Patty Presser’s small health department of four registered nurses, including herself, has just shrunk to two.
During the last week of October one of Presser’s staff retired and the other was was funded by a grant that was up.
Roosevelt County, with a population of about 11,000, has been hit hard by COVID-19. The county has already had 30 deaths associated with COVID-19 and at one point saw active cases reach more than 300.
Even before she lost two staffers, Presser wasn’t able to keep up. Now, she’s scrambling to finish routine tasks and get administrative work done.
“I’m just here all day,” Presser said, adding that her work-life balance has been shot since spring.
The county health department had already briefly closed in July after Presser tested positive for COVID-19.
Ideally, she will be able to hire at least two nurses to staff her health department, but finding available nurses isn’t likely, Presser said.
The need for healthcare workers extends beyond Presser’s small health department. A surge in COVID-19 hospitalizations in critical care hospitals across the Hi-Line has corresponded with a statewide shortage in healthcare workers.
COVID-19 cases began to creep up in Eastern Montana during the summer, and like most of Montana ballooned in September and October.
Hill, Blaine, Valley and Roosevelt County — all along the Hi-Line — spiked in mid-October with case counts each in the 100s. The northeastern counties have also seen more than 60 deaths combined.
The rural counties are at more of a disadvantage than Montana’s urban areas when it comes to combating the virus. In rural Montana, a shortage of medical professionals and a lack of access to healthcare was a problem long before the pandemic descended on Montana.
Critical access hospitals have relied on sending patients to larger hospitals for specific treatments or procedures, and the pandemic is no different, said Rich Rasmussen, president of the Montana Hospital Association.
But as Montana's urban hospitals continue to fill up with COVID-19 patients from across the state, critical access hospitals that have staff shortages and few beds are especially pinched.
'There are no beds'
In Glasgow, recent hospitalizations and staffing shortages have led Frances Mahon Deaconess Hospital to halt elective surgeries until mid-November.
"We have been affected like every other place in the community, where we’ve had our own people test positive or sent home for being a close contact," Randy Holom, the chief executive officer for the Frances Mahon Deaconess Hospital, said.
Holom painted a grim picture of the hospital during a Valley County Health board meeting on Oct. 21.
"If this pattern continues we are going to exhaust our capabilities in caring for the community and divert patients to other communities. And there are no beds in other communities,” he said.
By the end of October, Holom said the situation had marginally improved with a slight decrease in hospitalizations.
Valley County had 96 active cases as of Monday, according to the state.
In the Havre hospital, 24 staff members were quarantined as of Friday, said Candis Deruchia, vice president of information systems for Northern Montana Health Care.
Deruchia said in an email that the hospital, which has 49 beds, has been reassigning staff members from different departments to fill in quarantined staff’s positions.
For smaller hospitals, having just a few staff members out because of an illness or quarantine can be more than challenging, Rasmussen said.
“If you have 10 nurses in a hospital and you lose three, you’re down 1/3 of your workforce,” Rasmussen said.
For most critical access hospitals, trading shifts and working overtime is typically the only solution to these constraints.
“The general public senses that hospitals will be there and it’s by the sheer will of the caregivers to spend extra hours and work harder and take shifts from other folks,” he said.
Holom said that during a two-week period in October, the Glasgow hospital staff had worked about 500 hours of overtime.
"If this pattern continues we are going to exhaust our capabilities in caring for the community," Holom said.
The easy solution would be to send additional healthcare workers to hard-pressed hospitals, and transfer COVID-19 patients, who typically need a higher level of care than critical access hospitals can provide, to larger hospitals.
That option is running out, Rasmussen said.
In mid-October Bullock said the state had all but exhausted its own database of volunteer healthcare workers.
The state has been working to expedite licensing for Certified Nursing Assistants, calling on retired healthcare workers to rejoin the workforce, and working to renew recently-expired licenses, Rasmussen said.
"Even with all of that it’s not enough," he said.
Montana's Health Care Mutual Aid System, where Montana can ask for assistance from other regional states, is drying up too.
“We asked North Dakota for help, and they asked us for help,” he said. “Everybody is scrambling.”
Montana doesn’t always have the resources or pull of larger states that are also clamoring for health care workers, Rasmussen said.
On Monday, Gov. Steve Bullock announced 25 federal nurses from the Department of Health and Human Services, will be temporarily assigned to assist in rural areas including Sidney, Glasgow, and Shelby. The nurses could remain in the state for 30 days, and may be reassigned elsewhere in Montana as needed.
The nurses are now stationed in Billings Clinic, Sidney Health Center, Frances Mahon Deaconess Hospital in Glasgow, Benefis Health System and Marias Medical Center in Shelby.
Rasmussen called the nurses a “shot in the arm,” but said more help would be needed if Montana is to sustain the current rate of COVID-19 cases.
"The concern is when will we be confronted with the 'twindemic,'" Rasmussen said. 'Twindemic' is a phrase that refers to the culmination of the regular cold and flu season and the COVID-19 pandemic. "Where we are at right now (with cases) is just the beginning."