ALLENTOWN, Pa. — To fill holes in employment and meet updating guidelines, Cedarbrook is contracting out one-third of the nursing workforce to an outside employment agency.
Officials from the county-owned Cedarbrook Senior Care and Rehab in Allentown told Lehigh County Commissioners on Wednesday that staffing situations were improving better than at many other locations.
But they still fall short in the face of new state and federal requirements and continued staffing shortfalls from the coronavirus pandemic.
"Currently, there is still a 130,000 nursing home worker shortage in the United States versus pre-pandemic, and that certainly does impact access to care."Cedarbrook Director Jason Cumello
Cedarbrook Director Jason Cumello said in the presentation that staffing stabilized only in the second half of 2022, and they "still have a lot of ground to make up."
"Currently, there is still a 130,000 nursing home worker shortage in the United States versus pre-pandemic, and that certainly does impact access to care," Cumello said.
He said the outside nursing agency in three- to four-month contracts would allow employees greater flexibility, hence the appeal.
"Increasingly, people want to be paid all cash and really no benefits versus the way that we're paid with the county," Cumello said.
"We're paid very well, truly, and we have great benefits, but the desire certainly is all cash."
The presentation states the employees work like full-time employees, just on multi-month assignments.
Regulations put focus on staffing
The federal government's Centers for Medicare and Medicaid Services announced its final new regulations this week for long-term care facilities, noting specific staffing standards.
In the past, the regulation was far less specific, only stating that adequate staffing was needed.
For the nearly 1.2 million Medicare and Medicaid-certified long-term care facilities in the country, the report says, it will require a minimum of 3.48 staffing hours per resident day.
That must include at least 0.55 of an hour per resident day of direct registered nurse care and 2.45 hours per resident day of direct nurse aide care.
The report states that any combination of nursing staff can be used to account for the additional 0.48 of an hour per resident day required.
It also requires a registered nurse onsite 24 hours a day, seven days a week.
The new employee baseline "will significantly reduce the risk of unsafe and low-quality care for residents across all [long-term care] facilities."U.S. Centers for Medicare and Medicaid Services report
The report announcing the rule states that the new baseline "will significantly reduce the risk of unsafe and low-quality care for residents across all [long-term care] facilities."
The new standards will be implemented on a staggered timeline in coming years.
Also, new regulations put in place last year set a minimum number of hours each resident should get in direct care, and maximize the number of people assigned to each skilled worker at nursing homes as part of an effort to improve long-term care facilities statewide.
Facilities are required to provide each resident with at least 2.87 hours of direct care per day. That will increase to 3.2 hours on July 1.
Cumello said he was confident the facility could meet new staffing requirements, but that it would be difficult, particularly on weekends.
In the past 60 days, Cumello said, Cedarbrook was typically meeting 3.7 to 3.8 hours per patient day, but it varies.
High turnover, challenges continue
According to the presentation to the commissioners, facilities such as Cedarbrook see a turnover rate of 52.7% for nursing staff and 49.5% for registered nurses.
At Cedarbrook, nursing staff turnover is 33.7% and registered nurse staff is 18.6% — better than the national average for the industry.
Cedarbrook is "making progress with recruitment" but the management "still has a lot of ground to make up" in staffing.Cedarbrook Director Jason Cumello
The presentation said Cedarbrook is "making progress with recruitment" but that the management "still has a lot of ground to make up."
Cumello said they are evaluating new software for payment and tracking of staff.
He said the facility averaged 512 residents per day last year, down from about 625 in a typical year pre-pandemic.
Despite challenges, Cumello noted the facility's listing as one of the best nursing homes in the country as ranked by Newsweek, at No. 19.
He said it continues to perform above average, according to rating agencies.
