During Monday’s meeting of the board of the Nathaniel Witherell, Greenwich’s town-owned 202 bed nursing home, two concerns intersected: low Covid-19 vaccination rates among staff and layoffs.
Executive director John Mastronardi said that as of Monday just 38.8% of Witherell staff had been vaccinated.
He said the percentage of patients who were fully vaccinated had fallen from 90% to about 86% due to discharges and transfers.
Two weeks ago, at an “Isolation Kills Too”rally, which was attended by Greenwich First Selectman Fred Camillo, family members expressed their desperation for improved visitation.
They also urged the Witherell to improve staff vaccination rates.
“I implore healthcare workers in long term care facilities across the state and country to please, please get vaccinated,” Family Council Sheilah Smith said at the rally. “There are many healthcare workers who are refusing the vaccine and this just prolongs the isolation, contact starvation and lockdown.”
Callers to Mr. Camillo’s radio show on WGCH 1490 AM also expressed concerns, asking about the timing of layoffs.
“Last year the staff were hailed as heroes and today they are being terminated,” one caller said.
“We’re the only town left that runs a nursing home,” Camillo said. “There’s a huge push to get rid of it. We’re looking at a way to extricate the town from that yearly loss, but to retain some control over it so it’s not just throwing people to the wolves.”
A second caller also questioned the timing of cuts to staff.
“These are staff who busted their asses for the last year. This is really (directed) to the BET who said this was okay, and I don’t know how they can say that in light of the timing? Can’t we put it off six months?” she asked. “The timing is terrible.”
Camillo said the cuts had already been postponed since last fall.
“The timing is never good,” he added. “We can’t go through this every single year, I held off last spring because the pandemic had just started.”
Prior to Monday’s board meeting, the Witherell’s Family Council co-chair Sheilah Smith circulated an email to board members.
“Residents continue to be punished with cruel and relentless restrictions on activities and visitation due to the spread of Covid by unvaccinated staff,” Smith said, adding that there had been dozens of Covid-positive cases among unvaccinated staff.
“The failure of the Witherell Executive Director and Board of Directors to require staff vaccination jeopardizes the health and safety of all 160 residents and the families who visit them,” Smith said in her email.
At the board meeting, Mr. Mastronardi said he realized everyone wanted to return to indoor visitation.
He said the Centers for Medicare & Medicaid Services (CMS) had revised guidelines for in person visitation and a new Witherell policy for visitation had been drafted for circulation on Tuesday and implementation on Wednesday.
“Visits can be of unlimited length at the moment but we’re trying to figure out how to schedule visits, so we’ll probably ask them to say how long their visits will be,” said board chair Larry Simon. “It can be in the room if it’s a private room, or in the common area if they are in a shared room. With weather getting better you can (visit outside). I hope that will alleviate visitation problems.”
Mr. Simon said he believed it was too early to return to communal dining or restore the communal recreation program. “We don’t want cross infection.”
“I’m hoping that as all our residents get vaccinated or had Covid and have some immunity, that by this summer we’ll be able to return a great deal to the normality we had just one short year ago. Wednesday will be a great start toward moving toward that normality,” Mr. Simon added.
Board members asked whether flow of unvaccinated residents and fully vaccinated staff could be coordinated.
“That would be another way to avert risk until we have vaccination rates where they should be,” suggested board member Nirmal Patel.
Head of Director of Nursing Services, Nadia Benson, RN, said that staff’s vaccination status was confidential.
Ms Patel asked whether staff were required to have Measles, Mumps and Rubella vaccinations.
Ms Benson said said indeed staff were required to provide proof of MMR unless they have an allergy, though they are not required to be vaccinated for the flu.
“My own vaccination status has been openly discussed which I find very inappropriate,” Ms Benson said. “I feel like your vaccination status is your business.
“I’d hate to see our co workers possibly shamed. No one knows why anyone makes the choice not to be vaccinated. They may have a medical reason not to be vaccinated. It’s not fair,” she added.
Witherell Infection Preventionist Chris Ann Bennett said currently it was not mandatory for staff to be vaccinated for Covid-19.
