The pandemic has made staffing at nursing homes even more challenging. But for the first time, it's easier for people in the U.S. to find out what staff turnover is like at nursing homes in their area.

Medicare is now posting those details on its Care Compare website. Visitors can select a particular nursing home and then click to view staffing information.

Experts like Dr. David Gifford with the American Health Care Association say staffing turnovers at nursing homes are often high because of how payments are structured.

"We've historically been known to have a high turnover, as other sectors are too, and a lot of it relates back to that most of the nursing homes paid by Medicaid," Gifford said. "We just weren't able to offer the competitive wages that hospitals and other health care providers are."

The Centers for Medicare & Medicaid Services has researched the links between staff turnover and quality of care. Initial results suggest that as staff turnover decreases, the overall quality rating for a facility increases.

Starting this summer, the agency will use staff turnover information to calculate facility quality ratings.

Giffords says many workers at nursing homes do want to stay in their jobs. But he points to factors like low wages or child care problems as reasons for leaving.

"The staff there really do end up caring for the residents, almost as if their family members, and so it's very hard when someone leaves," he said. "We need to recognize that, and I think this data just shows that not making nursing homes sort of a priority has led to more turnover, and we need to solve that root problem with this information."

Medicare says posting the new turnover information for consumers won't create additional paperwork burdens for nursing homes. The data is already regularly reported to the government — it's just now becoming accessible to the public.

CINCINNATI — Two weeks after President Biden's Dec. 6 COVID vaccination deadline for healthcare workers, many nursing home employees are still unvaccinated, according to the most recent data published by Medicaid and Medicare Services.

The WCPO 9 I-Team reviewed data for dozens of local nursing homes and found many of them fall far short of the president's mandate.

Ohio has one of the lowest nursing home staff vaccination rates in the country, according to the Medicaid and Medicare data.

In Hyde Park Health Center on Cincinnati's East Side, 17% of the employees were vaccinated, according to data published Dec. 5 on the Medicaid and Medicare website.

On Friday, the nursing home's executive director declined the I-Team's request for an interview.

"After our conversation, I went back and reviewed our employee vaccination numbers," Hyde Park Health Center Executive Director Kevin Fluehr wrote in an email to the I-Team. "We are actually at a 72% employee vaccination rate."

Fluehr wrote, "There has been some turnover recently in our HR Department, but everything has been verified for accuracy and the error has been corrected."

Other nursing home operators have told the I-Team that the Medicaid and Medicare data, which is provided by the nursing homes, is often out-dated and not accurate.

The data shows only 29% of the employees at the Chateau at Mountain Crest Nursing and Rehab Center on Cincinnati's West Side had received at least one shot of the COVID vaccine.

The nursing home is managed by JAG Healthcare.

"At some point, this past fall, it might have been that low," JAG Healthcare CEO James Griffiths said. "But I know this, if they came in today, we can show them every single person has a vaccination card. We're going to comply with the law as all healthcare workers and healthcare employers should do."

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NEW ORLEANS —

Residents at an apartment building in New Orleans say they were abandoned after Hurricane Ida knocked out electricity, and the property manager offered little to no assistance to the 40 or so low-income residents. Many are elderly and have acute health conditions that were exacerbated by the oppressive heat after the storm.

Electricity was restored Thursday, but people who suffered through the heat are demanding answers.

"We went through a lot of pain and suffering, couldn't sleep, never got sleep or nothing, man," said Tyrone Webber, a resident at Boyd Manor.

Residents depended on local community volunteers who brought them food, water and ice. Some of the volunteers had been inside the building's apartments and shared videos that showed water on the floor and leaks around window sills.

The volunteers made patchwork repairs, but residents say they have not heard from the property manager about long-term solutions.

"The landlord didn't come here, not one day. We was without lights and everything for 10 days, and she's going to come here today talking about she want rent," resident Yolanda Lewis said.

National Baptist Housing and Economic Development own the property. Its chairman, who is also a local pastor, said he had evacuated from New Orleans for the hurricane and had not been to the residence since the storm.

The U.S. Department of Housing and Urban Development financed the property and pays 70% of the rent for tenants, who must qualify as low-income. This means residents did not have the means to evacuate on their own.

However, a representative for the company that manages the building told sister station WDSU that the residents were given information to arrange their evacuation through the city's 311 service. Only one resident chose that option.

The on-site manager has been to the building every day since Hurricane Ida and brought residents food and water, the representative said. Residents dispute that claim, saying volunteers and a council member have been their only sources of aid. One resident said the manager "snuck in through the backdoor."

A community member said conditions were substandard before the hurricane. He, too, said property management has been absent in the storm's aftermath.

Personnel is expected to be sent to complete an assessment of building damage. That process was hindered by the lack of electricity. There was no timeline given for when repairs would be made, but contractors are reportedly expected to be hired if the damages are extensive.

