"We did what we had to do": COVID-related money, emotional strains take toll on Piedmont nursing homes

Feb. 22—A year ago, Ed Weeks never would have expected his assisted living facility to look so empty.

Back then, families visited, residents gathered in the movie room, dining rooms were full of chatter and neighbors gathered in the halls to spend time together.

Now, Blakey Hall is quiet and solemn, with just a few residents masked up and walking back to the solitude of their rooms.

"Nobody really gave us a roadmap of how to get through a pandemic," Weeks said.

When COVID-19 struck the facility, Weeks and his staff had been bracing for impact. They expected a challenge, but what they didn't expect was the financial and emotional tolls it would take.

There are 15,655 skilled nursing facilities nationwide. In North Carolina, the Department of Health Service Regulation shows on its register 423 nursing homes and 591 adult care homes.

Alamance County accounts for eight of those nursing homes and 17 adult care homes. Randolph County has six nursing homes, six adult care homes and one multi-unit assisted housing facility registered.

All of them have felt the weight of the COVID-19 pandemic for the last 11 months, both emotionally and financially.

Before the pandemic, Blakey Hall in Elon had 63 residents in assisted living. By early February, 16 of those beds were empty.

"We had some people that went to the hospital and quite frankly declined to the point that they didn't come back because they needed to go to a skilled nursing facility," Weeks said. "I had a family that wanted to move their loved one out to get ahead on the safety side of it ... (and) we did have a couple people that got sick and didn't make it through."

Oaks of Alamance, another assisted living facility in Burlington, also lost residents from their original count of 62 before the pandemic hit.

"We did have one family who decided to take their loved one home to try to avoid the situation and then we had probably about three or four who had to go to a skilled nursing facility because they were progressing downward," Dustin Elledge, the administrator at Oaks of Alamance, said.

In Asheboro, Clapps Convalescent Nursing Home saw their occupancy decline from 93 percent before the pandemic to 80 percent as of February, administrator Grant Hollowell said.

"The number of admissions we were getting into the building has significantly decreased," he said. "We've (also) had to reduce the number of our short-term rehab beds because of COVID and quarantine and things like that."

While the loss of residents is heartbreaking, Weeks said these empty beds also affect the financial outlook for the facility.

"We're probably talking somewhere in the ballpark of a ($60,000- to $70,000-a-month) hit right now," Weeks explained.

A 2020 study conducted by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) asked 953 nursing home and assisted living facilities nationwide about their financial challenges during the COVID-19 pandemic. The results were grim.

The AHCA/NCAL study found that only 10 percent of facilities surveyed were operating with more than a 3 percent profit margin. In fact, 65 percent of respondents said their facility was currently operating at a loss.

Blakey Hall, Oaks of Alamance and Clapps Convalescent Nursing Home said they're just breaking even.

In an attempt to fill empty beds and recover lost revenues, Blakey Hall is still accepting new patients, but Weeks said it's been a challenge.

"Ever since March of last year, people just aren't real excited to moved their loved one into a place where they've been told upfront they're not going to be able to see them," he said. "A lot of people are just trying to figure out how to keep them at home or have support in-house until things loosen up."

Oaks of Alamance is also accepting new patients, but Elledge said they put those efforts on pause anytime there is an outbreak in the facility, adding to the challenge.

New cost burdens

On top of navigating those revenue losses, additional cost burdens have been added for these facilities.

Nine out of 10 AHCA/NCAL survey respondents said they had to hire additional staff and/or pay their staff overtime during their fight against COVID-19. Sixty-eight percent said they hired additional staff, 94% asked their staff to work overtime and 86% said they provided bonuses to their staff members during the pandemic. Of the respondents, 58% said these staffing costs were their biggest financial burden.

"We've definitely had to work a lot more overtime than usual," Weeks said.

"When we were hit in our dementia building with COVID, we had a lot of staff that were sick and not allowed to work either, and so I actually had to reach out to our local Alamance County Emergency Management. ... They sent me CNAs and LPNs and RNs to help me at least stay staffed during the actual outbreak," he added.

Oaks of Alamance also had to outsource additional staffing to prevent burn out.

"While we had COVID in the building, we had to use a temp agency," Elledge said. "We first let (our staff) work overtime, but at a certain point we didn't want to burn them out completely so we brought in extra staff as well."

Elledge also said that Oaks of Alamance has tried to not reduce staff hours or impact their personal finances throughout the pandemic, but without more residents coming in, that could become an issue.

"The big conversation has been matching the amount of staff that we have with the number of residents we have. ... We've tried to just match that and thankfully with our staffing it worked out that we've not had to reduce hours, but that might be something down the pipes if we can't get more residents in," he said.

Weeks said Blakey Hall has also been burdened by unexpected costs that many don't even think of, including things like disposable dinnerware for in-room food deliveries.

