Nursing homes and residents cope with staffing shortages, fiscal woes

For months, greater Peoria has seen headlines about Petersen Health Care, 830 W. Trailcreek Dr. in Peoria, which has faced foreclosures and bankruptcy due to hundreds of millions of dollars of unpaid debt. Petersen’s holdings include nursing homes in Iowa, Missouri and Illinois.

Illinois has almost 700 nursing homes and related facilities, with 61 in Peoria, Tazewell and Woodford Counties, according to the Illinois Department of Public Health (IDPH), which licenses, regulates and examines facilities’ documents for compliance.

Few face bankruptcy, but most cope with fiscal challenges affecting budgets, staffing and residents’ care.

“It’s all about staffing,” said Charlene Harrington, professor emeritus at the University of California, San Francisco, who specializes in long-term care research. “If you don’t have adequate staffing, you just can’t do the job.”

It’s daunting, according to a February report.

“Monumental and ongoing staffing shortages” and worker burnout have created a crisis, said the inspector general’s office at the U.S. Dept. of Health and Human Services. Its Centers for Medicare & Medicaid Services (CMS) supervises 1.2 million nursing homes where care is underwritten by federal funds.

This spring, the Biden administration sought to guarantee adequate staffing with tougher standards, and issued the first federal rules on minimum staffing for long-term care facilities. They could require many homes to boost staffing. Intended to “significantly reduce the risk of residents receiving unsafe and low-quality care,” the total nurse staffing standard will be 3.48 hours per resident day (the total number of hours worked by each type of staff divided by the total number of residents) and 2.45 hours per resident day of direct nurse aide care.

“But putting a law on the books is no guarantee of better staffing,” said Jordan Rau of KFF Health News. “Many nursing homes operated with fewer workers than required, often with the permission of regulators or with no consequences at all.”

Less than 20% of Illinois nursing homes meet the new federal criteria, according to CMS data analyzed by Chicago public media’s WTTW-TV 11. Failure to comply can lead to progressive penalties, from orders correcting violations to fines and even termination of licenses (although Illinois last year delayed fines tied to the state’s minimum staffing requirement until July 2025).

Some states also set minimum staffing levels, and Illinois mandates slightly more than the new federal standards.

Since January 1, 2014, the Illinois’ Nursing Home Care Act says, “The minimum staffing ratios shall be 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care. A minimum of 25% of nursing and personal care time shall be provided by licensed nurses, with at least 10% of nursing and personal care time provided by Registered Nurses.

“Compliance shall be determined quarterly by comparing the number of hours provided per resident per day using the Centers for Medicare and Medicaid Services' payroll-based journal and the facility's daily census.”

However, the IDPH has had its own staffing shortage, with too few employees assigned to inspect the facilities’ self-documented records.

In part, the staffing shortage stems from the industry’s inability to keep workers, Harrington added. 

In Illinois, the average percentage of total nursing staff turnover was about 52% this summer.

“They’re able to hire, but they’re not retaining people, and then they don’t really want to retain because every time you bring a new staff person in, they bring them in at the minimum wage at the bottom of the wage scale,” Harrington said. “They don’t value their workforce.”

Another factor could be how the nursing home owners use their revenue.

The mostly for-profit nursing home industry blames financial woes on reimbursement rates from Medicaid, the federal/state program that covers most nursing home residents’ costs. But studies and lawsuits show that owners and investors often generate huge profits.

“Some researchers, lawyers and state authorities argue that they could reinvest more of the money they make into their facilities,” said Rau. “Pay remains so low — nursing assistants earn $19 an hour on average — that homes frequently lose workers to retail stores and fast-food restaurants that pay as well or better and offer jobs that are far less grueling.

“Average turnover in nursing homes is extraordinarily high: Federal records show half of employees leave their jobs each year.”

The effects of for-profit ownership aren’t new.

“At the height of the pandemic, lavish payments flowed into real estate, management and staffing companies financially linked to nursing home owners throughout New York,” Rau continued. “Nearly half the state’s 600-plus nursing homes hired companies run or controlled by their owners, frequently paying them well above the cost of services, a KHN analysis found, while the federal government was giving the facilities hundreds of millions in fiscal relief.

“In 2020, these affiliated corporations collectively amassed profits of $269 million, yielding average [profit] margins of 27%, while the nursing homes that hired them were strained by staff shortages, harrowing injuries, and mounting COVID deaths, state records reveal.”

Whether by changing management or strengthening enforcement and penalties, reforming the nursing home industry could be critical in the next decade. By 2034, the U.S. population will have 77 million people 65 years and older compared to 76.5 million under the age of 18, according to the Census Bureau.

It may take regular Americans pressuring companies or lawmakers.

What’s needed is the political will to address the crisis, according to Elizabeth White, RN, a professor at Brown University School of Public Health and a long-term-care expert.

“The pandemic helped highlight the challenges facing nursing homes, but it’s still the elephant in the room,” she said. “The financing system is broken, and the problem is just so enormous that it’s very hard to get the political motivation to do anything about it.”

 

For related information, go to the “Nursing Home Inspect” tool-

http://projects.propublica.org/nursing-homes/