When local authorities launched a strike force team on April 22 to help reinforce long-term care facilities and nursing homes against the highly contagious coronavirus, health officials reported grim numbers: 96 residents and 60 staff had caught the virus and 15 people died.

Less than a week later, April 28, as testing has ramped up, health officials showed a surge in the numbers: 192 residents and 88 staff tested positive for the virus and 27 people died, one of which was a staff member. At a single facility, 12 residents died—nearly half of the total resident deaths attributed to the virus.

As of April 28, 62% of Austin-Travis County’s 42 coronavirus deaths have been people who lived in nursing homes or long-term care facilities.

Dr. Clay Johnston, dean of The University of Texas Dell Medical School, called the region’s nursing homes “shockingly vulnerable.”

Austin-Travis County Interim Health Authority Mark Escott said the high risk comes not just from the health of facility residents but from staff and resource shortages as well. Escott said the community needs state and federal assistance, and even publicly called on the National Guard.

As Texas slowly begins to reopen after a prolonged shutdown to mitigate the spread of the virus, health authorities say success will heavily depend on the community’s ability to “cocoon” or protect vulnerable populations, such as senior citizens and those at nursing homes. Resource-strapped, the industry for long-term care and nursing homes needs help, experts say.


Pre-pandemic problems now exacerbated

With the economy at a standstill, many industries have halted hiring; however, the nursing home and long-term care industry has increased efforts to bring workers in the door.

As of April 18, the industry had 377 job openings across the Austin metro—up by 52 jobs just two weeks prior—316 of which were directly related to healthcare, according to Workforce Solutions Capital Area, the local arm of the Texas Workforce Commission.

Kevin Warren, CEO of the Texas Healthcare Association, said the “staffing crisis” has long predated the pandemic. Warren said the industry suffers from a good economy.


Catherine Vergara, president of Care For, a home care and nursing home staffing business, said this is because the demands of the job far outweigh the pay scale.

“It’s physically and emotionally hard to care for someone, but you can work at Rudy’s BBQ and earn the same pay or even more” Vergara said. “You can be in the BBQ line, or you can deal with the complexities of an 85-year-old woman who’s combative because she has dementia.

“That’s not for everybody. That takes a level of heart, compassion and care that not everyone is wired for or willing to do. It takes a lot more emotional intelligence than some of the other industries that are paying the same.”

Vergara said, although rewarding, the job “isn’t glamorous,” and regularly requires 12-hour shifts.

According to the Workforce Solutions’ numbers, there were 68 open positions for caregivers, more than double the need for the second most sought-after position, licensed vocational nurses.


Margaret DeVinney, education director with Halcyon Home, which provides services for 12 nursing homes and long-term care communities across the Austin metro, said although the qualifications for caregivers are relatively light—possessing experience in or passion for caring for a person in-need—hiring is difficult.

“It’s not a livable wage—even if you’re working 40 hours a week at a higher-end rate of $15 per hour, that’s not a lot of money per year,” DeVinney said. “We’re competing with McDonald’s and Chick-Fil-A.”

Policy changes have also heightened staffing challenges. Typically, caregivers and nurses in the industry work at multiple facilities to supplement their income. The Centers for Disease Control and Prevention said these employees pose a higher risk for carrying the coronavirus. At Halcyon Home, the organization has restricted all of its 450 employees from working at more than one facility.

Sending necessary help


In an effort to remove barriers to staffing, Gov. Greg Abbott issued an order April 9 that, “temporarily allows nursing facilities to hire people to provide nurse aide services without having to complete a full certification program in their first four months of employment.” The order expands the eligible pool of workers who can help long-term care providers facing critical staffing shortages.

On April 22, Escott initiated a strike team of additional personnel and resources that could be deployed to facilities facing an outbreak. Escott’s orders also mandated that any nursing home or long-term care facility that had two more simultaneous coronavirus cases could not welcome new patients into the facility. It also had to make all staff and contractors available for testing, according to the order.

Escott also requested state and federal assistance and even called for the National Guard to be deployed in helping fortify these facilities.

“We cannot safely discuss reopening before we have successfully cocooned these vulnerable populations,” Escott said. “We must continue to look for additional personal protective equipment, more rapid testing, and increased staffing for nursing homes and long-term care facilities.”

According to models from Lauren Meyers, an integrative biology professor at The University of Texas at Austin who has led the coronavirus modeling on which city officials have relied heavily, the success of reopening society will depend on the ability to protect senior citizens and other high-risk residents from coming in contact with the virus. Although she emphasized the models are only projections, they showed effectively “cocooning” vulnerable populations could mean the difference between 2,900 deaths and 6,500 deaths.


“Cocooning” is a term officials are using to describe protecting vulnerable populations from coming in contact with the virus.

“First and foremost, it means taking care of the very high-risk, explosive situation in our nursing homes,” Meyers said. “These strike forces are absolutely essential to contain transmission once you have an outbreak but equally important is putting resources in place, now, ... so that we prevent the disease from ever arriving in the nursing homes in the first place.

“The problem is, once it gets to nursing homes, the transmission is just amplified so much because of the nature of the daily contact between the caregivers and residents.”

Staffing, testing and personal protective equipment stocks at nursing homes and long-term care facilities are crucial elements, according to state and local leaders. Kristin Satsky, regional director of growth and strategy with Halcyon Home, said when there has been a positive case at a facility it works with, the patient is isolated and everyone the person has come in contact with has to be tested. That practice is necessary, but a single positive test can temporarily wipe out a large swath of the already limited staff.

Escott told City Council April 28 that testing capacity has ramped up, and health officials are focused on testing all nursing home and long-term care employees as part of the new, heightened precautions.