Five years after the COVID-19 pandemic began, area hospitals and health systems are still reeling from its impact.
In the spring of 2020, hospitals were the first to feel the full force of the pandemic as they scrambled to find enough beds, ventilators and personal protective equipment (PPE). And yes, health care providers learned lessons that continue to help them care for the sick and prepare for any future outbreaks.
Anyone can see the impact in the easy availability of hand sanitizer and masks in health care facilities, the absence of salad bars in cafeterias and the prevalence of mental health therapists offering telehealth appointments.
And hospitals no longer struggle with a lack of basic outbreak supplies.
But the pandemic created huge staffing and financial challenges that have not gone away, health officials said.
“Our hospitals are still experiencing vacancy rates more than double pre-pandemic levels,” said Lauren Ford, vice president, strategy and analysis for the Iroquois Healthcare Association, which represents more than 50 hospitals and health systems in 32 upstate counties.
And those vacancies are hitting all departments, she said.
To fill the clinical vacancies, hospitals now rely far more heavily on traveling, or agency, nurses and other staff, driving expenses up. That’s one factor that led to 60% of their hospitals ending 2023 in the red, Ford said.
Proliferation of misinformation
The pandemic also created an atmosphere in which disease prevention has actually gotten harder, Dr. Gary Zimmer, chief medical officer in the Mohawk Valley Health System, argued. Too many people believe health misinformation, which has proliferated, and don’t trust the advice coming from public health professionals, he said.
“I think that we’ll be better prepared to respond to whatever the next outbreak is from a health system perspective,” Zimmer said.
But the public might be even less willing to follow the advice of public health officials given “such weaponization of information right now”, exacerbating any outbreak, he added.
“It’s very interesting to me,” Zimmer said, “how it has been turned into some political agenda, which is a shame.”
‘Politicization of science’
One of the biggest benefits of the pandemic lockdown was simply a fortunate side effect. With people staying home when they got sick, with people spending less time together in general and with people wearing masks, almost no one caught the flu during the first and second winter of COVID-19, Zimmer said.
But the discovery that flu really is preventable hasn’t changed much or prevented the rampant spread of flu, COVID-19, RSV and norovirus this winter.
Too many people aren’t wearing masks when they’re sniffling or coughing, or staying home from work when they’re sick, Zimmer said. And too many people don’t trust vaccines, he said.
“To me, it’s mind boggling that we didn’t learn our lesson,” he said.
He blamed conspiracy theories and the “politicization of science.”
“People don’t trust what they’re seeing (from public health officials),” Zimmer said. “I think we do know (best practices). I worry that that information is not being widely adopted.”
Health care providers and public health officials are doing a better job of reacting to outbreaks of illness, he added. But that’s not enough.
They need to get better at giving the public proactive messages about, for example, what to do when flu cases are rising: stay home, don’t go to the emergency room with sniffles, take a decongestant, stay well hydrated, don’t get other people sick, Zimmer said.
“Those, we still have more work to do,” he said, “to be able to get the word out to the community in a way that they believe it’s coming from a good place for their own health and welfare.”
Lessons at MVHS
Health care providers and public health officials did learn a lot during the country’s first pandemic in a century. That knowledge led to new protocols, procedures and data collection in hospitals for infection prevention, treatment and tracking, Zimmer said.
In the Mohawk Valley Health System, the changes were as small as more masks kept at the front desk, ready for visitors with respiratory symptoms, and the end of the salad bar and self-serve soup in the cafeteria, said Caitlin McCann, vice president of marketing and communications.
Wynn Hospital in Utica also restricted the public to accessing the hospital through its front door and emergency department door to improve security, but also to make it easier to ensure that infection control procedures are followed, McCann said.
The hospital has also put formal visiting hours back in place, no longer allowing visitors to stay past 8 p.m., except in special circumstances, to minimize exposure to infections, said Zimmer, who said he’s spoken to colleagues about changes since he did not work at the hospital during the height of the pandemic.
Wynn Hospital COVID designs
In one sense, the pandemic came along at a fortuitous time for MVHS since it was still designing Wynn Hospital, which opened in October, 2023.
A few things in the hospital’s design were changed based on what doctors learned about infection control and dealing with outbreaks during the pandemic, Zimmer said.
One big change was the inclusion of better isolation capabilities, he said. For example, an entire pod with 10 beds in the emergency department can turn into a negative pressure unit, which stops the spread of infection outside the room, if needed.
