'It's the hardest job you'll ever love': What it's like to work in a nursing home during COVID-19
The employees at Focused Care of Waxahachie, Texas, end each staff meeting with a group chant.
"RAMP it up!" they yell in unison. RAMP, which stands for "residents are my priority," is a call to action for the nursing home's 62 workers, charged with caring for the community's highest-risk populations.
And it's evident that the staff members take that message to heart. The nurses; certified nursing assistants, or CNAs; kitchen staff and housekeepers say they know their residents as if they were part of their own family.
As the omicron variant spreads, sickening some employees and forcing others to quarantine, Focused Care's staff have stepped up, as they did in every previous surge. They work overtime, stay late and answer calls in the middle of the night—all to ensure their residents are properly cared for.
"We know if we leave, nobody's going to be here for our residents, so we try to help each other out," said Shaniece Dickerson, a CNA at the nursing home.
Staffing shortages have plagued long-term care facilities throughout the pandemic, forcing some to limit the number of new residents they could accept.
Nationally, nursing homes and assisted care facilities lost more than 230,000 workers—more than 15% of the workforce—since the beginning of the pandemic, according to the American Health Care Association and the National Center for Assisted Living.
COVID-19 cases among North Texas nursing home residents are rising thanks to the omicron variant, according to Texas Department of Health and Human Services data. In the long-term care region containing Dallas, Denton, Tarrant and Collin counties, cases jumped from 1,139 on Jan. 11 to 1,633 on Jan. 18.
Focused Care officials say the nursing home has fared relatively well with staffing compared to other nursing homes. The facility didn't see a mass exodus of workers during four COVID-19 surges in North Texas, said Randy Langford, executive director of operations at the nursing home.
Filling open positions, on the other hand, has proven difficult. Langford said he's trying to hire more workers to give current staff more of a break, but candidates routinely don't show up to their interviews.
At the beginning of the pandemic, he blamed some of the lack of interest in the field on federal unemployment benefits, which gave workers the financial flexibility to stay home. Long-term care facilities also got a bad rap at the beginning of the pandemic, Langford said, because of early outbreaks at nursing homes.
Adding to staffing woes is the fact that nursing home workers aren't immune to COVID-19. Across the country, nursing home staffs had more than 58,000 weekly cases as of Jan. 16, up from 5,919 four weeks prior, the Centers for Disease Control and Prevention reported.
At Focused Care, 14 workers have tested positive for the virus during the omicron wave. The facility, which tests staff twice a week, has yet to have two consecutive weeks without at least one COVID-19 case since the omicron variant came to North Texas.
Dickerson, who started working on Focused Care's kitchen staff around 10 years ago, regularly picks up additional shifts, sometimes working 15 to 20 extra hours per week. She spends all of that time in an N95 mask to protect the elderly residents.
Even though it's physically and mentally exhausting at times, she said she's there to support the rest of the staff. "We are like family, and that's what keeps us together," she said.
Nursing homes, much like hospitals, are 24-hour businesses. They have to be staffed at all times, with additional staffing required in emergency situations.
Focused Care does not currently have any COVID-19-positive residents. But when a resident does contract the virus, the facility opens the "hot zone."
A six-room corner of the nursing home becomes a mini-COVID-19 ward, with red tape and curtains cautioning people from entering unless absolutely necessary. Employees working in the "hot zone" don't work anywhere else in the facility, and employees outside of the "hot zone" never enter it.
Decked in what interim director of nursing Julia Smith compared to a plastic trash bag, "hot zone" workers have to stay in full protective gear. It's a difficult reality when caring for patients who want the opportunity for human touch and connection, she said.
Visitors are allowed in the facility, unlike at the beginning of the pandemic, although they have to wear masks, answer questions about potential COVID-19 exposures and have their temperatures checked.
Watching her residents suffer from the isolation of the first year of the pandemic was particularly heartbreaking, Smith said. Even if they never contracted the virus, many residents saw their health decline from the sheer loneliness of not getting to be with their families.
"Whenever I'm interviewing someone, I ask 'What brings you to long-term care?' Because this is the hardest job you'll ever love," she said. "If you don't have the heart to do this, you're not going to be successful and you're not going to be happy."
Smith, like many of her coworkers, works far longer hours than she did before the onset of the pandemic. She started her role at Focused Care in late November, when COVID-19 numbers had been in decline for over a month. Then omicron hit.
Responsible for educating the nursing staff on the latest federal safety guidelines, in addition to coordinating care for the facility's residents, Smith said she regularly works more than 60 hours per week. That doesn't include the phone calls she gets from her staff at night when she's technically off-the-clock.
It's not uncommon for Langford to have to come back to Focused Care late at night because of a problem with a resident or the building. Langford, who worked as a pastor before transitioning into long-term care management, was at the facility in the middle of the night just a few days before because a breaker broke. COVID-19 has only made the hours worse, he said.
"I've worked more weekends than I've probably ever worked in my career since COVID," he said. "It has unique issues."
Focused Care's staff is trying to do what it can to remain positive, even with the uncertain future of the pandemic. The little things, like laughing with residents and "cutting up" with each other, are what keep them motivated to come into work each day. That, and love.
"As I said, it's the hardest job you'll ever love," Smith said. "Because, but for the grace of God, that person laying in there could be one of your loved ones."
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