Throughout 2020 and much of 2021, as the pandemic raged, nursing home staff fled their jobs amid the unsafe and poor working conditions, unfair compensation and the lack of work-life balance due to unrelenting overtime.
While staffing shortages have been commonplace in nursing homes for decades, the pandemic made it extremely hard to retain nurses in post-acute care/skilled nursing homes. U.S. Bureau of Labor Statistics data shows that the nursing home industry has lost approximately 235,000 jobs since the onset of the pandemic in March 2020 , representing a 15% loss in industry staffers. While some workers are shifting to healthcare jobs in hospitals or other types of facilities, many are leaving the industry entirely.
Nor is the staffing shortage expected to get better anytime soon. For example, a recent American Health Care Association/National Center for Assisted Living (AHCA/NCAL) survey finds that nearly every nursing home operator has trouble finding qualified workers. At the same time, a record three-quarters of facilities may close due to persistent staffing issues.
The ongoing shortage of nursing staff in the U.S. is causing a projected $19.5 billion in unrealized revenue by the end of this year. With organizational funding and reimbursement tied to patient volumes, every unoccupied bed equals a missed revenue opportunity and declining profitability. Without the necessary staff to increase patient volumes, nursing home operators nationwide are punting the organizational funding and reimbursement they need to thrive.
By Rebecca Love, chief clinical officer, IntelyCare.
The news media has done an excellent job of covering the country’s ongoing nursing shortage since the pandemic began. But one problem I have with the coverage is that most of the reports suggest the pandemic and the subsequent burnout suffered by nurses is to blame for the shortage.
Let’s be clear about what we in healthcare know all too well.
Years before February 2020, when COVID-19 began to spread across the globe, a growing number of care facilities around the country were chronically understaffed. The truth is the pandemic exacerbated and brought dramatic downward pressure on an already strained workforce. The issue came to the forefront because nurses were on the pandemic’s frontlines and in the spotlight. It shouldn’t have surprised anyone that the many ways the healthcare system has failed them – going back decades – were thrust into full public view.
Earlier this month, the St. Louis Post Dispatchpublished a story about the high turnover in area hospitals. At one hospital system, out of a 8,500-person staff, managers are losing 160 nurses a month, according to the paper. The story is much the same around the country. The Bureau of Labor Statistics estimates that the nation’s care facilities will be short 1.1 million registered nurses by next year. A problem is particularly serious for post-acute care facilities, which were seeing a pre-pandemic annual turnover rate of 128%.
Before the pandemic, shortages at facilities didn’t draw much attention because there was always some way to patch shifts together. Managers could hire per diem staff or travel nurses. Then, the pandemic struck and the backup resources administrators typically relied on dried up. With so many hospitals overflowing with COVID patients, few places possessed extra nurses.
When the COVID-19 pandemic first began affecting the United States, the entire healthcare industry moved swiftly to leverage existing technology and practices to meet the intensive demands of the global health crisis. Amid this incredibly tumultuous year, however, the healthcare community has also been able to actively develop new solutions and approaches to address some of the biggest problems we face, both related to the pandemic and beyond.
We connected with some of the leading voices in health IT to find out what they considered to be the biggest innovations of the past year and how they expect the landscape will continue to evolve in 2021, from advances in patient experience to greater public health data connectivity and more widespread digitization.
We saw prolific adoption of artificial intelligence (AI) solutions throughout 2020, particularly in the wake of the COVID-19 pandemic. For example, provider organizations leveraged chatbots and other rudimentary virtual symptom screening tools to decrease infection spread and address patients’ care needs without placing even more burden on the workforce. As we continue living in a global health crisis, we will see more provider organizations leveling up AI-enabled capabilities to help manage patient volumes as they ebb and flow during COVID-19 surges. Specifically, we will see providers bringing mature, AI-driven diagnostic tools into the exam room to provide reliable “second opinions” on demand.
As providers work to address the pandemic, they will also adjust their practice of medicine to better meet the needs of their BIPOC patients. In 2020, COVID-19 and racial injustice has highlighted serious racial disparities and underscored how important it is for health leaders to improve diagnostic accuracy and outcomes for traditionally disadvantaged populations. In 2021, I predict we will see greater inclusion and representation of patients of color in our medical education curricula and resources, clinical trials, and pool of medical students and residents.
2020 will be remembered for many things but in terms of healthcare information technology (HIT), it was the year of telehealth. 2021 will be the year that patients, providers, and payers blow the doors off the idea that “virtual” equals “video doctor’s appointments.” Virtual HIT enabling doctors and nurses to do their rounds virtually from down the hospital hall or the other side of the world will grow in popularity. It’ll be the year that hospital bedside patient engagement technology demonstrates its tremendous value in enabling higher quality and satisfaction from a pandemic-safe distance. We’ll also begin to see an increase of terrific HIT solutions integrating with the data plumbing that is an EHR to finally give nurses new efficiency and satisfaction.
