CORONAVIRUS (COVID-19) RESOURCE CENTER Read More
Add To Favorites

‘Outside the box’ solutions helped this nursing home excel, despite staffing challenges

Charlotte Observer - 6/9/2022

  Patients pay for nursing homes’ staffing shortages

A nationwide struggle to hire and retain caregivers is causing North Carolina nursing homes to reach a crisis point — a trend that endangers thousands of residents, our investigation has found. An influx of for-profit nursing homes and fewer regulations during the pandemic are compounding the crisis. So what should families do to protect their loved ones?

At a nursing home 40 miles northwest of Charlotte, nurse aide Sloan Rollins had grown concerned about a resident.

Despite her lung disease, 94-year-old Willie Miller was usually talkative. But Rollins noticed that Miller had recently become withdrawn. On a busy morning in May, he took her hands and gestured to two men seated in her room.

“Can you tell me who these people are?” he asked, kneeling so he could talk with her at eye level as she sat in her wheelchair.

“My sons,” she answered.

“I know you’re proud of them, aren’t you?” Rollins said.

Both Miller and Rollins began to tear up. But calm returned to Miller’s face as Rollins talked with her.

It’s the sort of thing that often happens at Abernethy Laurels, a nonprofit nursing home in Newton that has distinguished itself by providing ample staffing and exceptional care. Among North Carolina’s 250 nursing homes, Abernethy Laurels is one of roughly 70 that have earned five-star ratings from the federal Medicare agency.

In the initial installments of Left Alone, an ongoing investigation, The Charlotte Observer revealed how staffing shortages endanger thousands of nursing home residents in North Carolina, causing some to wait hours for needed help, miss crucial medications and develop life-threatening infections.

But Abernethy Laurels has managed to maintain better staffing than most, largely by pursuing “outside the box” solutions, according to executive director Amber McIntosh. One example: The home has recruited dozens of new caregivers by paying them to become trained and certified.

Most North Carolina nursing homes have been relying, at least in part, on staffing agencies for temporary help. While that has helped some homes survive the staffing crunch, experts say those short-term caregivers are less likely to know the wants and needs of each resident.

Abernethy Laurels has bucked that trend. It employs 130 certified nursing assistants, so it doesn’t need to use staffing agencies.

“That’s kind of a game changer in terms of the quality of care you can provide,” McIntosh said.

The 174-bed home is organized into small, 16- and 20-resident “households” where patients get to know fellow residents and caregivers. One group of nurses and nurse aides is assigned to each household, an arrangement that deepens their understanding of each resident’s needs and likes.

Experts embrace smaller settings like these as a healthier alternative to the institutional approach of many nursing homes.

One organization, the Green House Project, has put that philosophy into action. Serving as a consultant to both nonprofit and for-profit companies, it has helped spur the development of more than 350 dwellings that are designed to resemble actual homes. The homes are small in scale and simple to navigate, with private bedrooms, comfortable living rooms and easily accessible outdoor areas.

Rosemary Jones, a 95-year-old retired secretary who has lived at Abernethy Laurels for several years, said the approach works for her: “I like the home-like atmosphere.”

Staff members say they try to do more than merely meet the basic needs of residents. Roughly once a month, for instance, they work to make a wish come true for one resident.

In May, the “Grant a Dream” recipient was Charles Austin, a 71-year-old resident who grew up on a dairy farm. Staff members helped him rekindle childhood memories by taking him on a day trip to the Riverbend Creamery in nearby Lincolnton.

Making the job worthwhile

On a recent morning at Abernethy Laurels, physical therapist Matt Saunders worked with an elderly resident who was using a walker, coaching her how to lift her right foot onto a portable plastic step. He was preparing her for a task she once did without thinking: stepping over the threshold to her house.

In a spacious activity room, meanwhile, staff members sat beside residents at tables helping them with an art project: using markers to turn paper coffee filters into colorful fake flowers. At lunchtime, nurse aides patiently spoon fed residents who needed help eating.

Abernethy Laurels has been rewarded for its care. The nursing home gets a five-star rating from the federal government for various “quality measures,” such as a low percentage of residents who develop bed sores and urinary tract infections.

That sort of care can’t happen without sufficient staffing.

Like other Abernethy Laurels caregivers, CNA Kiley Parker said she’s ordinarily responsible for eight residents during her shifts — a ratio that she says allows her to give residents plenty of attention.

In other North Carolina nursing homes, CNAs are frequently asked to care for more than twice that number of residents, a situation that leaves patients vulnerable to neglect, The Observer’s investigation found.

Industry leaders say many homes simply can’t hire enough caregivers because too few people want those jobs.

Abernethy Laurels has faced hiring challenges, too. But its staff has found creative ways to address them.

