhoff said.

The nursing home workforce has been reduced by roughly 15 percent since the pandemic began, according to the American Health Care Association and National Center for Assisted Living. Westhoff estimated it may be lower in Maine, between 7 and 10 percent, but still more than the state can handle.

Agencies have tried increasing wages, offering bonuses, paying overtime, putting out requests for staff and relying on outside agency staffing just to meet basic needs.

“It’s a crisis,” she said. “I feel like we overuse that term a lot during the pandemic, but in this case, it’s true.”

Jeff Ketchum, administrator of Pinnacle Health and Rehab, formerly the South Portland Nursing Home, said that between agency and traveling staff, Pinnacle has been able to hold its own, at least well enough to meet state staffing minimums. But it has been a challenge.

Between the virus running rampant throughout the communities and constantly changing guidelines from state and federal governments, it has been a difficult time.

“It’s been like that for two years,” Ketchum said.

He commended the roughly 82 workers for their performance despite the constant anxiety and stress, both at work, and at home if they’re out sick.

“Today’s health care worker is dealing with it on all sides,” he said. “They’re tired, they’re exhausted, but they still come to work. They’re doing the best they can under excruciating circumstances.”

None of the roughly 58 long-term care residents has COVID-19 right now, and last year there were no positive flu cases, which Ketchum said is the goal for this year as well.

The Auburn-based John F. Murphy Homes employs roughly 850 people, Goodwin said, so the six new cases per day may not seem like a lot, but the absences already have had a tangible impact.

“We’re paying overtime at levels we’ve never seen to folks who are working just … obscene hours,” he said. “We’ve made massive changes to staffing schedules … We’re currently talking about consolidating assorted homes. It’s out of control.”

BETTER PAY NEEDED

He urged officials to properly compensate care workers for the important and difficult work they’ve been doing.

The Mills administration announced late last year a plan to increase Medicaid payment rates for 225 nursing and residential care facilities across Maine beginning Jan. 1.

The improved rates will allow those facilities to increase pay for direct care workers to at least 125 percent of the state’s minimum wage, the announcement said.

But Goodwin said the money hasn’t been distributed yet, at least not to his staff.

“They can’t wait any longer,” he said. “We have to quit talking about how wonderful they are and quit telling them they’re going to get more money and actually give them more money.”

Goodwin said he’s unaware of any confirmed cases of the flu across the agency’s 38 adult congregate care homes, which serve about 130 people, but that it’s always a concern.

Dr. Jabbar Fazeli, photographed in 2020, says residents at some facilities have shown that they didn’t develop adequate immunity from the vaccines, so they have to take extra precautions. Shawn Patrick Ouellette/Staff Photographer

OLDER RESIDENTS AT RISK

Dr. Jabbar Fazeli, a geriatrician and medical director at multiple care facilities in southern Maine, said he hasn’t seen any positive flu cases yet, but given the current challenges from the “tsunami of cases among staff” and residents across the industry, it “adds insult to injury.”

Fazeli noted that while omicron is often milder than other COVID-19 variants, it can still be a killer for older and more vulnerable populations.

Several residents have shown that they didn’t develop adequate immunity from the vaccines, he added, so for them it’s almost like they never received one. They have to take extra precautions, he said.

Testing bottlenecks also have posed a challenge. A test might be conducted and then the person will need to be retested in three days but the results from the first test haven’t come back yet, Fazeli said.

Last week, the state announced it had purchased 250,000 rapid COVD-19 antigen tests from Abbott Labs to help meet the high demand. Extra tests are great, Fazeli said, but they don’t help if the lab can’t process them.

It’s not all doom and gloom – Fazeli noted that the omicron surge is acting like a fourth vaccination for infected staff, who won’t need to be tested again for another three months. For the unvaccinated who get sick, “(omicron) is becoming the mandatory vaccine.”

“It’s the light at the end of the tunnel,” he said.

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