LOWVILLE — There has been no in-hospital spread of COVID-19 in the Lewis County Health System and no new cases in the nursing home for months. Some nursing home staffing goals are close to being met, and new strategies are being made to “un-pause” maternity.
It is taking a lot of flexibility and planning, but Lewis County Health System Chief Executive Officer Gerald R. Cayer believes that despite the challenges created by the vaccine mandate — which is “not political, just a fact” — the system’s mix of work-arounds and responses to those challenges are having some success.
When the vaccination deadline passed in September, five staff members had been granted medical exemptions. The health system still has 23 religious exemptions in effect as the validity of religious exemptions in New York’s mandate continues through the judicial process. The state is appealing a federal judge’s decision that religious exemptions should be allowed.
Mr. Cayer believes both sets of exemptions are likely to be temporary.
The medical conditions for which all five medical exemptions were granted have end dates when the medical situation will be resolved. Two of those staff members have already passed that point and will be vaccinated to return to work.
In the interim, anyone with an exemption is fitted for N95 masks, referred to by Mr. Cayer as “an incredibly effective tool,” that need to be worn constantly throughout their shifts. Every week, a rapid test is done to ensure they are COVID-free.
Originally, the health system had intended to test twice weekly, but the rapid test allocation for the health system isn’t enough to support testing demand.
“Recent history helped determine what our allocation would be for these tests,” through the supply chain process, Mr. Cayer said. ”It’s meeting our needs, but for the medical and religious exemptions, if we take those 26 people and tested them every single day, that would put us beyond the allocation that we receive today.”
While they could request more, it is unlikely the request would be fulfilled, Mr. Cayer said.
The health system’s share of rapid testing materials are used daily for asymptomatic individuals who are either given a directive by Lewis County Public Health, are symptomatic employees in the health system or as part of the pre-operative process for those getting elective surgeries at the facility.
“It’s not a crisis. We’ve been able to put different approaches together so we are able to test people appropriately and in a timely way,” he said. “The most important additional resource that has come to our community is being able to reopen the Maple Ridge Center.”
The approach to keeping the patients, residents and staff safe while meeting all of the safety requirements issued by state and federal authorities has been “thoughtful and efficient,” Mr. Cayer said, in part by approaching testing both outside and inside the hospital to make the best use of the resources available and identify cases of COVID-19 early.
“I think right now we have not had internal transmission and we haven’t for a long time here, so, if we step back and look at the whole big picture, our strategies are working,” he said. “At the nursing home, it’s been a long time since we’ve had a COVID infection. What does that tell you? That Deb (Nursing home administrator Deborah Wurz) and her team are doing a great job.”
What has also been working is the steps the health system has taken to alleviate nursing home staffing pressures in June, months before the vaccine mandate was implemented, when the starting wage was raised to $20 for certified nursing assistants — notoriously the most challenging positions to keep filled — and licensed practical nurse wages were increased by $2.50.
The program focuses both on hiring experienced, vaccinated CNAs and, through a training program at the facility, “growing our own,” Mr. Cayer said.
“It’s been good. ... One of our goals is to be able to staff the evening shift at the same level as the first (day) shift and most days we’re able to accomplish that,” Mr. Cayer said.
So far, 51 interviews have led to the training and hiring of 30 CNAs. There is a full CNA class in progress and another that begins in November.
There are also only two LPN positions still available and 11 more CNA spots.
“I think we’re making good headway,” Mr. Cayer said. “We’re still working on it but I’m really pleased with the success of the program and how the team has handled that at the residential facility.”
In areas where filling positions has been more challenging, like finding the six nurses necessary to “un-pause” maternity services, Mr. Cayer and his team are adjusting their approach.
The focus has shifted to recruiting an experienced labor delivery, postpartum nurse who can serve as the new maternity manager.
“I see that as our new next step in being able to move more quickly in replenishing that team,” he said. “We continue to work on that and remain hopeful that it will be sooner rather than later.”
He said the pause “was a hard blow,” but also a “short-term disruption” everyone in the health system is determined to rectify.
To address the staffing challenge throughout the facility, the support services arena — from cleaning and maintenance to food service workers — Mr. Cayer has proposed a “three-prong approach” to the executive and finance committees of the health system’s board. The plan includes recruitment, retention and crisis pay “to cover any holes.”
Discussions are underway with the local union around implementation of the plan.
Mr. Cayer said that while traveling nurses have been added and the Medical-Surgical Department has been stable, the Emergency Department fluctuates frequently. Last week, the Emergency Department went on four-hour diversions during which more patients could not be accepted on three occasions, he said. This week, there have been none.
“The best scenario is every slot is full, people are able to work the hours they would like to work and we’re able to meet the services. I would say we’re not there at that point,” Mr. Cayer said. “In the life of every organization, you hit tough periods. An organization doesn’t last for 90 years by walking away when you hit a tough period.”
The health system staff is 96% vaccinated. The remaining 4% are the exemptions.