Residents should not be expected to pay their portion of the rent in the immediate aftermath of the hurricane, a representative for the company said, adding that she was not aware that the onsite property manager had pressed tenants for payments. She also said she was not aware of residents' claims that problems such as mold, mildew and leaks were present before the storm.

CINCINNATI — Many Tri-State nursing homes are already facing staffing shortages worsened by the pandemic and a tight labor market.

Now one industry lobbyist warns that a federal vaccine mandate for nursing home workers could make staffing shortages so extreme that it forces facilities, especially ones in rural areas, to close.

“If you don't have enough staff to operate, you basically have to close down. There's no in-between,” said Pete Van Runkle, executive director of the Ohio Health Care Association, which represents hundreds of nursing homes in Ohio. “The worst-case scenario is that we have significant closures across the state, and significant dislocation of residents.”

President Joe Biden announced on Aug. 18 that all nursing homes must require employees to be fully vaccinated against COVID-19 if they want to continue receiving Medicare and Medicaid funding – which most facilities rely on to stay open. The new rule could take effect as soon as next month.

Lot Tan

The mandate brought mixed reactions from those in the industry.

The AARP applauded the news with executive vice president and chief advocacy and engagement officer Nancy LeaMond saying it “is a significant step in the fight against this pandemic.”

Locally, Laura Lamb, president and CEO of Episcopal Retirement Services, also supported the vaccine mandate as “an important step toward eradicating COVID-19.”

ERS, which operates nearly 30 retirement communities across the Tri-State, was one of the first in the area to announce in July that it would require all workers to get fully vaccinated against COVID-19.

But Van Runkle warns that many nursing home workers will quit if they are required to take a COVID vaccine, which could ultimately exacerbate a staffing shortage, hurt patient care, and cause facilities to close.

“We have a lot of folks who work in long-term care, whether we like that or not, who are not vaccinated,” Van Runkle said. “It’s their body and their choice.”

Van Runkle and the latest federal data show that 46 to 47 percent of Ohio nursing home health workers are not vaccinated against COVID, which he estimates at 50,000 workers.

“Who’s going to take care of people if we have a mass exodus or even a partial mass exodus of staff?” Van Runkle asked.

Van Runkle warns that facilities in rural areas with lower vaccination rates could be the most at-risk for closing. In Southwest Ohio, the counties with the lowest nursing home worker vaccination rates are Brown, Highland, Adams and Preble.

The latest federal data put Ohio, Kentucky and Indiana in the bottom 15 states with the lowest percentage of vaccinated nursing home staff per facility.

Lot Tan

Dennis Paulik, of Butler County, worries that his near 100-year-old mother, Helen, could face cold meals and delays in receiving personal care if the vaccine mandate is enforced.

She lived in isolation for months when visitors were banned from nursing homes during the height of the pandemic. He saw firsthand how staffing shortages impacted her care back then.

“If you need help getting dressed, there's nobody to help you get dressed in the morning,” he said, noting that his mother would sit for hours in a chair waiting for breakfast, often falling back asleep. She used her walker to go to the bathroom alone, despite being a fall risk, because no workers were available to help her.

Courtesy: Dennis Paulik

“You need help going to the bathroom, and nobody answers the bell,” he said.

Paulik complained and the nursing home, which he said is one of the best in the area, made improvements. But now he worries that a vaccine mandate will cause an extreme staff shortage and make life much harder for his mother – again.

“Even outside of COVID times, nursing homes have a hard time retaining staff, especially the nursing assistants who are the primary caregivers,” Paulik said. “It’s a minimum-paying job. It’s hard work. And a lot of people kind of pass through and figure out it’s not for them … so when you compound that with COVID restrictions, it’s been tough.”

An average nursing home in Ohio has 19 job openings, out of roughly 100 to 125 employees at an average facility, Van Runkle said.

“And that’s before this mandate,” Van Runkle said. “We’re already very short and then looking at this would just be disastrous.”

In the meantime, Van Runkle said, his parent organization, the American Health Care Association, is lobbying the Biden administration for federal funding to boost nursing home staff wages. He hopes any vaccine mandate includes exceptions for religious beliefs and medical conditions, while offering an alternative of more frequent COVID-19 testing for those who are opposed to taking the vaccine.

Paulik, who has been advocating for nursing home residents since the pandemic began, urges families to ask questions of nursing home administrators and stay in touch about staffing concerns or worries that a facility could close.

“Family councils may be another way of addressing the issue,” said Bob Vines, managing ombudsman at the nonprofit Pro Seniors Inc. “These are groups families have the right to form without interference to address any issue of concern to residents. We encourage all families to start one in the facility where their loved one resides.”

In the meantime, Paulik is planning a small outside picnic with a few family members to celebrate his mother’s 100^th birthday on Saturday and is hoping for the best.

