{"id":1734,"date":"2023-09-15T09:01:45","date_gmt":"2023-09-15T09:01:45","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=1734"},"modified":"2023-09-15T09:01:48","modified_gmt":"2023-09-15T09:01:48","slug":"rural-nursing-home-supporters-fear-proposed-staffing-standards-will-trigger-more-closures","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=1734","title":{"rendered":"Rural Nursing Home Supporters Fear Proposed Staffing Standards Will Trigger More Closures"},"content":{"rendered":"
\n

SYRACUSE, Neb. \u2014 Many rural communities like this one face a health care dilemma: Is it better to have a nursing home that struggles to hire workers or no nursing home at all?<\/p>\n

The national debate over that question will heat up now that federal regulators have proposed to improve care by setting minimum staffing levels for all U.S. nursing homes.<\/p>\n

Rural nursing homes would have five years to comply with some of the rules, versus three for their urban counterparts. Facilities also could apply for \u201chardship exemptions.\u201d But industry leaders predict the rules could accelerate a wave of closures that has already claimed hundreds<\/a> of rural nursing homes.<\/p>\n

Some families that rely on the Good Samaritan Society home in Syracuse fear the regulation could hasten its demise.<\/p>\n

The facility is the town\u2019s lone nursing home. It is running at barely half its licensed capacity, and managers say they\u2019ve been turning away prospective residents because they can\u2019t find enough staff to care for more.<\/p>\n

Lana Obermeyer, whose mother lives there, said employees take good care of residents. \u201cAre they overworked? Probably,\u201d she said. \u201cIsn\u2019t everybody these days?\u201d<\/p>\n

The Biden administration proposal, released Sept. 1<\/a>, is intended to ensure higher-quality care by requiring a minimum number of hours of average daily staffing per resident, including 2.5 hours from certified nurse aides and 33 minutes from registered nurses.<\/p>\n

The proposal also would require around-the-clock coverage by at least one registered nurse at every nursing home. Regulators estimate 1,358 rural nursing homes, including 58 in Nebraska, would need to add nurses to meet that standard.<\/p>\n

Patient-safety advocates have long pressed the government<\/a> to impose such standards to prevent neglect of nursing home residents. They blame the industry for letting its staffing problems fester for decades, and many hoped the federal proposal would be more stringent.<\/p>\n

The proposal would not affect assisted living centers, which are designed to care for people with less severe health problems.<\/p>\n

\n
\n
\n
\n\t\t\t\t\t
\n\t\t\t\t\t\t\tThe Good Samaritan Society nursing home is licensed to care for up to 88 residents, but it is running at barely half of its capacity. Administrators say they would accept more residents if they had more staff.\t\t\t\t\t\t(Tony Leys\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n
\n
\n\t\t\t\t\t\"\"
\n\t\t\t\t\t\t\tInspirational signs, including many with religious themes, are common throughout the Good Samaritan Society nursing home. The facility is owned by a Lutheran-affiliated nonprofit chain based in South Dakota that operates dozens of rural facilities.\t\t\t\t\t\t(Tony Leys\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n

Syracuse, which has about 1,900 people, serves a farming region in southern Nebraska. Its red-brick nursing home sits near a cemetery, a hearing aid store, and a tractor dealership. It would need to hire several more aides and an overnight registered nurse to meet the requirements.<\/p>\n

Most of the nursing home\u2019s 46 residents are from the area. So are most employees. Staffers often care for their former teachers, coaches, and babysitters. They know each other\u2019s families.<\/p>\n

If the facility closed, many residents likely would be transferred to larger nursing homes in the city of Lincoln, a 40-minute drive northwest, or Omaha, which is an hour northeast. They would be placed among strangers.<\/p>\n

\u201cI truly think it would kill half of these people,\u201d said Obermeyer, whose mother, Sharon Hudson, has been in the Good Samaritan home five years.<\/p>\n

Obermeyer lives less than a block away, and she walks over to see her mom several times a week. Hudson also enjoys frequent visits from other locals, who stop by to see her after visiting their own parents in the facility.<\/p>\n

Hudson has advanced Alzheimer\u2019s disease. She can no longer speak many words, but she smiles and giggles often, and tries to communicate with garbled sentences. \u201cShe\u2019s a very happy, happy person,\u201d Obermeyer said.<\/p>\n

Ideally, she would be served in a specialized \u201cmemory care unit,\u201d for people with dementia. The Good Samaritan home once had one, but the unit closed several years ago for lack of staff. The wing now sits dark.<\/p>\n

\n

\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n

\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n

Ten Nebraska nursing homes have shut down since 2021, said Jalene Carpenter, president of the Nebraska Health Care Association. Most have been in small towns.<\/p>\n

The state\u2019s long-term care facilities have raised wages as much as 30% in recent years, partly because Nebraska joined most other states<\/a> in substantially increasing how much its Medicaid program pays for nursing home care, Carpenter said. But many of the state\u2019s 196 remaining nursing homes are limiting admissions because of staffing shortages, she said. \u201cIt\u2019s unsustainable.\u201d<\/p>\n

Carpenter said part of the problem is that the population of seniors who need care in many rural areas outpaces the supply of working-age adults. Job seekers have plenty of choices outside of health care, many with better hours and less stress. She noted that nine rural Nebraska counties had no registered nurses<\/a> in 2021.<\/p>\n

A prominent consumer advocate scoffed at claims that rural facilities would be unable to comply with the proposed staffing rules.<\/p>\n

