Wave of Rural Nursing Home Closures Grows Amid Staffing Crunch

WAUKON, Iowa — Marjorie Kruger was surprised to study final fall that she must depart the nursing dwelling the place she’d lived comfortably for six years.

The Good Samaritan Society facility in Postville, Iowa, would shut, directors instructed Kruger and 38 different residents in September. The ability joined a rising record of nursing houses being shuttered nationwide, particularly in rural areas.

“The rug was taken out from underneath me,” mentioned Kruger, 98. “I believed I used to be going to remain there the remainder of my life.”

Her son discovered a room for her in one other Good Samaritan heart in Waukon, a small city 18 miles north of Postville. Kruger mentioned the brand new facility is a nice place, however she misses her pals and longtime staffers from the previous one. “We have been as shut as a pleasant household,” she mentioned.

The Postville facility’s former residents are scattered throughout northeastern Iowa. Some have been compelled to maneuver twice, after the primary nursing dwelling they transferred to additionally went out of enterprise.

Homeowners say the closures largely stem from a scarcity of employees, together with nurses, nursing assistants, and kitchen workers.

The issue might deepen as pandemic-era authorities help dries up and care amenities battle to compete with rising wages supplied by different employers, business leaders and analysts predict. Many care facilities which have managed to stay open are preserving some beds vacant as a result of they don’t have sufficient employees to responsibly look after extra residents.

The pandemic introduced billions of additional federal {dollars} to the long-term care business, which was inundated with covid-19 infections and greater than 160,000 resident deaths. Many amenities noticed enterprise decline amid lockdowns and stories of outbreaks. Workers members confronted further hazard and stress.

The business remains to be feeling the results.

From February 2020 to November 2021, the variety of employees in nursing houses and different care amenities dropped by 410,000 nationally, based on the federal Bureau of Labor Statistics. Staffing has rebounded solely by about 103,000 since then.

In Iowa, 13 of the 15 nursing houses that closed in 2022 have been in rural areas, based on the Iowa Well being Care Affiliation. “In additional sparsely populated areas, it’s tougher and tougher to workers these amenities,” mentioned Brent Willett, the affiliation’s president. He famous that many rural areas have dwindling numbers of working-age adults.

The shortage of open nursing dwelling beds is marooning some sufferers in hospitals for weeks whereas social employees search placements. Extra persons are winding up in care amenities removed from their hometowns, particularly if they’ve dementia, weight problems, or different circumstances that require further consideration.

Colorado’s govt director of well being care coverage and financing, Kim Bimestefer, instructed a conference in November that the state acknowledges it wants to assist shore up care amenities, particularly in rural areas. “We’ve had extra nursing houses go bankrupt within the final yr than within the final 10 years mixed,” she mentioned.

In Montana, a minimum of 11 nursing houses — 16% of the state’s amenities — closed in 2022, the Billings Gazette reported.

Nationally, the Centers for Medicare & Medicaid Services reported just lately that 129 nursing houses had closed in 2022. Mark Parkinson, president of the American Well being Care Affiliation, mentioned the precise rely was considerably larger however the federal stories are inclined to lag behind what’s taking place on the bottom.

For instance, a current KHN evaluate confirmed the federal company had tallied simply one of many 11 Montana nursing dwelling closures reported by information shops in that state throughout 2022, and simply eight of the 15 reported in Iowa.

Demand for long-term care is predicted to climb over the following decade because the child growth era ages. Willett mentioned his business helps altering immigration legal guidelines to permit extra employees from different international locations. “That’s bought to be a part of the answer,” he mentioned.

The nursing dwelling in Postville, Iowa, was considered one of 10 care facilities shuttered prior to now yr by the Good Samaritan Society, a big chain based mostly in South Dakota.

“It’s an absolute final resort for us, being a nonprofit group that may in lots of instances have been in these communities 50 to 75 years or extra,” mentioned Nate Schema, the corporate’s CEO.

The Evangelical Lutheran Good Samaritan Society, the complete title of the corporate, is affiliated with the enormous Sanford Well being community and serves 12,500 shoppers, together with residents of care amenities and folks receiving companies of their houses. About 70% of them stay in rural areas, primarily within the Plains states and Midwest, Schema mentioned.

