WAUCOME, Iowa — Last fall, Marjorie Kruger was shocked to learn that she would have to leave the nursing home where she had lived comfortably for six years.
Administrators told Krueger and 38 other residents in September that Postville, Iowa, would be closed. The facility joins a growing list of nursing homes closing nationwide, especially in rural areas.
“The rug was taken from under me,” said Kruger, 98. I stayed there for the rest of my life.
Her son found her a room at another Good Samaritan center in Waukon, a small town 18 miles north of Postville. Krueger said the new facility is a Pleasant place, but she misses her friends and longtime staff at the old facility. “We were as close as a good family,” she said.
Former residents of the Postville facility are scattered in love Northeast Iowa. Some were forced to move twice after the first nursing home they transferred to also closed.
Owners say the closures were largely due to a shortage of workers, including nurses, nursing Assistants and kitchen staff
Industry leaders and analysts predict problems could deepen as government aid dries up in the pandemic and nursing facilities struggle to compete with rising wages offered by other employers. Many care centers that have managed to stay open are keeping some beds empty because they do not have enough staff to responsibly care for more residents.
The pandemic has brought dozens of $100 million in additional funding – for the long-term care industry, which has been overwhelmed by covid-19 infections and the death of more than 160,000 residents. Business has declined at many facilities due to lockdowns and outbreak reports. Staff are under additional danger and stress.
The industry is still feeling the impact.
From February 2020 to November 2021, the number of workers in nursing homes and other settings according to the federal Bureau of Labor Statistics , with a decrease of 410,000 nursing facilities nationwide. Since then, headcount has rebounded by only about 103,000.
In Iowa, according to the Iowa Health Care Association, Thirteen of the 15 nursing homes set to close by 2022 are in rural areas. “It’s getting harder and harder to staff these facilities in sparsely populated areas,” said Brent Willett, the association’s president. noted that the number of working-age adults in many rural areas is declining.
Due to a lack of open nursing home beds, some patients had to spend weeks in the hospital while social workers sought placement. The more Increasing numbers of people are ending up in care facilities away from home, especially if they have dementia, obesity, or other medical conditions that require additional attention.
Colorado Health Care Policy and Financing Enforcement Director Kim Bimestefer, speaking at a November meeting, said the state recognizes it needs to help strengthen nursing facilities, especially in rural areas. “We went bankrupt last year more nursing homes than in the past 10 years combined,” she said. “
In Montana, at least 11 nursing homes — 16 percent of the state’s facilities — are closing by 2022, according to the Billings Gazette.
Nationwide, the Centers for Medicare and Medicaid Services recently reported 129 nursing home closures in 2022. Mark Parkinson, president of the American Healthcare Association, said the actual number is much higher many, but federal reporting often lags behind what is happening on the ground.
For example, a recent KHN review revealed that the federal agency counted only one of 11 paramedics in Montana in 2022. Number of home closures reported by state news media compared to only 8 of 15 reported in Iowa.
Demand for long-term care over the next decade as baby boomers arrive Ages are expected to climb. Willett said his industry supports changing immigration laws to allow more workers from other countries. “This has to be part of the solution,” he said. “
The nursing home in Postville, Iowa, was one of 10 nursing homes closed over the past year by the Good Samaritan Society, a large South Dakota-based Chain stores.
“This is an absolute last resort for us, as a non-profit organization, which has been in these communities for 50 to 75 years or more in many cases ,” said Nate Schema,
The Evangelical Lutheran Good Samaritan Society, the full name of the company, is part of the vast Sanford Health network, serving 12,500 clients, including residents of nursing facilities and those receiving services people their homes. Schema says about 70 percent of them live in rural areas, mostly in the Plains states and the Midwest.
Schema says many Frontline staff in nursing homes have found work stress lessened by the covid pandemic, when they had to wear extra protective gear and undergo regular infection screening as they faced ongoing risk.
Nationwide Healthcare Lori Porter, chief executive of the Assistant Association, said nursing home staffing issues have existed for years. “No one in the business is shocked by the status quo,” she said. “The pandemic has raised concerns.
Porter, who has worked as a certified nursing assistant and nursing home administrator, said the industry should emphasize the rewards of the work and the ways in which working as an aide can lead to higher paying jobs, including as a registered nurse.
Nursing industry leaders say they have raised wages for frontline workers, but they cannot always keep up with other industries. This, they say, is largely because they rely on Payments from Medicaid, a government program for low-income Americans that covers the bills of more than 60 percent of those living in nursing homes.
In recent years, most states have increased their The Medicaid program pays nursing homes, but those rates are still lower than what facilities pay from other insurance companies or the residents themselves. In Iowa, Medicaid pays to Each resident pays about $215 a day in nursing home fees. That compares with about $253 a day that people pay themselves. When nursing homes provide Medicare patients with short-term rehabilitation services, they get about $450 a day. But , the federal program does not cover long-term care.
The Evangelical is located in Love The Lutheran Good Samaritan Society Nursing Home in Postville, Iowa, closes in November 2022. It was the only nursing home in the town of 2,500 people and one of at least 15 nursing homes in Iowa that closed last year.(Tony Rice/KHN)
According to Willett, a recent survey found that 72% of Iowa’s remaining nursing homes are freezing or limiting admissions below their capacity.
Prairie View Nursing Home in Sanborn is one of them. Owned by a local nonprofit, the facility is licensed for up to 73 beds. Administrator Wendy Nelson says it has only been able to handle about 48 residents recently.
“We could take more patients, but we can’t give them the care they deserve,” she said.
Prairie View’s painful options include closing a There is a 16-bed dementia care unit.
Nelson has worked in the industry for 22 years, 17 of which were at Prairie View. Easy stuff. But the pandemic has added stress, danger and hassle.
“It drained some human energy. They just say, ‘I’ve had enough,'” she said.
Prairie View has repeatedly raised wages, and now starts at $21 an hour for certified nurse aides and $40 an hour for registered nurses dollars, Nelson said. But she’s still looking for more workers.
She realizes other rural employers are struggling too.
“I know we’re all struggling ,” Nelson said. “Dairy Queen is also struggling, but Dairy Queen can change their hours of operation. We can’t do it. “
David Grabowski, a professor of health care policy at Harvard Medical School, said some of the closed medical facilities had a poor safety record. Seems like a tragedy, especially in a metro area where there are so many other options.
Bad hotels are closing,” he said. But in rural areas, even the closure of low-quality care facilities can leave holes that are difficult to fill.
For many families, the preferred option is home care, but there is also a shortage of workers to provide these services, he said.
Findings may prolong the patient’s hospital stay and they may receive services at a nursing facility or home health aide, if available.
Iowa Rachel Olson, a social worker at Pocahontas Community Hospital in the Northwest, said some patients have been waiting a month or more at her hospital while she tries to find a place for them in a nursing home to transfer once they are stable enough.
She said it was especially difficult to place certain types of patients, such as those who needed extra attention because they had dementia or needed intravenous antibiotics.
Olson began calling nursing homes near the patient’s home before attempting to call nursing homes further afield. She had to house some as far as 60 miles from their hometowns. She said the family would have preferred her to find somewhere closer. “But when I can’t, I can’t, you know? My hands are tied.”