“If I was an administrator and a director of nursing, I’d be really scared,” Paulik said.

April Kapu is president of the American Association of Nurse Practitioners. She says some of her exhausted members are now ready to quit. 

"Today we're seeing the nurses go back in and say, 'Oh my goodness, I thought this was over. I thought I was in the recovery phase,' and we're still in it," she said. 

Sophia Morris, vice president of account management at Aya Healthcare, said, "We're seeing a high level of burnout; hospitals are seeing their highest vacancy rate in several years."

Kapu said, "We're hearing nurses say, and nurse practitioners say, 'I can't do it again,' and so they leave for different types of jobs – some leave the profession entirely."

Kapu says RNs and nurse practitioners were already dealing with coworker shortages pre-pandemic. That meant unwanted overtime. Then the vaccines rolled out — and so did the skeptics. Some of those people flooding hospitals are now asking for the vaccine, but in many cases are too late.

"Being a critical care NP, I can handle a lot, but this has just been overwhelming," said Kapu.

The shortage of health care workers isn't isolated to hospitals. Some nursing home facilities across the country say they're also feeling the pinch, but for a different reason: workers with COVID, and some unwilling to get vaccinated.

Joseph Brown is the executive director of Savannah Court of the Palm Beaches. He said, "It's a selfish attitude to take, so I think it's more education and more dedication in the right direction." 

According to AARP, as of late June, nationally about 78% of nursing home residents have gotten a shot and are considered fully vaccinated. But only 56% of the health care staff can say the same.  

Nursing home operators want staff to get the shots, but some are worried that requiring workers to do that will end up with them quitting in an already tight job market. 

Mary Daniel's husband lives in a Florida care facility. She said: "They care about the elderly; they care about the disabled. And if that is truly the case, then to work in this environment – in an inpatient facility where there are residents – then you have to be vaccinated."

Kapu says the good news is that out of the association’s 325,000 members, 94% are vaccinated, and she says boosting the numbers could be as simple as talking to someone.

"So what we really need is to bring in more counseling, more ears to listen, so that we can bring our very best selves to the patients that are there right now," Kapu said.

This story was originally reported by Tammy Estwick on Newsy.com

WASHINGTON, D.C. — For Margo Buda, suiting up for work during the past year involved far more than it ever did before.

“It seems like a big blur to me,” she said. “There was concern that there was not going to be enough PPE.”

Personal protective equipment, referred to as PPE, became a major part of Buda’s work life, not at a hospital or a research lab, but at Knollwood Life Plan Community.

“If you’re over the age of 75, the last year and a half have been a little scary,” said resident Priscilla Cunningham.

It’s a senior living facility whose residents include military veterans and their spouses, all of whom were potentially vulnerable to COVID-19.

“We knew right away that testing was going to be a good way of finding out who's infected,” Buda said.

Yet, that was nearly an impossible task in the early days of the pandemic. So, to protect residents and staff, Buda, who is a nurse clinic manager, took it upon herself to set up a COVID-19 testing lab right inside the senior community.

“This is our instrument that we got,” she said, pointing to a machine inside the lab. “We became certified with the Department of Health, the forensic science division, and we just started testing anybody.”

It’s a move that potentially saved lives and has now led Buda to a national award for her efforts from the Ceca Foundation. The nonprofit honors caregivers in some of America’s 15,000 nursing homes.

“Our job basically is to recognize these caregivers for outstanding acts of care and many of them are under-recognized,” said Ceca Foundation co-founder Matt Lawlor.

Lawlor, along with his wife, Rosemary, started the foundation after his mother was in a care facility. There, they witnessed the hard work of those who were caring for her.

“It doesn't have to be a frontline worker. The caregiver can be the person in the kitchen where the person mopping the floors,” Rosemary Lawlor said. “You'd be amazed at the relationships that some of them have developed with people, and we never even think of them.”

However, the pandemic may have begun to change that.

“It raised the appreciation people have for health care givers,” Matt Lawlor said.

Those health care givers include people like Margo Buda.

“Margo's an unsung hero,” said Col. Brickerboss, Buda's boss and chief operating officer for Knollwood. “She's not going to brag about herself. She's very much like soldiers that I served with in Iraq and Afghanistan.”

Much like a soldier, Buda would put on her uniform and head out.

“She would suit up in PPE and go out and test 80, 90-year-old residents,” Col. Bricker said. “And you could see the fear in their eyes. But when Margo shows up, it almost builds confidence in them.”

With nearly everyone there now vaccinated, the constant testing will likely start winding down. For Buda, the vaccinations bring some relief.

“The pressure is a little bit off,” she said, “and people have more of a sense of normalcy.”

It’s a normalcy that comes thanks to the work of so many during the past year, including caregivers on the front lines.