The wave of nursing home closures in rural areas is increasing amid the employment crisis


Marjorie Kreuger was shocked to learn last fall that she would have to leave the nursing home where she had lived comfortably for six years.

Officials told Kruger and 38 other residents in September that the Good Samaritan Society’s facility in Postsville, Iowa, would close. The facility joined a growing list of nursing homes that are closing across the country, especially in rural areas.

“The rug was pulled out from under me,” said Kruger, 98. “I thought I was going to be there 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 nice place, but she misses her old friends and staff from the old building. “We were close, like a nice family,” she said.

Former residents of the Postville facility are spread across northeastern Iowa. Some have been forced to move twice, after the first nursing home they moved into went out of business.

The owners say the closures stem largely from a shortage of workers, including nurses, nursing assistants and kitchen staff.

The problem may deepen as government aid dries up in the era of the pandemic and care facilities struggle to compete with the increased wages offered by other employers, industry leaders and analysts predict. Many of the care centers that manage to stay open are keeping some beds vacant because they don’t have enough workers to responsibly care for more residents.

The pandemic has brought billions of additional federal dollars to the long-term care industry, which has been swamped by COVID-19 infections and more than 160,000 resident deaths. Many facilities have seen a decline in business amid closures and reports of outbreaks. Employees faced additional danger and stress.

The industry is still feeling the effects.

From February 2020 to November 2021, the number of people employed in nursing homes and other care facilities decreased by 410,000 nationwide, according to the federal government. Bureau of Labor Statistics. Employment has only rebounded by about 103,000 since then.

In Iowa, 13 of the 15 nursing homes that closed in 2022 were in rural areas, according to the Iowa Health Care Association. β€œIn sparsely populated areas, it is harder and harder to staff those facilities,” said Brent Willett, president of the association. He noted that many rural areas have dwindling numbers of adults of working age.

The lack of open beds in nursing homes leaves some patients stranded in hospitals for weeks while social workers scour for places. More people are ending up in care facilities away from their hometown, especially if they have dementia, obesity or other conditions that require extra attention.

said Colorado executive director of health care policy and financing Kim Pemstever conference in November The state understands that it needs help in supporting care facilities, especially in rural areas. “More nursing homes went bankrupt last year than in the past 10 years combined,” she said.

In Montana, at least 11 nursing homes — 16% of state facilities — will close in 2022, Billings Gazette reported.

nationally The Centers for Medicare and Medicaid Services reported Recently, 129 nursing homes closed in 2022. The actual number was much higher, Mark Parkinson, president of the American Health Care Association said, but federal reporting tends to lag behind what’s happening on the ground.

For example, a recent KHN review showed that the federal agency had recorded only one of 11 Montana nursing home closures reported by news outlets in that state during 2022, and only eight of the 15 reported in Iowa. .

Demand for long-term care is expected to rise over the next decade as baby boomers age. 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 Postsville, Iowa, was one of 10 nursing homes closed last year by the Good Samaritan Society, a large chain based in South Dakota.

“It’s an absolute last resort for us, being a nonprofit that in many cases has been in these communities from 50 to 75 or older,” said Nate Schema, CEO of the company.

The Evangelical Lutheran Good Samaritan Society, the company’s full name, is affiliated with network giant Sanford Health and serves 12,500 clients, including residents of nursing homes and people receiving services in their own homes. About 70 percent of them live in rural areas, mainly in the Plains and Midwest states, Sakma said.

Schema said many frontline workers in nursing homes have found jobs less stressful after working during the worst days of the Covid pandemic, when they had to wear extra protective gear and be routinely tested for infections in the face of constant risks.

Lori Porter, CEO of the National Association of Health Care Aides, said staffing issues in nursing homes have been increasing for years. “Nobody who’s been in this business is shocked by the way things are going,” she said. The pandemic has brought it to light.”

Porter, who has worked as a certified nursing assistant and as a nursing home manager, said the industry should highlight how rewarding the work is and how working as an assistant can lead to a higher-paying job, including working as a registered nurse.

Care industry leaders say they have raised wages for frontline workers but can’t always keep up with other industries. They say this is largely because they depend on payments from Medicaid, the government program for low-income Americans that covers their bills. More than 60% of people live in nursing homes.

In recent years, most states increased How much does their Medicaid programs pay to nursing homes, but those rates are still lower than what facilities get from other insurance companies or from residents who pay their own way. In Iowa, Medicaid pays nursing homes about $215 per day per resident, according to the Iowa Health Care Association. That compares to about $253 a day for people who pay their own way. When nursing homes provide short-term rehabilitation for Medicare patients, they receive about $450 a day. However, this federal program does not cover long-term care.

A recent survey found that 72% of the remaining nursing homes in Iowa were freezing or limiting admissions below capacity, Willett said.

The Prairie View Nursing Home in Sanborn is one of them. The facility, which is owned by a local nonprofit, is licensed for up to 73 beds. Recently, it only managed to handle about 48 residents, said Administrator Wendy Nelson.

“We can take in more patients, but we can’t give them the care they deserve,” she said.

Distressing Prairie View choices included closing a 16-bed dementia care unit last year.

Nelson has been in the industry for 22 years, including 17 years at Prairie View. It’s never been easy, she said, to keep nursing facilities fully staffed. But the epidemic added tension, danger and trouble.

“I’m so exhausted by that mud from some people. They just said, ‘I’m done with it,'” she said.

Prairie View has repeatedly boosted wages, Nelson said, with certified nursing assistants now starting at $21 an hour and registered nurses at $40 an hour. But it is still looking for more workers.

She understands that other rural employers are also experiencing stress.

“I know we all struggle,” said Nelson. “DQ is struggling too, but DQ can change its hours. We can’t.”

Some closed care facilities have poor safety records, said David Grabowski, a professor of health care policy at Harvard Medical School. Those closings may not seem like a tragedy, he said, especially in metro areas that have plenty of other options.

“We might say, ‘Maybe this is the business of the market, the way a bad restaurant or a bad hotel closes,'” he said. But in rural areas, closing even a low-quality care facility can leave a gap that will be difficult to fill.

For many families, the preferred alternative would be home care, but there is also a shortage of workers to provide these services, he said.

The result could be an extended hospital stay for patients who could instead be served in a nursing facility or by home health aides, if such services are available.

Rachel Olson, a social worker at Pocahontas Community Hospital in northwest 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 once they are stable enough to be transferred.

It’s especially difficult to put in certain types of patients, she said, such as those who need extra attention because they have dementia or need intravenous antibiotics.

Olson begins calling the nursing home that is closer to the patient’s home, then tries homes further afield. She had to put some people 60 miles away from their hometown. She said families would prefer to find something closer. “But when I can’t, I can’t, you know? My hands are tied.”


Kaiser Health News

This article has been reprinted from khn.org Courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization not affiliated with Kaiser Permanente.



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