\u201cThat\u2019s always their first response: \u2018We\u2019re going to have to close,\u2019\u201d said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care. \u201cIt\u2019s like, \u2018The sky is falling.\u2019\u201d<\/p>\n

Smetanka said the industry should have improved working conditions and wages long ago, and she contends the proposed standards are too lenient.<\/p>\n

Regulators shouldn\u2019t offer rural nursing homes extra time to meet the staffing rule, she said. \u201cResidents in rural facilities have the same level of needs as those in urban facilities,\u201d she said. \u201cEvery resident deserves quality care today.\u201d<\/p>\n

Smetanka\u2019s group favors offering incentives, such as pay raises and housing assistance, to employees in the long-term care industry. It also wants the government to strengthen options for care in people\u2019s homes instead of in facilities.<\/p>\n

Industry leaders have suggested easing immigration rules to allow more workers from other countries. Smetanka said that such workers might help ease the staffing shortage but that they shouldn\u2019t be subjected to the poor conditions and low pay that have driven many previous employees away.<\/p>\n

In Iowa, 27 nursing homes have closed over the past two years, according to the Iowa Health Care Association. Most were in rural areas. About 400 remain open in the state.<\/p>\n

John Hale, an Iowa advocate for improved long-term care, said he sympathizes with rural residents who worry about facilities closing. But he said companies sometimes use staffing woes as an excuse to shutter money-losing facilities.<\/p>\n

Hale has roamed the halls of Iowa\u2019s Capitol for years, trying to persuade legislators to protect vulnerable seniors and people with disabilities. He said minimum staffing proposals have always been blocked by the nursing home industry, which receives millions of state and federal tax dollars from Medicaid. The industry\u2019s message to government officials boils down to \u201cgive us more money and leave us alone,\u201d he said.<\/p>\n

Hale noted Iowa\u2019s government sets minimum staffing levels for child care centers to ensure kids\u2019 safety, but hasn\u2019t done so for seniors in care facilities. \u201cI just wonder what that says about our values as a government and as a people,\u201d he said.<\/p>\n

The longtime federal standard for nursing homes has been that they have \u201csufficient\u201d staff. Hale said that vague standard is akin to replacing speed limit signs with suggestions that motorists drive \u201cat reasonable speeds.\u201d<\/p>\n

Nursing homes are required to report their staffing to federal regulators, who use formulas to measure how much daily attention residents receive from various types of professionals, including registered nurses, licensed practical nurses, and certified nursing aides. Some states have set specific minimum staffing levels, but many, including Nebraska and Iowa, have not.<\/p>\n

The Good Samaritan home in Syracuse is rated three out of five stars for overall quality on the nursing home comparison website<\/a> run by Medicare. Its staffing level is rated at four stars, although its reported ratio of staff hours to residents was below national and Nebraska averages.<\/p>\n

The Good Samaritan Society, which owns the nursing home, is one of the country\u2019s largest nonprofit chains of care facilities. In 2021, it reported<\/a> nearly $78 million in losses on nearly $1 billion in revenue. The company is owned by the giant Sanford Health system, based in South Dakota. It has closed 13 nursing homes in the past two years, mostly in rural areas.<\/p>\n

Good Samaritan Society President Nate Schema said he fears the proposed federal staffing standards would spark more closures, forcing rural residents to seek care far from their hometowns. Family members would not be able to visit as often, he said. \u201cAre they going to have to drive 20 or 30 or, God forbid, 100 miles?\u201d<\/p>\n

In a letter to federal regulators, Schema wrote that his company owns 139 nursing homes in 19 states, with nearly 1,700 open positions. At one facility in rural South Dakota, he wrote, a night-shift nursing job has been vacant for three years.<\/p>\n

The possibility of closure is on the minds of residents and families at the Good Samaritan nursing home in Syracuse.<\/p>\n

\"A
Nellie Swale, a resident of the Good Samaritan Society nursing home, takes a break from a coloring project while visiting with Karena Cunningham, a certified nursing assistant. Cunningham says several former colleagues took less stressful jobs outside of health care but that she decided to stay because she feels a bond with the residents. \u201cIt\u2019s my family here,\u201d she says. (Tony Leys\/KFF Health News)<\/span><\/figcaption><\/figure>\n

Resident Nellie Swale said she knows people who had to transfer to the facility from other nursing homes that closed. They were stressed and saddened by the move, she said. \u201cOld people really depend on routines,\u201d she said.<\/p>\n

Certified nursing assistant Karena Cunningham tells residents she hopes the Syracuse nursing home stays open. But, she said, \u201cwe can\u2019t make them any promises.\u201d<\/p>\n

Cunningham considered looking for a less stressful job, but she couldn\u2019t leave. \u201cIt\u2019s my family here. I love the friends I\u2019ve made,\u201d she said.<\/p>\n

The facility currently has 82 employees, with 10 vacant full-time positions. The company said it spent $150,000 in the past year raising pay at the facility. The lowest starting wage for a nurse aide there has reached $18 an hour, a 30% increase from 10 months earlier.<\/p>\n

Cunningham said that with a bigger staff, the nursing home could accept more residents, including those with complicated issues, such as addiction, mental illness, or severe obesity.<\/p>\n

A national minimum staffing rule sounds like it would make sense, \u201cin a perfect world,\u201d she said.<\/p>\n

\u201cBring me these people that we\u2019re supposed to have for staff,\u201d Cunningham said. \u201cWhere are they?\u201d<\/p>\n