Claudine Bruff-Lopes works over 12 hours a day and until recently, did not have a day off in two months. She has two sons — a seven-year-old she hasn’t seen since March, and an older, immunocompromised son, from whom she’s to be socially distant at all times.
But as an ambulatory care nurse working at long-term care facilities, Bruff-Lopes knew what she'd signed up for. Bruff-Lopes has been on the frontline of the virus, witnessing and wading through the coronavirus pandemic
“It is hard, but I understand that I chose this profession for a reason,”she said. "Going in, [one] might be anxious, scared, nervous or sad. But these patients may not see their loved ones but they can see us smile through our masks. And that’s what motivates me.”
Claudine Bruff-Lopes is a registered nurse with IntelyCare, a Quincy-based startup with an app that lets post-acute facilities hire on-demand nursing professionals. Founded in 2014, IntelyCare, which is often billed as the “Uber for nursing home staffing,” runs a network of 11,000 nursing professionals who have the flexibility to pick their own shifts.
As a company that provides staffing assistance to long-term care services, IntelyCare’s workforce watched the pandemic unravel from the frontlines.
“We did actually see it pretty early on,” said CEO David Coppins. “And we believed it was going to have a significant impact on the U.S. and specifically our business. We knew early that this would cause a massive disruption in the lives of our primary customers and, in particular, our nurses.”
When Coppins raised $45 million in a Series B funding in February, it was to support the company’s expansion plans and product development. Little did Coppins know then that a pandemic would have other plans for his startup.
The company went from trying to actively hiring more health care workers to protecting and retaining the existing nurses on its payroll.
“If you work in a hospital, you always know there's some level of infectious disease that occurs at a hospital. But in nursing homes, the most they’ve ever had to deal with was the flu,” Coppins said. “This is completely new ground. [Nurses] just never had to deal with something as insidious, infectious and devastating as a disease like this. And so, across the board, the entire workforce that works in long-term care facilities are just scared. They have a lot of fear about this, and with good reason.”
Coppins said there has been a 37 percent dropoff in the availability of certified nursing assistants (CNAs), since the outbreak.
Workforce retention
In her previous life, Bruff-Lopes worked remotely for an insurance company, but the conveniences of the work-from-home lifestyle was not to deter her from rushing to the frontlines of a public health emergency.
“We joke about it saying we are going to war,” Bruff-Lopes said. “But when I look at the [IntelyCare] app and see that there’s a need, it speaks to me. I will not sit on the sidelines and collect unemployment.”
Many others, though, fear for their personal and family’s safety.
“Just the volume of people that have gotten sick in nursing homes and many that, sadly, have passed, adds another layer of fear,” Coppins said. “So right away, [nurses] are dealing with something that they've never had to deal with before. It certainly is the case for everybody, but this just ups the ante substantially for health care workers.”
Fear is but one factor. Capped pay rates are another.
To prevent price gouging, the hourly wages of temporary nursing home workers are regulated in Massachusetts. A certified nursing assistant can be paid at most $27.42 per hour on a weekday in Greater Boston and as much as $29.60 on the weekend. But that amount includes agency cuts. IntelyCare, for instance, gets a 20 percent commission from the facilities.
That considered, Coppins noted that with the government’s coronavirus relief check, unemployment benefits and support of supplementary income, some health care professionals are opting to not work and risk their safety.
But again, pay rates is only one of the factors, and as evident, one of the easier problems to fix. After mounting pressure from staffing agencies including IntelyCare, which wrote a letter earlier this month urging the state to allow agencies to pay more. As a result, Massachusetts recently announced that it will allow these temporary workers to be paid 25 percent more.
And this certainly helped. Bruff-Lopes said she only takes shift with hazard pay.
And since mid-March, IntelyCare has seen its workforce stabilize, thanks to two main factors: increased pay and the slow but gradual reopening of the economy.
“Reopening sends signals to the workforce that the fear factor is diminishing,” Coppins said.
Tried, but not tested
But as Gov. Baker has asserted before, reopening of the state critically depends on testing capacity.
