Inside a Bellingham nursing home, life feels a bit closer to normal compared to the past two years, even as workers at the 122-bed facility still feel like they’re in crisis mode.

North Cascades Health and Rehabilitation Center is no longer on lockdown, so visitors can come inside and see their loved ones. Residents having a hard night can stay in the nurses station and do arts and crafts. There’s weekly coronavirus testing, and workers only have to wear surgical masks.

But there is still a frantic energy in the building, said Shelly Hughes, a certified nursing assistant. She wonders: What if there’s another COVID-19 outbreak, like the brutal one they experienced this winter? With turnover so high, will there be enough staff for the week? What’s going to happen tomorrow?

“The level of frustration is high, in workers and residents,” Hughes said. “We feel like we are past the pandemic in a lot of ways, but we have this whole new crisis.”

Few environments in Washington witnessed the devastation of the pandemic quite as severely as the state’s 4,760 long-term care facilities.    

Washington’s nursing homes, assisted-living facilities and adult family homes account for 30% of all COVID deaths over two years, but just 3% of total cases, according to the Washington State Department of Health. Because of visitor restrictions, even residents who survived the virus were still susceptible to the mental and physical effects of isolation. Workers experienced high rates of burnout amid low pay and an ongoing threat of illness.


Now, more than two years into the pandemic, COVID cases and deaths are comparatively low, and vaccination rates are steady, though booster shot rates lag among nursing home workers.

Meanwhile, the number of nursing homes reporting short staffing has increased considerably since the start of the pandemic, according to a Seattle Times analysis of data from the Centers for Medicare & Medicaid Services, which doesn’t track other types of long-term care facilities.

As of mid-April, 3,779 people associated with a long-term care facility — a vast majority of them residents — had died of COVID complications, according to the DOH. There has been a total of 40,774 cases.

Both cases and deaths plummeted beginning in January 2021, in large part because of widespread vaccinations. For nearly a year, there were 40 or fewer verified COVID deaths per week, until the height of the omicron surge, when, at its peak, 57 new deaths were reported during one week in January 2022. New case counts swelled to 1,454 in one January week.

North Cascades Health and Rehab had an outbreak during the omicron winter, and several residents died, according to Hughes. The outbreak was traced to a visitor, she added.

“That was really brutal,” she said. “It was as horrible as I’d imagined it would be.”


Since March, there have been fewer than 100 new cases and 10 new deaths associated with long-term care facilities reported per week.

The omicron spike also forced many workers to stay home, causing widespread staffing shortages. The staffing situation in nursing homes has stabilized since the peak, but remains an issue at facilities throughout the state, said Bea Rector, acting assistant secretary of the state Department of Social and Health Services’ Aging and Long-Term Support Administration.

“Understandably, many caregivers have chosen to leave the profession after enduring long hours during the pandemic,” she said in an email.

About half of the state’s nursing homes report being short staffed, according to CMS data, approximately three times more than the number reporting low staffing levels near the start of the pandemic. Patricia Hunter, the state’s long-term care ombudsman, said she continues to hear complaints about low staffing levels causing poor care and safety issues.

“I’ve heard from nursing home staff who have been doing this work for many years that the quality of care and staffing levels are the worst they have seen in their long careers,” Hunter said. “They say that staffing has always been bad but now it is so very bad.”

In nursing homes, vaccination rates among residents and workers are higher than the national percentage, though the booster rate lags among workers. Among residents, 90% are fully vaccinated, compared with 88% nationally, according to CMS, which counts a person as fully vaccinated two or more weeks after they’ve received a two-dose Pfizer or Moderna vaccine or the one-dose Johnson & Johnson vaccine.


Among Washington’s nursing home staff, who are required to be fully vaccinated but not required to be boosted, 92% have received their shots, compared with 87% nationally. All residents and workers are eligible to receive booster shots, but 83% of residents and 47% of workers have done so.

CMS “continues to encourage all those eligible for additional doses to consider further vaccination as an important step toward protecting people,” the agency said in a statement.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and the Commonwealth Fund.