BRISTOL, R.I. (WPRI) – Health care providers at the R.I. Veterans Home claim they are still struggling to adequately protect themselves and maintain safe staffing levels, contradicting a different version of the same story told by state officials.
The safety concerns were raised Wednesday by the union representing registered nurses at the state-owned nursing home for wartime veterans, where 17 residents and 28 employees have tested positive for COVID-19. At least four people have died after contracting the disease.
“They’re frustrated, they’re worried and they’re wondering why they don’t have the supplies that they should have,” said Cindy Lussier, president of UNAP Local 5019. “They wonder why they don’t have the staff that they need, they wonder why they don’t have a good method of communicating how things are going forward and they wonder why things like fit-testing for N95 masks have not been done.”
The union president sounded off during an interview with Target 12, claiming nurses and certified nursing assistants, or CNAs, have been forced to share protective equipment, including gowns and masks. When N95 masks are made available, she added, they’re not being fit-tested to each person’s face in accordance with recommendations by the U.S. Occupational Safety and Health Administration, or OSHA.
“Yesterday, I got a phone call from a nurse that said they were searching from unit to unit to try and find gloves,” Lussier said Wednesday. “We’ve been told that from time to time masks are not available.”
The narrative, however, is sharply contradicted by state officials, who insist there’s no longer any equipment shortages and supplies have been adequate since the nursing home started segregating sick patients to restricted parts of the nursing home last Friday.
“New surgical masks, N95 masks, gloves and gowns are provided at the beginning of each shift, and can be replaced during a shift if soiled,” Veterans Home spokesperson David Levesque wrote in an email. “Face shields are washed at the end of shifts, as they would normally be.”
Levesque also said nursing homes don’t typically fit test N95 masks, saying that’s something that happens at hospitals where health care providers work in negative pressure rooms. He also pointed to a memo from the U.S. Centers for Medicare and Medicaid Services, which directed health care facilities not to validate that fit tests have happened. (The validation process typically happens annually.)
OSHA officials have likewise issued guidance saying the validation process doesn’t need to happen during a time of limited supplies. But the agency also made clear that the guidance only applied after an initial fit test is provided when a health care providers first receives a N95 mask — which is not happening at the Veterans Home, according to the union.
“An N95 mask that is not properly fit-tested is ineffective. Period,” said union spokesperson Ray Sullivan. “Why is a nurse who works in a hospital entitled to a higher level of safety than a caregiver (or resident) who works in a nursing home?”
‘Go where the money is’
Beyond PPE, Veterans Home employees have also raised concerns about staffing shortages. The nursing home, with about 200 residents, was struggling to adequately staff operations even before COVID-19.
But the problem has worsened during the public health crisis, according to Lussier, especially since Raimondo announced the state would start giving more money to low-wage nursing home workers at privately operated long-term care facilities.
The Veterans Home, which is publicly owned, relies heavily on private staffing agencies for CNAs to work alongside full-time state employees. But Veterans Home employees don’t currently qualify for the hazard pay, effectively incentivizing agency workers to seek more shifts at private nursing homes, according to Lussier.
“If I’m going to make – in some cases — $8 or $9 more per hour plus bonuses to work additional shifts then I’m going to go where the money is,” she said. “The work is the same, but the money is just so much greater.”
The R.I. Department of Health, meanwhile, has asked nurses to stop picking up shifts at multiple locations in an effort to stop the disease from spreading into different nursing homes. Nursing home residents currently make up about three of every four COVID-19 related deaths in Rhode Island.
With fewer employees, Lussier said it’s not unusual for one registered nurse and one CNA to be caring for 16 residents at a time. And employees are frequently required to work two consecutive shifts because it’s a 24/7 operation and no one is available to pick up shifts.
“This is forced overtime,” Lussier said. “Nurses come to work prepared to work their eight-hour shift and then go home to care for their family … only to find out that they are going to be stuck there until midnight.”
Levesque did not respond to the concerns raised about hazard pay, but he acknowledged the shortage of agency staffing that he pointed out is prevalent across the nursing home industry.
“The competition for staffing during this public health crisis has been intense and the Home is not able to get additional staff from personnel agencies,” Levesque wrote in an email.
To help make up for those shortages, the R.I. National Guard has deployed 12 CNAs to the Veterans Home to work for two weeks, which will be followed up by 12 new CNAs that will work for two more weeks, Levesque added.
The nursing union, however, said the current staffing levels are still not enough, and Lussier said the prolonged shifts coupled with heavier caseloads elevates the probability of risks to
“You run the risk of increasing what’s referred to as ‘pressure ulcers’ because people don’t get turned is frequently and they don’t get up as much,” Lussier said. “It’s simply impossible with this sort of skeleton type staff to do all the things that are required. I mean, it’s simply impossible.”
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