Nancy Snyder has worked as a certified nursing assistant for over 40 years and has never been as stressed at work as she has been lately.

“I feel like I’ve lost my compassion, and it really upsets me,” Snyder said. “I’m angry. People come to work grumpy. It’s just awful. The environment itself is not good.”

Snyder is one of the employees at Portland’s city-run long-term care and rehabilitation facility feeling frustrated and burned out by a persistent staffing shortage.

The Barron Center currently has 80 open jobs, or roughly one of every three positions at the facility. In direct care nursing, 61 positions – or 44 percent – remain open.

“It’s absolutely something we’ve been hearing about for a while and something we’ve been trying to work on for a while,” said Kristen Dow, director of health and human services for the city of Portland. “We’ve implemented different measures to try and combat the vacancy rate and to hire more staff, especially in direct care nursing, but what we’re seeing is unfortunately something that’s being felt at long-term care facilities across the state.”

The center is the largest division within the Department of Health and Human Services, which is the city’s largest department, and the staff vacancies make up a significant portion of about 250 openings citywide. The city employs about 1,400 people fully staffed.

‘THE DURATION OF IT’  

Staffing shortages are a problem across the city and state, although long-term care facilities such as the Barron Center are being hit particularly hard, said Angela Westhoff, president and chief executive officer for the Maine Health Care Association, a nonprofit trade association representing 200 Maine nursing homes and assisted-living and residential care facilities.

Westhoff said the staffing problems in long-term care facilities and nursing homes predate, but have been exacerbated by, the COVID-19 pandemic.

“One thing that’s important to point out now is the duration of it,” Westhoff said. “Now, two years into the pandemic, burnout and stress is at an all-time high with direct care workers.”

When the association surveyed its members last fall, 94 percent of those who responded said they were short on staff and 50 percent categorized it as crisis level, with numerous openings and very few qualified applicants.

Ninety-three percent said they believed COVID-19 had increased staff turnover. “That’s clear,” Westhoff said. “The pandemic has really taken a toll on direct care workers.”

She said some staff are leaving because they are burned out and stressed. Some may have taken early retirement or gone to work in other areas of healthcare.

“Long-term care has definitely been the slowest to rebound,” Westhoff said.

She said the pandemic had been harder on those in long-term care because they spend so much time working with residents. “Coupled with the difficulty of competing with other employers in the marketplace because of chronic underfunding, our sector is dealing with a workforce crisis of historic proportions,” Westhoff said.

‘THINGS ARE NOT OK’

At the Barron Center, Dow said, the city is abiding by state minimum staffing levels, which require a ratio of at least one staff member to five residents during the day, one to 10 in the evenings and one to 15 at night. “I realize that doesn’t make it any less challenging for the staff that are there,” Dow said. “I fully recognize that, but we are still meeting minimums.”

Snyder works the 11 p.m. to 7 a.m. shift, which she said is one of the worst-staffed. Her job is to provide general patient care – which includes checking on residents, helping them change and go to the bathroom, and helping them move around. She said it’s been hard with staff stretched so thin to provide the care each resident needs.

“We have a lot of residents who need two people to get them up – and if you don’t have the staff, that person has to stay in bed all day,” Snyder said. “There’s truly no other way you can do it, and it’s just not fair.”

Linda Merrill, who has worked at the center for almost five years as a certified nursing assistant, said some staff have been staying late or coming in early to help co-workers. She said it’s been difficult to adequately care for residents, especially those who have higher levels of need because they’re at risk of falling or have mental health issues.

“There are some heavy residents and some who you’re … ducking punches,” Merrill said. “You try to care for them and keep them clean and safe, but there are nights where you can’t because you don’t have an extra set of hands to help you control their behaviors or keep themselves and yourself safe.”

It wears on staff over time, Merrill said. “We’ve been down (staff) forever it feels like,” she said.

News that the center’s building administrator, Rebecca Gagnon, and director of nursing, David Langstaff, are leaving also has not helped morale.

“Once (the director of nursing) left, it’s a sign to us things are not OK,” Snyder said.

Langstaff did not respond to phone messages or an email seeking information about why he is leaving.

Gagnon, in an interview Monday, said she was approached by a recruiter months ago about a new position and will be leaving next month to become chief operations officer for the Maine Veterans’ Homes. She said her decision is not related to the staffing challenges at the Barron Center, which she said are widespread throughout long-term care right now.

“COVID has been such a detriment to long-term care,” Gagnon said. “It’s not something unique to the Barron Center. It’s something industry-wide, that it’s very difficult to recruit and retain staff into an industry that has been really hit hard by the pandemic.”

ADDRESSING VACANCIES

The center is licensed for 219 beds but is limiting the number of residents because of the staffing shortage – it has just 117 right now.

It provides both short-term rehabilitation and long-term care and is dually certified by both Medicare and Medicaid. It also accepts private payments and contracts with many managed care insurers. Dow said admissions are currently being made on a case-by-case basis depending on levels of need and whether adequate staff is available to provide safe care.

She also said several steps have been taken to hire more staff.

In November, the city hired a recruiter for the Barron Center, who has been working on recruitment and retention. Certain positions now come with referral and signing bonuses. Staff can get $1,000 referral bonuses. Full-time registered nurses and licensed practical nurses who stay for a year can get $5,000 signing bonuses and full-time CNAs who stay for a year can get $2,500. The bonuses are pro-rated for part-time employees.

The center received $4.1 million in state funding last year to work on recruitment and retention of long-term care employees. Dow said the money has been used for one-time and ongoing bonuses, including an increase of $5 per hour for staff that was recently extended through the end of December. Additional one-time bonuses could still be coming, she said.

Dow said the city is looking at how pay at the center compares to other long-term care facilities and plans to make adjustments if the rates are not competitive.

According to the Maine Health Care Association, the average hourly wage for an RN working in long-term care in Maine is $35.10. LPNs earn an average of $27.45, according to the association, and CNAs an average of $18.34.

Registered nurses at the Barron Center make between $25.93 and $33.68 per hour, while LPNs make between $21.74 and $29.24 and CNAs between $14.90 and $21.81, depending on experience, the city said. Those rates don’t include night and weekend differentials or the additional $5 per hour they’re getting right now.

A new union contract is being finalized, with updated pay rates expected.

“This is something the industry as a whole is facing,” Dow said. “I care deeply for both the staff and residents of the Barron Center, and we’re committed to working together to come up with solutions.”

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