As we look forward to 2021, healthcare IT will see a continued focus on the COVID-19 pandemic response, including the highly anticipated roll out of a vaccine. Vaccine administration is a key component of an effective pandemic response plan at both a local and state level. Health information exchanges (HIEs) have the ability to ingest and leverage data, including demographic information, from individual access points of care across the health system and will play a critical role in matching the COVID-19 vaccine data to the correct patient. HIEs also have the potential to streamline the reporting of individual vaccination information to the state for analytics. Harnessing this technology to accurately track vaccine data in near real time will provide crucial insight around who has been immunized and who hasn’t; who has received which vaccine and any side effects in the event that multiple vaccines are available; the ability to target under serviced populations and support ongoing resource planning as we continue to navigate these unprecedented times.
As the public is ordered to stay home to flatten the curve, healthcare systems are tasked to ‘raise the line’ by increasing staffing, adding beds, and moving to a telehealth model to keep patients out of hospitals. Clinicians who are not on the frontlines of the COVID-19 response are being asked to help assist the rest of medicine. During these virtual care visits, it’s critical for these clinicians to utilize clinician decision support software to aid in diagnosis and keep as many patients out of the acute care setting. These software systems can not only help triage cases of COVID-19 but also help quickly and accurately treat patients presenting with other conditions that still require care. Clinical decision support also supplements telehealth services to improve the patient experience, ease patient anxieties, and reduce some administrative burden for providers.
Response from Chris Caulfield, RN, NP-C, co-founder and chief nursing officer, IntelyCare
As a result of COVID-19, demand for healthcare professionals is at an all-time high, with nurses on the front lines providing care to patients in need. In this unprecedented time, nursing and other healthcare professionals need their provider organizations more than ever to support and protect them. One significant aspect of keeping nurses and their patients safe is COVID-19 education. The virus is rapidly evolving and nurses don’t always have time to find and walk through new COVID-19 protocols before each shift. Organizations can offer and promote online learning so that nurses can complete training on their devices and on their own time, and so facilities can ensure the entire workforce is well-equipped to treat and prevent the spread of COVID-19.
Another way to protect facilities, staff, and patients from unnecessary exposure to COVID-19 is the implementation of an online symptom screening that enables workers to remotely verify whether or not they are experiencing COVID-19 symptoms. Nurses that are experiencing COVID-19 symptoms can be removed from the shift without penalty, which can prevent the further spread of the virus to other nurses and the vulnerable populations they’re treating.
Response from Erin Jospe, MD, chief medical officer, Kyruus
With health systems needing to respond nimbly to the rapidly evolving landscape of caring for patients in the midst of a public health crisis, the key, as with any crisis, is to pursue a plan of action with thought and purpose. At a time when the majority of people seek healthcare information and services online, this principle and plan must extend to the role of digital access. The promise of digital technology is to leverage it creatively as a force multiplier, and to do so with an eye toward minimizing friction in care delivery and enabling the safest care possible. In the ambulatory setting, there are three distinct populations we need to think about servicing this way.
The first is the general population needing guidance on safely assessing their health while physically staying in their homes if at all possible. This is best achieved through the interplay of screening tools and virtual assistants with appropriate triaging for 1) those who can safely obtain self-care instruction 2) those who should have additional assessment through a combination of virtual appointments and direction for screening tests if warranted and 3) those who require immediate direction to the closest hospital or care facility. Screening engagement platforms, in conjunction with telemedicine, can decompress call centers, thereby freeing up staff, and help keep more patients safely at home.
In addition, more clinical staff can work remotely to provide virtual visits, maximizing the use of dwindling PPE resources for those who continue to serve on the front lines in direct patient contact. Digital technology can thus similarly benefit this second population, your health system staff and clinicians, by respecting their need for technology that works for and with them, promotes their physical safety, and conserves increasingly limited resources.
The third key population is patients with non-COVID medical needs, who require attention and outreach to help maintain their health. Digital platforms (e.g., telemedicine, automated outreach) can play an important role in keeping these patients well-informed, monitored, and safe, with clear access to information, both static and offered dynamically through real-time interactions when needed. Furthermore, those with chronic conditions that can become increasingly complex if left unchecked and where compliance issues may be exacerbated due to economic pressures, must be supported during this time even in the absence of acute symptoms – for their own well-being and to minimize the need to compete for scarce complex care resources.
While we all struggle to act quickly under these exceptional circumstances, using your digital investments to speak creatively to the needs of these populations is not only possible, it is necessary.
