Nursing homes for veterans grapple with staffing

By Jim Saunders
News Service of Florida

Grappling with problems that began during the depths of the COVID-19 pandemic, Florida veterans’ nursing homes have empty beds because of staffing shortages.

Bob Asztalos, deputy executive director of the Florida Department of Veterans’ Affairs, told a House panel last Tuesday that 34 veterans have met criteria for admission to nursing homes but are waiting for placement. He also said 120 applications are in the process of being completed.

Asztalos said six nursing homes are at 80 percent capacity. Two others that opened last year in Port St. Lucie and Orlando are at far lower capacity: The 120-bed Port St. Lucie nursing home, for example, has 19 residents.

Like other parts of the health-care industry, veterans’ nursing homes have been forced to turn to costly staffing agencies for people to work in the facilities. The Department of Veterans’ Affairs has taken steps to try to reduce the number of workers from the agencies.

In addition to higher costs, Astzalos said staffing-agency workers do not know residents and don’t provide the same quality of care as permanent employees.

“There’s no magic formula to it,” Astzalos told the House Local Administration, Federal Affairs & Special Districts Subcommittee. “It’s just grinding down. It’s getting out there. It’s hiring people. Hire a person. Move an agency person out.”

Nursing homes were hit hard early in the pandemic, as COVID-19 poses a particular threat to seniors and people with pre-existing medical conditions. Many facilities also struggled with staffing, as workers got sick or left their jobs.

Astzalos said the “census” — a measurement of the number of residents — was about 60 percent of capacity in the six veterans’ nursing homes at the worst part of the pandemic.

To help deal with the staffing problems, Astzalos said the Legislature last year provided $5.6 million for incentive pay. He said that has helped veterans’ nursing homes fill 123 positions since July 1, including 93 direct-care positions of nurses and certified nursing assistants. But he said the department would still need to hire about a third of nursing-home staff to be able to fill all of its beds.

Astzalos said the department pays $17 an hour for certified nursing assistants, who provide much of the hands-on care to residents. But it had to pay as much as $40 to $45 an hour to staffing agencies, though it now pays $23 to $32 an hour.

Rep. Robin Bartleman, D-Weston, said during Tuesday’s meeting that she understands the concerns about using staffing agencies, but she said some veterans are in “dire situations” and don’t have nursing-home beds.

“For me, it’s more important to get that veteran in that bed, whether or not it’s your employee or somebody else’s employee,” Bartleman said. “Some veteran is in dire straits right now, and their family is in dire straits because you are having this tug-of-war with the staffing agencies. And so, is that (a matter of) raising the salaries of your staff? Because it’s not just your problem. It’s every nursing home. It’s every hospital.”

Astzalos said Bartleman’s comments reflect the “challenges that we face.” He said he thinks veterans’ nursing homes pay competitive salaries with the private sector for nurses and certified nursing assistants, but “it’s just a matter of being able to hire.” He said veterans’ homes are not competitive in paying people such as human-resources employees, which causes turnover.

“It’s about putting veterans into beds. But it’s also about quality care, too,” Astzalos said. “If we put a veteran in our bed, we want to make sure that we can provide the highest-quality care and we want to have the right people to do that. And that’s what we wrestle with.”

The six nursing homes that were open before last year are each 120 beds. They are in Daytona Beach, Land O’ Lakes, Pembroke Pines, Panama City, Port Charlotte and St. Augustine. In addition to the Port St. Lucie nursing home and the 112-bed Orlando nursing home that opened last year, the department plans to build homes in Collier and Marion counties.