The Gallatin Center for Rehabilitation and Healing in Gallatin, Tennessee, is shown in this March 30 file photo. Nursing homes were having difficulty hiring staff before the coronavirus pandemic, which has made staffing even more challenging at nursing homes, which have seen coronavirus outbreaks across the country. Credit: Mark Humphrey | AP

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The already daunting task of finding staff for Maine’s nursing homes and assisted living facilities is only growing more difficult now that the spread of the coronavirus has been documented in some of those places.

At least two dozen workers have been infected in the ongoing outbreaks that have been detected at facilities in Belfast, Augusta and Scarborough. That’s 24 workers who must now leave work for at least two weeks to recover and ensure they’re not contagious, even as the facilities must take on the added stress of caring for sick residents.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

Even before the coronavirus pandemic swept across the country, finding substitutes for those 24 workers would have been a challenge in an industry facing trenchant staff shortages.

Facilities may have had to pay extra for outside agencies to supply temporary workers. The absences also would have rippled out to any other long-term care facilities where the infected employees worked second, third or fourth jobs. That’s common in a profession where the nursing assistants who help residents with everything from bathing to dressing to going to the bathroom earned a median wage of $14.59 per hour in Maine last year.

Now, the difficulty is multiplied by the risk that any substitute workers may catch COVID-19 — the disease caused by the novel coronavirus — when they enter the facility that has the outbreak. What’s more, there is also the danger that employees who work in several different locations could unknowingly spread the infection outside the site of the outbreak, too.

The situation is even more challenging because the state has only been able to provide limited supplies of personal protective equipment, or PPE, to the state’s long-term care facilities, according to Jess Maurer, executive director of the Maine Council on Aging, a network of groups trying to improve elder care across the state. She noted that at least 14 workers have tested positive for the virus at the Augusta Center for Health and Rehabilitation, where nearly two-thirds of the 63 residents also tested positive.

“All those staff people have to be gone. They can’t continue to work,” Maurer said. “Now, you’re bringing in 14 new people and potentially exposing them and trying to contain the spread, and you’re dealing with very, very sick people and going through PPE like crazy. My heart just completely is breaking for these situations.”

In Maine, at least one worker from the three facilities that have ongoing outbreaks worked at “a number of different facilities,” according to Nirav Shah, director of the Maine Center for Disease Control and Prevention.

“It is not uncommon for facilities to share staff, for example therapists or technicians who may have appointments at different facilities and rotate across the state,” Shah said during a press conference Tuesday afternoon. “That is a common practice not just with long-term care facilities, but in the health care world overall.

“We haven’t identified a single person that unifies all three of these facilities, yet,” Shah said, “but that is part of our investigative process.”

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To help long-term care facilities weather the new challenges posed by the coronavirus, the Maine Department of Health and Human Services is now providing an additional $8.8 million in state and federal dollars to nursing facilities for the three-month period that started in March to cover coronavirus-related costs, according to Commissioner Jeanne Lambrew. A supplemental budget bill the Legislature passed as it was wrapping up business last month also included funding to raise pay for direct-care workers at nursing homes and other long-term care facilities.

And on Monday, Shah announced that the Maine CDC was preparing to send dozens of shipments of personal protective equipment to long-term care facilities across the state.

Those shipments are on top of emergency supplies it has already delivered to the three facilities that have so far experienced outbreaks: the Maine Veterans’ Home in Scarborough, Tall Pines Retirement and Healthcare Community in Belfast and the Augusta Center for Health and Rehabilitation.

The pandemic has exacerbated a number of existing pressures on long-term care facilities in Maine, according to Rick Erb, executive director of the Maine Health Care Association, the trade group for Maine’s nursing homes and assisted living facilities.

“Before the COVID-19 crisis, there was already a well-documented workforce shortage in long-term care. That was our starting point,” Erb said. “COVID-19 has made that situation even more complicated, because of the need for additional staffing and the problems that come up when staff begin testing positive, which we are seeing now.”

Erb said that the new state resources will help facilities to handle the increased demand of the coronavirus, but he also said that some facilities are still concerned about whether they’ll have enough protective equipment if they also experience outbreaks.

One of the unique challenges of this pandemic will be finding staff to work at long-term care facilities that are short-staffed when there is a risk that asymptomatic employees could be spreading the infection, especially when they work at other places, Erb said.

While those facilities may not have the luxury of turning down staff who work in other centers, he said they could try to mitigate the risks with other steps, such as rigorous screening of workers and additional use of protective equipment.

“Long-term care is very labor-intensive,” he said. “It requires people with specific skills and licenses. That hasn’t changed, and there is a limited pool to draw from.”

Watch: Should you remove loved ones from care facilities during the outbreak?

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