Nursing Homes in Crisis

If you’ve read my book, you know how hard I worked to get Dan into the nursing home that in the book is called Harbor House, how delighted I was when he moved there, and how happy he was and how much ground he regained while he lived there. First, administration changed hands, and then COVID demolished the conditions there, as it did in nursing homes all over the country. When he left in 2021, we were relieved to get him out of those conditions, and when he returned last December 31st, we expected (because we were told) that conditions had improved.

And they had. But, as we have found over the past six months, not really enough.

Harbor House—again, like nursing homes across the country—is severely understaffed. Although it has increased salaries significantly and has taken steps to generate better working conditions, it just hasn’t been able to attract competent new employees. As a result, it has come to rely on agency workers—temporary, rotating staff who are employed from an outside company.

In my experience, overall the nursing and CNA staff seem to be well-trained and caring. But the reliance on agency workers has drawbacks. Because agency staff command high wages, Harbor House can’t hire enough of them. So it remains severely understaffed, with few workers caring for many residents. That means long wait times for residents who need their help.

Also, the temporary nature of their assignment results in a revolving door of nurses and CNAs, which hinders the development of relationships—relationships not only with other staff, but (more importantly) with residents themselves, and their family members. For someone in Dan’s position, someone who can’t speak and who relies on slow and imperfect media to communicate, relationships with those caring for him are acutely important. It requires time to understand what he works so hard to say, and to get a sense of the rhythms of his routine to give his needs a consistent context. And the mutual lack of familiarity precludes the kind of trust and acceptance that makes the intimacy of his needs (showering, dressing and undressing, toileting) more comfortable.

I’ve spoken at length with the very caring staff at Harbor House and am convinced that it is doing all it can to address its staffing woes. I certainly can’t think of any solution that they’re holding back on. It’s just a bad situation, and I hope (but without any real confidence) that it gets better soon.