During the pandemic, with fears about COVID-19 running high, most nursing homes lost employees. Abernethy Laurels was no exception; about half of its CNAs left.

Administrators discovered an obstacle to attracting new caregivers: Some people who were interested couldn’t afford to take time off work, so they couldn’t get the training needed to become certified.

To become trained and certified as CNAs in North Carolina, students are required to undergo at least 75 hours of instruction. Classes, instructional materials and exams typically cost students more than $1,000, the Observer found. But many with the potential to become good nurse aides don’t have that time or money.

Members of Abernethy Laurels’ recruitment and retention committee — a mix of front-line caregivers, members of the kitchen staff and cleaning crew, administrators and others — began brainstorming. They decided to try something new: paying people to become trained as CNAs.

Under an “Earn and Learn” program launched in February, would-be CNAs now come to Abernethy Laurels to take a 120-hour training class taught by staff members. They don’t pay for the training. Instead, they get paid to take it — $12.15 an hour. In exchange, they sign contracts promising to work at Abernethy Laurels for at least a year after they become certified.

When the nursing home launched employment ads telling touting the program, the response was “overwhelming,” McIntosh said.

One who responded: Jacqueline Rojo Sanchez, 21, who had previously worked in a textile factory but saw in Abernethy Laurels an opportunity for more rewarding work.

She previously looked at becoming trained and certified at a community college, but that would have been too expensive — and would have required her to take too much time off work without pay. But at Abernethy Laurels, she found training, better pay and a more satisfying job.

“I really liked the class, and I really like the residents,” she said. “...I like building relationships here.”

The program has brought the nursing home 30 newly minted nurse aides. More aspiring CNAs are being trained now.

McIntosh said it’s an investment that she believes will improve care and help the nursing home save money down the road by reducing staff turnover. It costs about $2,000 to hire and train each new employee, she noted, so it makes good financial sense to provide employees incentives to stay.

Decent pay and good benefits have also helped the home attract and hold on to qualified workers.

Nurse aides there earn a minimum of $16 an hour, and they are eligible to receive affordable health, dental, prescription, vision and disability benefits. They can take three to eight weeks of vacation each year, depending on their years of service. They can also get help funding their retirements. Under Abernethy Laurels’ retirement plan, the organization matches employee contributions up to 6% of their salaries.

Adam Sholar, president of the N.C. Health Care Facilities Association, applauded Abernethy Laurels’ innovations and success. But he said not every nursing home can replicate them. That’s because Abernethy has a lower-than-average percentage of residents dependent on Medicaid, which pays homes less than private-pay patients do.

“Most North Carolina nursing homes care for about seven Medicaid long-stay patients for every one private pay patient; Abernethy cares for a roughly equal number of ‘private pay’ and Medicaid residents,” Sholar said.

That underscores the need to increase North Carolina’s Medicaid reimbursement rates, which are lower than those in many other states, he said.

But not everything Abernethy Laurels does for its staff costs a lot of money.

During staff appreciation weeks, administrators have washed employees’ cars and treated them to dinners, chair massages, ice cream parties and other perks.

And administrators often write employees handwritten thank-you notes.

“You have such care and compassion for your residents, providing comfort when needed and working with others in such a calm manner,” nursing home administrator Ashley Jones wrote in a note to one recently hired CNA.

“We are so fortunate to have you here on our team,” she added.

‘We’ve got the resources’

To fill positions that became vacant during the pandemic, all members of the administrative team pitched in to do direct care work.

Beverly Parker, a CNA who has worked at Abernethy Laurels for 11 years, said she was gratified to see administrators “put on their boots and help people shower.”

“It sends a great message that we’re one big family,” she said.

During the pandemic, the home’s leaders also called on others who were eager to help: About a dozen people who resided in the independent living village at Abernethy Laurels volunteered to help feed the nursing home’s residents.

In a state where more than 80% of nursing homes are for-profit businesses, Abernethy Laurels’ nonprofit status makes it easier to devote resources to patient care, McIntosh said. EveryAge, formerly United Church Homes and Services, owns the Newton nursing home and others in Thomasville and Suffolk, Virginia.

EveryAge also has a nonprofit foundation that funds the “Grant a Dream” program, helps cover other expenses at its nursing homes, and provides financial assistance to employees who encounter unexpected hardships, such as large medical bills.

Money is not the first concern at Abernethy Laurels, McIntosh said. For instance, the nursing home has limited admissions and temporarily closed one household so that it can be sure that its staff isn’t stretched thin.

“The way we make decisions is not based on the almighty dollar,” McIntosh said. “...We know if we need something, we can pick up the phone and call the CEO. There’s not that fear factor of ‘I’m going to lose my job if I don’t meet the bottom line.’ ”

©2022 The Charlotte Observer. Visit charlotteobserver.com. Distributed by Tribune Content Agency, LLC.

Nationwide News