Jon Lips, JD, Vice President of Legal and Regulatory Affairs with LeadingAge Minnesota, joined the January 19, 2022 Leading Age Coronavirus Update call. He responded to questions from Ruth Katz and from callers. Here is a summary of the conversation.

Q: What is happening with COVID in Minnesota?

A: The first case of confirmed omicron occurred in early December in MN and it is now the dominant strain. The community transmission rate is high across MN, as is the positivity rate. We are seeing cases in long term care, but at a lower level than we might have seen without the beneficial effects of vaccinations and boosters.

Q: Indeed, omicron has spread very rapidly and is creating new challenges. What is the number one issue for providers in MN right now?

A: As you might guess, it is definitely workforce. We are experiencing a very severe staffing shortage across all settings. In addition to longer term macro shortages, we are also seeing short term outages because of omicron – cases, exposure, etc. MN was not under the injunction for the CMS mandate and so our Phase 1 deadline for the mandate is January 27.

Q: What was involved in building the case to the Governor for the involvement of the National Guard?

A: We did not advocate specifically for the deployment of the National Guard, but we did advocate that the state find a way to provide staffing relief. We are concerned not only about the need to fill open shifts, but also about the need to provide some respite for staff who have been doing double shifts, working understaffed, etc. We built the case to the state using data. We conducted a survey in partnership with the AHCA MN affiliate to get real time data from our members on staffing issues. The data were compelling and showed the many effects of staffing shortages, including how it was impacting access to care. We put a plan together to share that information with state agencies, law makers, and the media. The strong relationships we have developed within the state proved valuable.

Q: What did you find surprising about the data?

A: We certainly knew what the categories of problems might be, but what was surprising was how much the key data points had changed in just a few months. We learned that there were 23,000 open positions in nursing homes and assisted living centers – about 20% of the MN caregiving workforce. This eclipsed even the earlier COVID- related staffing issues, and the gap was widening – we were losing more staff than we were hiring.

Q: More than half of the National Guard members deployed have been sent to work in long term care. What, specifically, are they doing to provide help, and how is it going?

A: It is going very well so far. What we are hearing is that the National Guard members are helpful, respectful, reliable, and capable. For people often from coming from other walks of life, they are doing a very good job. They have only been sent to nursing homes at this point. They are receiving training commensurate to the roles they are playing. Some are being trained as Certified Nursing Assistants and are receiving the 75+ hours of training in a condensed time frame and then throwing themselves into the work. There are also some with a bit less training who would have other direct care roles. National Guard members can also provide support in dining and housekeeping.

Q: When a nursing home requests help, how does that work?

A: There is an application process in which the nursing home provides information about their workforce, what their unfilled shifts are, and whether they are in nursing, dining or housekeeping. They need to describe what they have already tried to mitigate the staffing situation. The State looks at this and then prior to assigning someone, a site visit is conducted.

Q: What has been the experience of the National Guard members who are filling these roles?

A: They are being trained before being deployed through partnerships with colleges, and others who provide the training. This is only anecdotal, but I have heard that the men and women of the Guard have been favorably impressed with the work and with our field. Some have expressed interest in exploring a more permanent move into the long term care field.

Q: That is good to hear. How long are the assignments and how long will the whole project last?

A: Most deployments are 10-14 ys – two weeks is standard. The idea is to stabilize the facility and then taper off. But if the facility is still having problems that can be extended an additional week. How long the project will last is an unknown. It is likely that the level of need, hospitalization rates, and other types of data will influence the decisions as to when to end the program.

Q: Is there a way nursing homes can see in advance what sorts of support might be available?

A: The determination of what National Guard members are going to do is worked out individually with the facility based on their needs. The State also operates a matching service for facilities that are in outbreak. Through the Department of Health they can enter open shifts into a system and there is a pool of individuals who can decide whether to pick up those shifts or not. So far, this only applies to nursing and CNA positions, but it may open to dining and housekeeping at some point.

Q: Will the National Guard help be available if you are in an outbreak?

A: When the National Guard deployment began, the mission was to find facilities that were not in outbreak and serve them. The matching program is targeted to facilities that are in outbreak. But this is a fluid situation, and we are hearing talk that there may be flexibility in the future.