Schema mentioned many front-line employees in nursing houses discovered much less disturbing jobs after working by way of the worst days of the covid pandemic, once they needed to put on further protecting gear and routinely get screened for an infection within the face of ongoing threat.

Lori Porter, chief govt officer of the Nationwide Affiliation of Well being Care Assistants, mentioned nursing dwelling staffing points have been constructing for years. “Nobody that’s been on this enterprise is in shock over the best way issues are,” she mentioned. “The pandemic put a highlight on it.”

Porter, who has labored as a licensed nursing assistant and as a nursing dwelling administrator, mentioned the business ought to spotlight how rewarding the work may be and the way working as an aide can result in a higher-paying job, together with as a registered nurse.

Care business leaders say that they’ve elevated wages for front-line employees however that they will’t at all times sustain with different industries. They are saying that’s largely as a result of they depend on funds from Medicaid, the federal government program for low-income Individuals that covers the payments for more than 60% of people living in nursing homes.

In recent times, most states have increased how a lot their Medicaid packages pay to nursing houses, however these charges are nonetheless lower than what the amenities obtain from different insurers or from residents paying their very own manner. In Iowa, Medicaid pays nursing houses about $215 per day per resident, based on the Iowa Well being Care Affiliation. That compares with about $253 per day for folks paying their very own manner. When nursing houses present short-term rehabilitation for Medicare sufferers, they obtain about $450 per day. That federal program doesn’t cowl long-term care, nevertheless.

The Evangelical Lutheran Good Samaritan Society nursing dwelling in Postville, Iowa, closed in November 2022. It was the one nursing dwelling within the city of two,500, and considered one of a minimum of 15 care facilities to shut in Iowa final yr. (Tony Leys / KHN)

Willett mentioned a current survey discovered that 72% of Iowa’s remaining nursing houses have been freezing or limiting admissions under their capability.

The Prairie View nursing dwelling in Sanborn is considered one of them. The ability, owned by an area nonprofit, is licensed for as much as 73 beds. Currently, it has been capable of deal with solely about 48 residents, mentioned administrator Wendy Nelson.

“We might take extra sufferers, however we couldn’t give them the care they deserve,” she mentioned.

Prairie View’s painful selections have included closing a 16-bed dementia care unit final yr.

Nelson has labored within the business for 22 years, together with 17 at Prairie View. It by no means has been straightforward to maintain nursing amenities totally staffed, she mentioned. However the pandemic added stress, hazard, and hassles.

“It drained the crud out of some folks. They only mentioned, ‘I’m accomplished with it,’” she mentioned.

Prairie View has repeatedly boosted pay, with licensed nursing assistants now beginning at $21 per hour and registered nurses at $40 per hour, Nelson mentioned. However she’s nonetheless in search of extra employees.

She realizes different rural employers are also stretched.

“I do know we’re all struggling,” Nelson mentioned. “Dairy Queen’s struggling too, however Dairy Queen can change their hours. We are able to’t.”

David Grabowski, a professor of well being care coverage at Harvard Medical Faculty, mentioned a few of the shuttered care amenities had poor security information. These closures won’t look like a tragedy, particularly in metro areas with loads of different selections, he mentioned.

“We would say, ‘Perhaps that’s the market working, the best way a nasty restaurant or a nasty lodge is closing,’” he mentioned. However in rural areas, the closure of even a low-quality care facility can depart a gap that’s laborious to fill.

For a lot of households, the popular different can be in-home care, however there’s additionally a scarcity of employees to offer these companies, he mentioned.

The outcome may be extended hospital stays for sufferers who may very well be served as a substitute in a care facility or by dwelling well being aides, if these companies have been accessible.

Rachel Olson, a social employee at Pocahontas Group Hospital in northwestern Iowa, mentioned some sufferers wait a month or extra in her hospital whereas she tries to discover a spot for them in a nursing dwelling as soon as they’re steady sufficient to be transferred.

She mentioned it’s notably laborious to position sure forms of sufferers, akin to those that want further consideration as a result of they’ve dementia or want intravenous antibiotics.

Olson begins calling nursing houses near the affected person’s dwelling, then tries ones farther away. She has needed to place some folks as much as 60 miles away from their hometowns. She mentioned households would favor she discover one thing nearer. “However once I can’t, I can’t, ? My fingers are tied.”


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