In February, right before the pandemic began, there were about 5,600 vacancies at nursing homes across Massachusetts —the vacancy rate has jumped from six percent to 17 percent over the past decade. And the coronavirus pandemic made this problem more severe.
To Coppins’ point earlier, fear and uncertainty have played a definitive role. But not nearly as big as the lack of testing and proper gear.
A registered nurse’s job got a risk score of 86.1 out of 100 for covid-19 transmission. And yet, as of May 19, Bruff-Lopes, who has spent well over 40 hours a week interacting with the riskiest population, hadn’t been tested.
“I behave as if I am positive and treat everyone as such,” she said. “The staff should have been tested first. If I invite you into my home and don’t wash my hands, I am contaminating you.”
Before the spike in the availability of tests, IntelyCare’s tools to fight the pandemic were assessment and education. The company’s tech team swiftly put together a feature for nurses to do a mandatory self-check for symptoms before picking up shifts. And, facilities got a risk score based on the number of positive cases present.
The company also launched a free, web-based training certification program specific to nursing facilities. The training updated nurses on prevention and treatment practices. Over 400,000 people reportedly took the training in a matter of six weeks.
But it wasn’t enough to allay fears. When tests did become available, the company had to scramble to get its CNAs tested. While not all states require temporary nursing staff to get tested, Coppins made it mandatory for all IntelyPros to get a one.
“We don’t want to be contributing to the problem,” he said.
No armor, no fight
“There are a lot of frustrating things: the lack of understanding, the lack of seriousness, but what’s most frustrating is the lack of PPE,” said Bruff-Lopes.
Coppins said that the lack of PPE has been a foremost contributing factor causing anxiety and fear of personal safety among CNAs.
“General unavailability of PPE is why people are sitting at home,” Coppins said.
While Bruff-Lopes expected IntelyCare to dispatch N95 masks, Coppins noted that some facilities restrict CNAs from bringing their own PPE. To that end, IntelyCare began tagging the facilities with their PPE status so nurses could be informed before picking shifts.
But Coppins said that the company is negotiating with PPE suppliers to make discounts available for its client facilities.
Build it and they will come
In its early days in 2015, IntelyCare was initially envisioned as “Uber for homecare “ — providing a way for customers to find caregivers able to take care of an elderly person at home.
But thanks to the pivot it made in August 2016, as Coppins told our sister publication Boston Business Journal, “We’re very fortunate to provide a critical service during these times. The needs of nursing homes during the pandemic are extraordinary right now: They’re short-staffed … We’ve been called from all over the country.”
Coppins is not exaggerating. When Massachusetts needed to enlist medical help to respond to the public health emergency, it turned to IntelyCare to white label its staffing app to manage the volunteers who signed up.
“[Massachusetts] is interested in partnering with us,” Coppins said. “Others states are interested in doing [recruiting] too. We are going to offer it to all states.”
The company did not disclose the other states it’s in talks with.
Not only has the company found more takers for its technology, its core business grew too.
“As far as a sales element of it, I think [business] really accelerated faster than we had originally planned. We've been able to bring on many new clients and nursing homes [as clients].”
“But we also had to delay other projects.”
Business as usual?
More work comes with the demand for more workers. But with normal worklife being upended, the challenges of managing a remote workforce became acute for the company — especially for its call center in the Philippines.
“In the very early days of this, we immediately started to prepare [call center employees] to help them actually achieve the ability to work from home,” Coppins said. “I think we bought the last laptops in the Philippines because they also halted all shipments coming into that country”
There were also other firsts for the company. It hired three senior vice presidents of product, engineering and market growth — all without an in-person interview.
“Since the beginning of March we have hired 28 people,” Coppins said. “All Zoom interviews. Never before has this happened.”
But as companies start mulling over what offices will look like in a post-covid world, IntelyCare has another task added to its plate: redesigning its Quincy headquarters, which the company signed an expansion lease for 2,500 sq. ft.
“We are redesigning the office, bringing in all new furniture,” Coppins said. “We used to be an open office, but we are now putting in dividers and creating one way pathways. We are trying to provide the best care for our staff.”
