Who would open a senior care home in the middle of a pandemic? These Sacramento nurses

The staggering death toll in nursing homes during the COVID-19 pandemic brought heartache and suffering to tens of thousands of families. More than 130,000 residents and nearly 2,000 staff members have died from the virus across the U.S.

Given these grim numbers, why would anyone open a new long-term care facility for the elderly in the middle of an ongoing pandemic?

In Sacramento, a group of nurses is doing just that.

With no positive COVID-19 cases to date for both staffers and residents in their current three board and care homes in California, including in Lincoln, a group called Care Home by RNs decided to take on a new project: Quiescence Care Home.

Opening a new elder-care home, even a small one, represents a sliver of hope in an industry ravaged by a global pandemic despite every effort to isolate and protect their residents and staff. To experts who study the industry, the pandemic has forced nursing homes to recalibrate how they are going to care for a burgeoning elderly population and prepare for the next one.

Experts believe elder care will transition to smaller, more community-oriented homes with specialized care or acute-level patients. Many recently opened homes fit this model, according to Dr. Laura Wagner, a nursing professor at UCSF.

“Nursing homes are going to become almost mini hospitals,” Wagner said.

Located on Walnut Avenue near American River College, the high-ceilinged, six-bed congregate living health facility was built by nurses, including Dr. Ron Ordona, the founder, and many of the current team members.

In 2006, Ordona, along with a group of good friends and colleagues, pooled their money together to buy their first board and care home in Lincoln. The company has added two more facilities in Lincoln and South San Francisco, and now Quiescence Care Home, their first home that will care for more complex, acute-level patients.

“Our company is founded and run completely by nurses,” said Grace Hawkins, the clinical and community liaison for Quiescence Care Home.

After purchasing the facility from a retired nurse, Ordona and his team have been planning to open Quiescence Care Home for about a year. The COVID-19 pandemic has delayed the licensing processes, Hawkins said.

With the goal of opening the new home’s doors on Aug. 1, the home was inspected on July 21 by the California Department of Public Health to earn a provisional license. As of July 21, the decision is pending and the Quiescence Care Home awaits approval from the survey representatives, according to Hawkins.

Shifts in care and business models

What is the future of nursing homes in a post-pandemic world?

Wagner, the nursing professor at UCSF, said acute-level facilities will likely take care of “very sick people” and then shift patients into specialized home and community-based models of care, such as hospice or dementia care. Individualizing care for each patient is crucial.

Business models will change as well, with medical professionals and nursing home team members making decisions about the restructuring of facilities. Hopefully, this will lead to fairer treatment and higher retention levels for workers, said Dr. Susan Chapman, a professor in the school of nursing at UCSF.

“I think it’s important for the workers to be involved in those decisions,” Chapman said.

Retention rates will also improve if care teams feel like management cares about their success, according to Bob Kramer, the founder and a fellow at Nexus Insights, an aging think tank, and former CEO at the National Investment Center for Seniors Housing and Care.

“More than anything — does the staff feel management has their back and treats them as family justice as they would treat residents as family,” Kramer said.

Future nursing homes should also offer more career advancement opportunities and higher salaries for care teams. The COVID-19 pandemic has accentuated the need for these opportunities, Kramer said.

“We’ve always realized that these folks are the heroes, but they certainly [have] been much more front and center as a result of COVID,” Kramer said.

As the United States population gets older, innovative nursing homes may find greater significance and higher demand.

State projections show significant increases in the senior population: by 2030, the 60-and-over population will be 40 percent larger than it is now and by 2036, seniors will be a larger share of the population than kids under the age of 18.

“The demand for paid caregiving is going to soar, whether it’s in a family home, or whether it’s in a community, like an assisted living community or a skilled nursing setting,” Kramer said.

Despite the projected increases in demand, today, Kramer has seen a “declining occupancy trend” in nursing homes — which started even before the pandemic. COVID-19 only further accentuated the trend.

The time required to build and open homes, high costs and the growth of home and community-based services are some of the reasons for this trend, Kramer said.

The toll of the COVID-19 pandemic

Beyond licensing delays, the pandemic severely impacted nursing homes in California. As of this month, more than 9,000 residents of skilled nursing homes have died in California as a result of the virus.

While visitors are now allowed at Care Home by RNs facilities, during the peak months of the pandemic, visitation was restricted per Centers for Disease Control guidelines. Ordona remembers many residents experiencing depression with fewer visitors.

