WAUKON, Iowa — Marjorie Kruger was stunned to learn last fall that she would have to leave the nursing home where she would be comfortable for six years.
The Good Samaritan Society facility in Postville, Iowa, will close, administrators told Kruger and 38 other residents in September. The facility joins a growing list of nursing homes being closed across the country, especially in rural areas.
Kruger, 98, said, “The rug was pulled out from under me. I thought I was going to be there for the rest of my life.”
Her son found a room for her at another Good Samaritan center in Waukon, a small town 18 miles north of Postville. Kruger said the new facility is a pleasant place, but she misses her friends and former employees from the old one. “We were as close as a good family,” she said.
Former residents of the Postville facility are scattered throughout Northeast Iowa. Some were forced to relocate twice, first relocating to a nursing home that also went out of business.
The owners say the shutdown has been largely due to staff shortages, including nurses, nursing assistants and kitchen staff.
The problem could deepen as pandemic-era government aid dries up and care facilities struggle to compete with rising wages offered by other employers, industry leaders and analysts said. Many care centers that have managed to stay open are keeping some beds vacant because they do not have enough staff to responsibly care for more residents.
The pandemic brought billions of additional federal dollars to the long-term care industry, which was battered by COVID-19 infections and more than 160,000 resident deaths. Many facilities saw a drop in business amid the lockdown and news of the outbreak. Staff members faced additional hazards and stress.
The industry is still feeling the effects.
From February 2020 to November 2021, the number of workers in nursing homes and other care facilities decreased by 410,000 nationally, according to the federal Bureau of Labor Statistics. Since then the number of employees has increased by about 103,000.
In Iowa, 13 of the 15 nursing homes slated to close in 2022 were in rural areas, according to the Iowa Health Care Association. “In areas with higher populations, it’s harder and harder to staff those facilities,” said Brent Willett, the association’s president. He noted that many rural areas have a dwindling number of working-age adults.
A shortage of open nursing home beds in hospitals has turned some patients away for weeks while social workers seek placement. More people are ending up in care facilities away from their hometowns, especially if they have dementia, obesity, or other conditions that require extra attention.
Kim Bimstefer, Colorado’s executive director of health care policy and financing, told a conference in November that the state recognizes it needs to help scale up care facilities, especially in rural areas. “We’ve had more nursing home bankruptcies in the last year than in the last 10 years,” she said.
In Montana, at least 11 nursing homes — 16% of the state’s facilities — are set to close in 2022, the Billings Gazette reported.
Nationally, the Centers for Medicare and Medicaid Services recently reported that 129 nursing homes were slated to close in 2022. Field.
For example, a recent review by KHN showed that the federal agency had lengthened just one in 11 Montana nursing home closures reported by news outlets in that state during 2022, and 15 in Iowa. Reported only eight.
As the baby boom generation ages, the demand for long-term care is expected to increase over the next decade. Willett said his industry supports changing immigration laws to allow more workers from other countries. “It has to be part of the solution,” he said.
The nursing home in Postville, Iowa, was one of 10 care centers closed last year by the Good Samaritan Society, a large chain based in South Dakota.
“This is an absolute last resort for us, being a non-profit organization that in many cases will have been in these communities for 50 to 75 years or more,” said company CEO Nate Schema.
Evangelical Lutheran Good Samaritan Society, the full name of the company, is affiliated with the larger Sanford Health Network and serves 12,500 customers, including residents of care facilities and people receiving services in their homes. Schema said about 70% of them live in rural areas, mainly in Plains states and the Midwest.
Schema said many front-line workers at nursing homes found less stressful jobs after working through the worst days of the COVID pandemic, when they had to wear extra protective gear and get regularly tested for infections due to ongoing exposure .
Lori Porter, chief executive officer of the National Association of Health Care Assistants, said issues with nursing home staffing have been building for years. “Anybody who isn’t in this business is in shock at the way things are,” she said. “The pandemic shone a spotlight on that.”
Porter, who has worked as a certified nursing assistant and as a nursing home administrator, said the industry needs to shine a light on how rewarding work can be and how working as an aide can be beneficial. A high-paying job can be found as a registered nurse.
Care industry leaders say they have increased wages for frontline workers, but they can’t always keep up with other industries. They say this is largely because they rely on payments from Medicaid, the government program for low-income Americans that covers the bills for more than 60% of people who live in nursing homes.
In recent years, most states have increased how much nursing homes pay for their Medicaid programs, but those rates are still lower than facilities with other insurers or residents paying their own way. In Iowa, Medicaid pays nursing homes about $215 per resident per day, according to the Iowa Health Care Association. This compares to about $253 per day for people paying their own way. When nursing homes provide short-term rehabilitation for Medicare patients, they receive approximately $450 per day. However, that federal program does not cover long-term care.
Willett said a recent survey found that 72% of Iowa’s remaining nursing homes are keeping or limiting admissions below their capacity.
Prairie View Nursing Home in Sanborn is one of them. This facility, owned by a local non-profit, is licensed for up to 73 beds. As of recently, it has only been able to handle about 48 residents, said Administrator Wendy Nelson.
“We could have taken more patients, but we couldn’t give them the care they deserved,” she said.
Prairie View’s painful choices include closing a 16-bed dementia care unit last year.
Nelson has worked in the industry for 22 years, including 17 in Prairie View. He said that keeping nursing facilities fully staffed has never been easier. But the pandemic has increased tensions, threats and troubles.
“It got the crud out of some people. They just said, ‘I’m done with it,'” she said.
Nelson said Prairie View has raised pay repeatedly, with certified nursing assistants now starting at $21 an hour and registered nurses starting at $40 an hour. But she is still looking for more workers.
He learns that other rural employers are also drawn.
“I know we’re all struggling,” Nelson said. “Dairy Queen is struggling too, but Dairy Queen can change its hours. We can’t.
David Grabowski, a professor of health care policy at Harvard Medical School, said some closed care facilities had poor safety records. Those closures may not seem like a tragedy, he said, especially in metro areas with no other options.
“We can say, ‘Maybe that’s how the market is acting, which is how a bad restaurant or a bad hotel is closing,'” he said. But in rural areas, even the closure of a low-quality care facility can leave a hole that is difficult to fill.
She said that for many families, the preferred option would be in-home care, but there is also a shortage of staff to provide those services.
The result can be longer hospital stays for patients who could be served in a care facility or by home health aides, if those services were available.
Rachel Olson, a social worker at Pocahontas Community Hospital in northwestern Iowa, said some patients wait a month or more at her hospital while she tries to find a place for them in a nursing home when they become stable enough to be moved.
She said it is especially difficult to keep certain types of patients, such as those who need extra attention because they have dementia or need intravenous antibiotics.
Olson begins by calling nursing homes closer to the patient’s home, then tries those farther away. He has had to put some people 60 miles away from their hometown. She said the family would prefer she find something closer. “But when I can’t, I can’t, you know? My hands are tied.”
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