That’s in addition to regular negative pressure rooms in the department, Zimmer said.
And there are more inpatient isolation units than had originally been planned, he said.
On a treatment level, doctors learned a lot about managing an infectious respiratory illness when resources, especially beds and ventilators, were tight, Zimmer said. As the pandemic progressed, they got better at deciding exactly which patients needed to be in the hospital; managing low-oxygen patients when there weren’t enough ventilators, treating patients on other oxygen-delivering devices and managing patients on ventilators or other devices outside the intensive care unit, he said.
The pandemic changed “the dynamic about the care of contagious people and people with respiratory illnesses very dramatically,” Zimmer said.
And hospitals also learned about preparation.
“We have lot of ventilators (now),” Zimmer said.
Rome Health also learned from capacity issues during the pandemic.
Lessons at Rome Health
“COVID-19 was a catalyst for Rome Health to refocus efforts to ensure access to care was available in Rome,” said Cassie Winter, vice president of communications and marketing. “With regional demand exceeding capacity, we needed to be ale to provide the care locally because of the difficulty of transferring patients due to a lack of capacity at tertiary care facilities and the lack of ambulance availability due to staffing shortages.”
Winter also noted another big change that has done a lot to increase access to care: telehealth. Medicare, Medicaid and insurers wouldn’t generally pay for providers for services delivered through telehealth before the pandemic. But that changed during the pandemic and telehealth continues to be used far more frequently.
And now providers all have telehealth infrastructure for smoother transitions during future crises, Winter said.
“For example, during the snow emergencies this season,” she said, “some in-person visits could be converted to telehealth and some job functions could telecommute.”
Staffing challenges
One of the biggest impacts of the pandemic on health care has been how difficult it’s gotten to hire and retain employees in every department, Zimmer said.
And for workers not involved in direct patient care, commutes have become a major problem, he said.
“People have opportunities to work in a lot of other areas that don’t require them to drive to work every day,” he said.
There are even fewer volunteers now than before the pandemic, Winter said.
And burnout and anxiety from the pandemic continue to plague many clinical workers, which has contributed to staffing shortages, she said.
For registered nurses, the job with the highest gap between need and employees, the vacancy rate across the Iroquois Healthcare Association’s member hospitals and health systems was 15.4% as of January, Ford said. That translates to over 2,600 unfilled nursing jobs, she said.
And in the long term care facilities run by the association’s members, about 20% of positions for R.N.’s, licensed practical nurses and certified nursing assistants are unfilled, limiting facilities’ capacity to care for patients just when the demand for services is rising, Ford said.
There’s also a big shortage of behavioral health workers and a physician shortage that cuts down on services and leads to lower revenues, Ford said.
Even vacancies among, for example, patient registration clerks, affects operations and patient experience “in really meaningful ways,” she said.
Contract workers
With all the staffing issues, hospitals have been forced to hire workers, particularly nurses, who work for agencies and take on jobs per diem, Ford said. During the pandemic, these nurses made up staffing shortfalls given the surge in patients.
But hospitals have continued to rely on them to make up for unfilled positions, she said. At the height of reliance on them in 2022, some hospitals’ costs for contract labor went up as much as 300% to 400%, she said. That year association member hospitals spent close to $1.2 billion on contract labor, Ford said.
By 2024, that had fallen to about $700 million, but that’s still considerably more than they spent before the pandemic, she said.
Hospitals are trapped in a vicious cycle in which the cost of travel nurses prevents them from offering the kinds of compensation packages that would help them to hire the permanent staffing they’d prefer, Ford said.
Some hospitals never even used travel nurses before the pandemic, but they now form a consistent percentage of everyone’s workforce, she said.
“I think there’s just been a fundamental change in staffing models,” she said.
Financial strain
Total labor expenses for area hospitals and health systems have gone up 37% since 2019, Ford said. And other expenses have risen sharply, too, with medication showing the sharpest increase, she said.
And that’s all contributed to financial struggles for hospitals and health systems. By the end of 2023, 60% of hospitals in the association had negative operating margins, Ford said. Things improved somewhat in 2024 given strong investments in health care by the federal and state governments, she said.
But some hospitals remained in the red and very few reached the 2.5% operating margins that experts in hospital finance believe to be healthy, Ford said.
And that means that the final state budget and the federal government’s decisions on how much to cut health care expenses, Ford said, will play a big role in determining the health and stability of upstate New York’s hospitals.
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