By BROOKLYN BROWN
One Feather Reporter
CHEROKEE, N.C. – Dinilawigi (Tribal Council) held a work session on the morning of Thursday, Aug. 8 to discuss recent staffing issues and community concerns regarding Tsali Care Center senior living facility. Tsali Care Center is an entity of the Cherokee Indian Hospital Authority (CIHA), under the management of Lutheran Services Carolinas, a faith-based non-profit health and human services organization.
On July 19, Ugvwiyuhi (Principal Chief) Michell Hicks posted on Facebook,
Construction progress at the new Tsali Care Center is shown on the morning of Thursday, Oct. 19, 2023 – the day of the topping out ceremony for the new facility. (SCOTT MCKIE B.P./One Feather photo)
“We are very much aware there are concerns regarding the staffing ratios and the quality of care levels our elders are receiving at the Tsali Care Center. These concerns are taken very seriously. I want to assure you that we have been in contact with hospital leadership and are in the process of scheduling a working session during the first two weeks of August for further community input.
Your concerns are our priority, and we are committed to ensuring our elders receive the best possible care and attention, meeting the standards expected by our Tribal members.”
The Aug. 8 work session included comments from Casey Cooper, chief executive officer of CIHA, who stated, “In the last 60 days, for 16 days out of the last 60 days, our staffing ratios were below the state and national average. That’s not acceptable,” Cooper said.
“Thirteen of those days were Friday, Saturday, Sunday, and Monday. Clearly, the challenges are staffing on weekends and evenings, and callouts on weekends and evenings. The way it’s wreaking havoc on our system is the dedicated nursing leadership down there are working night shifts, they’re working weekends. One of the nurses who I talked to yesterday had worked 21 hours of the last 48. They’re exhausted.”
Cooper listed several strategies for addressing the staffing issues. “We have completely revamped our hiring and onboarding for Tsali Care alone so that they have expedited hiring. We are advertising throughout this entire region and we’re also advertising in east Tennessee and north Georgia. We’ve built partnerships with all of the community colleges in western North Carolina, and we precepted more than 30 nursing students last year,” he said.
“We’ve increased salaries. We think that we’re paying higher on an hourly rate than any of our competitors in the region. We know that our benefits are better, and we’re paying sign-on bonuses. We’re offering $10,000 sign-on bonuses for nurses, and $15,000 sign-on bonuses for CNAs. And that’s good, except that our competitors like Swain County Hospital, they’re offering $30,000 for a sign-on bonus, and Harris Regional and Haywood Regional are offering $20,000 for night shift, and $15,000 for day shift.”
Tsali Care Center also held a job fair last week where they hired 10 new employees, two of whom have already exited the system. Tsali Care will hold another job fair in September.
Cooper also noted that CIHA built an internal Certified Nursing Assistant (CNA) training program, which will produce its first eight graduates soon. “These are local people from the community. We stood up our own program and we’re training them ourselves,” Cooper said.
Tsali Care Center also made the recent decision to bring back agency staff, which Cooper characterized as an unwanted but necessary decision to address staffing shortages. Tsali Care had released agency staff earlier in the year under the management consultation of Lutheran Services. Cooper said agency staff contracts had been cut due to “low quality training and commitment, and, arguably, a lack of commitment to the local community.” Cooper also noted that agency staff require an expensive wage and Tsali Care has little control over their schedules.
Tsali Care also recently implemented a new policy that requires two-deep staffing in the memory care unit.
Ugvwiyuhi Hicks asked about improvements for the process of Tsali Care employees expressing concerns to administration. “There’s continual feedback and concern on being overworked, getting tired, and meeting the standard of care that’s expected in this community,” he said. “How do these employees get an ear, because they feel like they don’t have an ear. How do they flow up through a process of some sort so that people are hearing their concern, because, currently, they don’t feel like the administrator hears their concerns.”
Cooper responded, “There’s things that we’ve tried, but obviously they’re not satisfactory to the staff, so we’ll continue to work on it. I had a town hall meeting with them yesterday. I was there for over two hours. We have a formal grievance procedure, and I’ll be continuing to make myself more available to the staff.”
Cooper thinks the concerns of staff stem from administrative decisions made at the beginning of the year.
“I take full responsibility for this,” Cooper said. “I think this is a function of my perception that in January, we were in acute crisis. We were on track to lose $6 million. We had a $40,000 fine from the Centers for Medicare and Medicaid Services (CMS), and in crisis, we don’t have time to negotiate and get people on board. We had to take action and we had to take it immediately,” he said.
“I had to send the message that Marcheta Campbell [Tsali Care Center Facility Administrator] has my full support in order to get us out of that, and I think the adverse effect of that, the unintended consequence, is that might’ve made people feel like they were shut down and they didn’t have a voice.”
Kolanvyi (Big Cove) Rep. Perry Shell discussed the effects of staffing shortages on the patients at Tsali Care, “There are major challenges here. There are ramifications for the shortages. There is human discomfort and pain involved, sometimes.”
Rep. Shell also addressed the perception of Tsali Care employees let go due to voicing complaints, “I’ve heard, ‘Well you know, no one’s gonna get in trouble if they make a complaint,’ but actions speak louder than words. It’s cause and effect. If they know that this person who’s been there for years spoke up on something and now they’re gone, that’s cause and effect,” he said.
Cooper insisted that no employees had been fired for filing a complaint.
Chairman Mike Parker requested a five-minute break, which resulted in the session going off air for the remainder of the allotted two hours.