PPE was also a significant cost, especially as prices ballooned. The AHCA/NCAL study reported that 79 percent of nursing homes and 78 percent of assisted living facilities surveyed listed PPE as a top cost.

"All the PPE that we've had to purchase has been very expensive," Casey Conner, the director of operations at Clapps, said.

"A case of gloves was running $25 to $30 and now we're looking at $70 for those. Nitrile gloves were $40 to $45 and now we're paying $160 per case for those. We're also buying more stuff," Hollowell said.

When supply was limited, these facilities had to buy what they could, no matter the price tag.

"We were starting to get worried that we weren't even going to be able to get the supplies that we needed. ... We did what we had to do," Weeks said.

State officials, once they got their hands on the supplies, were able to help.

"I was trying to purchase PPE from vendors and they were actually telling me, 'I'm sorry. We've been ordered that we can only sell to the state and to hospitals,'" Weeks said. "The state did jump in once they were able to get the PPE."

Distribution of PPE was also supported by the federal government, Weeks added. All long-term care facility providers in the area were able to go to the Greensboro Colosseum to pick up more supplies during designated time slots.

"I think that everybody has done the best they could moving forward with something that's completely unknown. ... Everybody was just pulling together trying to figure this thing out as we went," Weeks said.

Looking ahead

With these added cost burdens, the financial futures of these facilities are unclear.

"I can't say if it's going to be two months or six years (that we can keep operating). We're just going to keep controlling our expenses and going from there," Hollowell said.

Weeks said administrative changes made throughout the pandemic have kept Blakey Hall going to the point where he thinks the facility will make it through financially.

"Like every other facility, you're just trying to survive this," he said. "I feel pretty confident in our personal plan that we'll get through. ... Now that we're able to start vaccinating, we're seeing a light at the end of the tunnel that we didn't for the last 11 months."

In the AHCA/NCAL survey, 66 percent of nursing homes said they will not make it another year given their current operating pace. Only 34 percent said they will make it more than one year, with 28 percent estimating they can hold on for seven to 12 months and another 28 percent saying they can make it another four to six months. Ten percent of respondents said they couldn't make it more than three months.

Other long-term care facilities in the area, Weeks said, may not be as lucky, depending on where their revenue comes from.

"A lot of other communities focus a lot on more solely as a Medicaid provider for residents and they don't have the flexibility because they're already sorely underfunded," Weeks explained. "When (COVID began), there was some additional assistance, but not really enough to keep them afloat so they're really, really struggling."

Elledge said Oaks of Alamance was one of those facilities that received support in the form of increased Medicaid funding.

"When you have COVID in the building, the state does allow additional funding for those Medicaid residents that you do have. It increases the amount that you receive off them to try to offset the extra spending. It's great, but it doesn't pay for everything. I'm happy to have it, but again, it puts us in the middle in terms of profit," he explained.

Clapps also benefitted from that extra funding, with Hollowell stating, "If we had not received funds from the federal government and North Carolina Medicaid, (the financial impact) would have been very, very significant, but the help they've been able to give nursing homes has helped out tremendously."

The AHCA/NCAL study found that 45 percent of nursing homes that responded said they will experience "significant operational challenges" once they exhaust that additional funding.

The emotional toll

In addition to the financial struggles, the pandemic has also brought heaps of emotional turmoil for these communities.

"You're not just afraid of the coronavirus, you're also seeing major depression kick in with residents," Weeks said. "You felt like well maybe this will only last a month, maybe it will last two months, maybe it will be six months and here we are almost to a year and it's just been really, really difficult on them."

"I've had a resident say the coronavirus isn't as bad as what this is," he added. "I've had a resident that said I'd rather not live like this and they were kind of insinuating that death is better than solitude."

Staff members have not been immune to these emotional challenges.

"Our staff is dealing with things they've never dealt with before," Hollowell said. "You hear that it's going to come through and decimate nursing homes and then it does."

"It's been pretty rough to sort of lock the door, put a sign on the door and prevent families from doing that one-on-one visiting," Elledge said. "We've been stuck in this box where families have been able to visit by phone or through a window but that's still not as personal as walking into Mom's room."

"It breaks your heart because you are an extension of these folks' families and you're watching people just lose weight, in some cases they're starting to give up," Weeks said. "It's really difficult for the staff to see somebody that they see every day and they're just declining and there's nothing that they can do."

In an attempt to keep up morale, these facilities have provided bonuses, increased pay, free meals and more to staff. For residents, vaccination events have been planned, special meals have been brought in and iPads have been purchased to facilitate more e-visits with family.

"Emotionally, it's been a toll for everybody," Elledge said.

Elizabeth Pattman is the trending topics reporter for the Times-News in Burlington, covering business, COVID-19 and all things trending. Contact Elizabeth (she/her) at epattman@gannett.com. I'm also available on social media @EPattmanTN on Twitter or @burlingtontimesnews on Instagram.

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