BISMARCK — More than half of North Dakota’s nursing homes have frozen admissions as they struggle to maintain staffing and have seen their occupancy rates slump during the coronavirus pandemic.

As a result of the reduced occupancy capacity, nursing homes report that families trying to place residents in care centers are calling all over the state.

A survey of the more than 200 North Dakota nursing homes found that 57.6% are no longer admitting new residents, according to the North Dakota Long Term Care Association, which conducted the survey.

Many nursing facilities are straining to maintain staffing — a problem that could be exacerbated if a federal mandate requires nursing home employees to get vaccinated, some administrators warn.

Although hiring challenges are nothing new, administrators are trying to make plans to care for residents and keep their facilities open if some employees refuse to be inoculated.

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“We’ve never been that desperate before,” said Shelly Peterson, executive director of the North Dakota Long Term Care Association. “We have administrators cooking and cleaning.”

The St. Luke’s Care Center in Crosby closed in September, with its administrator citing mounting financial and staffing pressures during the pandemic among the reasons. Several others are discussing closing, Peterson said.

Michael Hall, administrator of the Wishek Living Center, said 23 of his 85 employees are unvaccinated. Despite ongoing efforts to try to convince the doubters of vaccine safety and effectiveness, Hall fears eight or 10 won’t be persuaded.

“We’ve been doing a lot of education,” he said. “We’ll be doing even more,” including meeting individually with employees.

Tanya Schnabel, finance director at Wishek Living Center, said administrators are waiting anxiously for federal regulations on the vaccine mandate to come out, including a timeline for implementation and whether a testing option will be allowed for those who refuse immunization.

“We’re just waiting for the other shoe to drop,” she said. “In the meantime, we have to plan.”

Wishek Living Center, once licensed to have 60 beds, already reduced its occupancy to 54 beds, 48 of which are occupied.

“At this point, we’re just looking at how we can care for the residents we already have,” Schnabel said.

If staffing drops by eight or 10 people, as Hall and Schnabel worry it could, more drastic steps will have to be taken.

“It’s not going to be good for our facility if we do lose that many employees,” she said.

The Wishek Living Center is making do with 10 traveling helpers, mostly nursing aides but also one kitchen staff member, Hall said. The center pays the traveling staff about twice what it pays employees.

“So we’re in a staffing crunch already,” he said. “This could push us over the edge.”

Meanwhile, as most other nursing homes also freeze admissions, the Wishek Living Center is getting calls from people across the state desperate to place an elderly loved one in care.

“We’re getting them from all over the state,” Hall said, adding that priority is given to residents from the area. “We need to serve our local community.”

Vaccine hesitancy is due to several factors. “Some people say, 'I don’t like injecting anything into my body,'” Hall said. One woman said her husband wouldn’t allow her to be vaccinated, he added, and some cite religious reasons.

“Some people feel it should be their choice,” Schnabel said. “I don’t want to be pointing fingers at the unvaccinated staff. It takes a special person to be in health care.”

Wishek Living Center is testing unvaccinated staff twice each week, requires mask-wearing among staff and has a special visitation room. Since the start of the pandemic, three residents have tested positive for the coronavirus, none resulting in death, Schnabel said, adding that 93% of residents are vaccinated.

“We would just like to see options for our employees,” such as testing for the unvaccinated, she said, "not a straight-up mandate.”

The vaccination mandate for nursing home staff is coming in the midst of decreasing numbers of nonrenewal of certified nursing assistants during the pandemic, Peterson said.

Nonrenewals jumped from 3,705 in 2019, before the pandemic, to 4,607 in 2020, she said. At the same time, the number of new certified nursing assistants has dwindled during the pandemic, decreasing from 4,545 in 2019 to 4,059 in 2020, Peterson said.

“We need staff,” she said. “They have to be staffed beds.”

Besides the risk of infection, nursing home staff also must deal with cumbersome precautions, including wearing personal protective equipment.

“It’s been a really intense 20 months for them,” Peterson said.

North Dakota has 5,211 licensed nursing home beds, 84% of which were occupied as of early October, she said.

Thirty-eight of North Dakota’s 216 nursing homes imposed their own vaccine mandates. Those nursing homes are largely located in Bismarck and Fargo, but Sanford Health’s Good Samaritan Society, which serves many rural communities, is among the organizations requiring vaccination, Peterson said.