Nursing homes struggle as omicron depletes staff, sickens residents

Staff shortages, rising infections complicate nursing home operations, but few COVID-19 deaths



COVID-19′s omicron-fueled winter surge has raced through Georgia nursing homes, bringing infections to an all-time pandemic high, depleting staff and raising concerns for the impact on residents’ care and health.

High vaccination and growing booster rates among residents have made illnesses usually less severe, though deaths remain a worry. Instead, with facilities seeing the biggest outbreaks they’ve ever had among both staff and residents, a more persistent problem looms: dangerously low staffing levels.

So many nursing home workers across the state have tested positive for COVID-19 that facilities are seeing the worst worker shortage in a generation, one that is sending waves of disruption throughout the state’s health system. The sick workers add to a shortage of long-term health care workers that had already strained the industry.

In the first full week of January, more than 1,600 workers were out sick with COVID, according to industry officials, shredding staffing plans. More than 1,000 patients were down with the virus that week, the latest week recorded, requiring special arrangements for their care and adding to the load.

“It’s very serious, not having enough staff,” said Toby Edelman, senior policy attorney at the Washington-based Center for Medicare Advocacy. The dangers posed range from delays in regular care that lead to bigger problems, such as pressure sores or infections, to missed warning signs of more serious illnesses, she said.

“A lot of residents, particularly residents with dementia, can’t tell staff with words what’s going on,” Edelman said. “And so you need to have staff who know the people, who can be attentive, and...recognize that something has happened, that there is a change, that something is going on.”

Moreover, state and federal help that arrived in previous surges has not been renewed for the omicron wave, nursing home officials said. A federal program that sent CVS and Walgreens workers in to vaccinate nursing home residents with primary doses is nowhere to be found for boosters. National Guard troops mobilized by the governor’s office for the first waves have gone to hospitals during the omicron wave, but not nursing homes, said Tony Marshall, the CEO of the Georgia Health Care Association.

The shortage of staff to meet the existing need inside nursing homes has shut down new admissions at some facilities across the state. That has in turn left hospitals holding patients that need to be transferred out, and left families searching for options.

Credit: Curtis Compton

Credit: Curtis Compton

“In my entire career, I’ve never seen the staffing crisis as acute as it is today,” said Neil Pruitt, CEO of the giant long-term care company Pruitt Health. As he spoke Tuesday, he had 619 staffers out with COVID-19, and had recently recovered himself. Pruitt said despite the strain, care standards at the company’s facilities remained high.

Hospital CEO Joe Austin at Phoebe Putney’s flagship facility in Albany agreed.

“Today, at Phoebe Putney Memorial Hospital we are caring for more than 20 patients who ideally would be cared for in a nursing home,” Austin told the AJC in a written statement Friday. “Obviously, that puts more strain on our already taxed resources, but there simply aren’t staffed beds available at nursing homes in our area right now to provide relief.”

Omicron not always ‘mild’

In Georgia, case numbers caused by omicron are near the highest point in the pandemic. It may be cresting in metro Atlanta, but not in many parts of the state.

Increases in deaths typically arrive weeks after infections spike. In the last report available, the state reported 17 nursing home residents died of COVID in the first week of January, according to the state Department of Public Health.

The first three waves of the virus swept through the state’s nursing homes in 2020 and early 2021 before vaccines were widespread and with devastating consequences.

COVID and Georgia nursing homes

67.2%: Number of residents of Georgia nursing homes who have received booster vaccinations

28.1%: Number of Georgia nursing home staff who have received booster shots

17,899: Seven-day rolling average of new confirmed and probable COVID infections statewide as of Wednesday

5,398: COVID-19 patients in Georgia hospitals Wednesday

Source: state Department of Public Health; Centers for Medicare and Medicaid Services

The vaccines proved remarkably effective at reducing deaths in nursing homes during the summer delta wave. And the severity of this wave might have been blunted further by wider adoption of boosters.

As of early January, 83% of nursing home staff statewide were fully vaccinated, according to the association, while fewer than a third had booster shots. That figures masks a wild variation statewide, with companies like Pruitt several months into vaccination mandates for its entire staff, while others, especially rural facilities, have few staff vaccinated.

Under a recent Supreme Court decision upholding a mandate from the Biden administration, all of them will soon have to be vaccinated. That may cause more workers to quit, a concern voiced by a national advocacy group for the facilities.

“It's very serious, not having enough staff. ... You need to have staff who know the people, who can be attentive, and...recognize that something has happened, that there is a change, that something is going on."

- Toby Edelman, senior policy attorney at the Washington-based Center for Medicare Advocacy

Unvaccinated staff likely played a key role in this surge and the resulting staff shortage. Data from the Georgia Health Care Association show infections among staff appeared first, before the rise in resident cases.

Ben Lopman, a professor of epidemiology at the Emory University School of Public Health, said long-term care facilities have instituted strong infection control protocols, but caregivers work closely with residents and often with multiple residents each day, increasing the chance a worker might unwittingly transmit the virus before they even know they’re infected.

The road ahead

Emory University epidemiologist Jodie Guest said she was hesitant to say Georgia had reached its peak because of holiday reporting and recent winter weather might have depressed testing.

The five core Atlanta area counties have all reported declines in new infections, but many rural counties in Georgia continue to report growth in infection rates. Those rural areas generally have lower vaccination rates than the metro Atlanta area, and less access to health care, meaning they are at higher risk of severe outcomes.

Guest said even if Georgia has reached or is nearing its peak, many people will become infected on the downslope.

“That’s still a lot of cases to be had,” she said. “Getting to the peak and past the peak is certainly good news but it does not mean we’re done.”