Taking care of patients during the pandemic also had its toll on nurses and caregivers — on both their mental and physical health.

“It’s been quite challenging to see so many people go through the hospital and don’t make it out,” said Dr. Anquinette Cray, the program director at Unitek’s vocational nurse program and one of the nurse shareholders at Care Home by RNs.

Since Quiescence Care Home will care for acute-level patients, Ordona hopes that will potentially decongest hospitals and allow patients to heal in “a home setting” — especially in a future pandemic.

“When the pandemic hit the hospitals, especially the ICUs were overwhelmed and impacted,” Ordona said. “If we could just help out — even just for a few patients and take care of them in our facility — we feel it’s a great way to help out.”

Despite the pandemic, Hawkins still believes there is much demand for homes providing direct, personalized care, like Quiescence Care Home, with one nurse always on duty to care for six patients. A registered nurse or a licensed vocational nurse will work alongside a certified nursing assistant every shift.

Business opportunities for nurses

Care Home by RNs allows nurses and caregivers to become part owners in the company and homes in which they work after working for the company for two years, or a 4,160-hour equivalent.

“We’d really like to encourage our nurses to become entrepreneurs and have a bigger vision than really working beneath someone else,” Hawkins said.

At least 70% of Quiescence Care Home is currently owned by shareholding nurses and caregivers, according to Ordona. While each individual only receives about a 1-5% percent share, nurses like Cray and caregivers like Yasser Patawaran, said they appreciate being included as part owners.

These opportunities have led to higher levels of job satisfaction and retention, according to Care Home By RNs’ lawyer, Joe Caffrey of Caffrey Law.

“The satisfaction, the fulfillment is just different,” said Patawaran, a longtime caregiver and director of operations for the new home. “Sometimes hard work really pays off.”

Before joining Care Home by RNs, Cray had only worked for facilities run by people who were not nurses and was “excited” to join this team of nurses who fund and run the facility.

“I think it’s just wonderful — especially being able to have nurses run it, nurses fund it and nurses take care of all portions,” Cray said.

The future of elder care

Throughout California, nursing homes may shift their care and business models, especially after the COVID-19 exposed flaws in the industry, experts said. For example, in California, as many as 64 nursing homes failed to report the number of workers that died due to COVID-19.

The Corporate Transparency in Elder Care Act of 2021, sponsored by AARP California, California Advocates for Nursing Home Reform and SEIU California, proposes greater transparency on how nursing homes are spending funds to care for patients.

For future pandemics, nursing homes are likely more prepared, especially with regard to improved infection control practices. While nursing homes “were already doing a great job,” issues with the supply of practices affecting the capabilities of facilities to manage their infection control, Wagner said.

Improved knowledge about infection control and prevention has resulted in a push for smaller facilities with private rooms. Smaller facilities with fewer workers doing more “universal” roles also helps with infection control.

“The higher the number of staff, the higher the amount of traffic in and out of the facility,” Kramer said.

The role of technology has also shifted because of COVID-19, according to Kramer. Electronic medical records and digital meeting platforms allow for virtual visits from medical professionals, as well as family members.

Nursing homes are still “far behind” in their technology use, which Wagner believes will improve in the future.

“We haven’t been able to infiltrate technology into these facilities and technology can be used as a way to improve and make care more efficient,” Wagner said.

The long-term success of nursing homes through high staff retention rates and best practices for patient care are becoming top priorities. Bill Kauffman, the senior principal with NIC, predicts more homes will champion mental health for their workers, such as by providing meditation programs, stress management counselors and opportunities to take time off.

At UCSF, Wagner and her colleagues make predictions about the future of care at nursing homes and provide policy recommendations for funding. Wagner shared that this work stems from low wages and other “deficiencies” for workers in the industry.

“I would love to see long-term care be a place where people ... want to aspire to work and be proud of the work that they’re doing,” Wagner said.

At Care Home by RNs, Ordona believes that nursing homes are here to stay, which is one reason why he is expanding the company.

Ordona attributes the homes’ success to their diligence in monitoring staff and following CDC guidelines.

“I’m happy to report that, partly because we really monitored closely our residents and our staff for the group of care homes that we have, we never had — and I’m knocking on wood here — a COVID positive resident,” Ordona said.