She said that there were 42 staff members who are now willing to be vaccinated, and that she had reached out to Dept of Health director Carolyn Baisley about fitting the staff into the vaccine schedule at town hall.
“Last Thursday around 12:00 noon we were told, ‘If anyone interested could come that time (between 12-3:00pm),” Bennett said, adding that the offer was too last minute. “(The 42 staff members) are not all local. It didn’t make sense to call them all to see if they could stop by during that time.”
“People want it from the town,” Bennett said. “They are asking which vaccine they are getting. A large portion of staff registered have some challenges with language and would prefer to go to town hall.”
Board member Nisha Hurst said time was of the essence.
“All our employees were offered a vaccine at one point, and that was their time,” she said. “As someone who just got her appointment, there are millions who didn’t have a chance already for an appointment. I didn’t get to pick and choose which vaccine. I took what I could get. I was extremely grateful.”
“You’re working hard. We acknowledge that, but we need to make sure these vaccinations happen,” Hurst said. “You can’t just say, ‘Oh this is inconvenient.’ However the board can help. …Let’s make it happen.”
Mr. Simon invited Ms Hurst to be the vaccination liaison along with two board members.
“My request will be to for you to make sure the staff understand,” Ms Hurst said to Ms Benson.
Ms Benson said ideally The Dept of Health would set aside a block of time for Witherell staff to be vaccinated at town hall.
Ms Benson said ideally staff would be given 72 hours advance notice so they could, “Rework their lives, arrange childcare, and arrange their work schedule. I think three days notice is fair. There is interest for this. They are calling me and asking, when, when, when?”
Mr. Simon offered to reach out to First Selectman Fred Camillo to see if he could work with the Dept of Health to set up a block of time for Witherell staff vacciantions at Town Hall.
Staff Cuts, Finding Savings
While the facility is beloved in town, it has been losing millions of dollars annually. Mr. Mastronardi said that when he was hired he was made aware of the urgency of reining in costs.
“When I interviewed for his position everyone asked me the same question: ‘John, do you realize the urgency we have to turn things around?’ My answer was yes,” he said.
Mastronardi said any company that might purchase the Witherell would make cuts.
He said at his previous job the management team did “not have the courage” to do what was necessary and in the long run it resulted in more staff cuts.
“My manager called in consultants to advise him what to do to turn around things financially, but he would not do the cuts the consultant said would save us,” he recalled. “The organization was doing a slow bleed of money and because of that, over time we had to sell. As a condition of that sale, the buyer made it very clear that we had to cut 30% of our staff or they wouldn’t make the deal. As part of our management team, I stood in our auditorium as 30+ nursing staff filed in and tell them they would lose their jobs. They were stunned.”
“After that, I made myself a promise that if and when I led an organization that was in the same or similar situation I would find ways to save as much as possible before making deep cuts to staff, and save as many jobs as possible, which is what I’m doing.”
Mastronardi said the “right sizing plan” included eliminating 3 patient care coordinators (PCCs), 2 RNs plus 1 who retired and 1 who could not return for medical reasons, 1 CNA plus 3 who retired but whose jobs will not be filled, plus 1 admissions representative whose position was not being backfilled.
“TNW has operated as a loss for years,” Mastronardi said. “Instead of using the deep cut 30% formula, our leadership team took a much more conservative and thoughtful approach to right-sizing the ship.”
He said that before staffing cuts were considered, they had found other cost saving measures including managing staff overtime, reviewing and negotiating unfavorable vendor contracts, standardizing our medication formulary, purchasing through a GPO (group purchasing organization), and inventory management.
He said the staff cuts represented a 4% cut, or $740,000 in salary. But that amount did not include fringe benefits which add over $250,000 for a total of $995,000 savings annually.
“I think everyone wants to make sure as we go forward and report that we’re not having a lower quality of care,” Mr. Simon said. “I think we’ll be able to become what I’d describe as less top heavy and more care oriented.”
“I’ll leave you with four words,” Mastronardi said. “No margin. No mission.”