Indiana among states urging feds to reconsider nursing home staffing requirements

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At the Prairie View skilled nursing home in Sanborn, Iowa, the cafeteria was noisy on a recent Thursday.

But not far from the sounds of conversation among dozens of residents is a unit that sits quiet and empty.

Wendy Nelson, Prairie View’s administrator, used a code on a keypad to enter into what used to be Prairie View’s memory care unit. A corkboard in the eating area still displays the date–Feb. 22–that the unit closed in 2022.

They closed it because they couldn’t find enough staff, Nelson, who’s managed the facility for nearly two decades, said.

“We were kind of in a situation where we had eight residents out of 16,” she said. “You have to have a nurse for the whole 24 hours. You have to have at least one to two aides for the whole 24 hours.”

Staffing is a chronic issue at Prairie View, and Nelson said it’s only gotten worse since the pandemic when many staff members burned out.

Many nursing homes like Prairie View across the country, including those in Indiana, are facing critical staffing shortages, which can lead to dangerous conditions for residents and force facilities to limit the number of residents it can take. This fall, the Biden administration unveiled a controversial proposal that would create a staffing requirement, which has faced significant pushback from the nursing home industry.

Staffing shortages lead to serious issues

Prairie View maintains an eleven to one staffing ratio. It’s not a state or federal requirement, but Nelson said she believes it’s necessary so that residents get enough attention.

But this means with current openings, the nursing home–one of the few in the rural area–can only take 45 residents and is only at 60% capacity, Nelson said. In March of 2020, it was nearly full.

Nelson struggles to attract applicants even though she’s significantly bumped up pay for all positions from nursing to housekeeping–up to $10 an hour. She knows it’s a hard job to work in a nursing home.

“You’re able to go to Casey’s [gas station], you know, and get paid pretty good nowadays, or McDonald’s,” she said.

This summer, more than half of nursing homes across the country reported turning away prospective residents due to labor issues, according to a survey from the American Health Care Association, which represents nursing homes.

But staffing issues affect more than bed space for those who need high levels of care. When facilities don’t have the workers they need, studies show residents are more likely to receive poor, inadequate care.

To address these concerns, the Biden administration has proposed setting a minimum staffing level for nursing homes. This includes having at least one registered nurse on-site at all times and requiring employees to spend a minimum amount of time with each resident daily. These new measures would require more than 75% of nursing homes to hire additional staff. The requirement would be phased in.

Labor unions representing nursing home workers strongly support the proposed rules.

Other proponents, like senior organizations, say it will make nursing homes safer.

“We have seen time and time again, nursing homes that don’t have adequate staffing, lead to serious problems when it comes to resident care,” Brad Anderson, the executive director of AARP Iowa, said.

‘A mandate is not going to create another single worker’

Last month, a group of Republican governors including those in Iowa, Indiana, Nebraska and Missouri sent a letter to the Biden administration urging it to reconsider the staffing requirement, echoing the concerns of the nursing home lobby.

“If adopted, [the Centers for Medicaid and Medicare Services’] proposed regulations will force many long-term care facilities in our communities to close, eroding access to health care for some of our most vulnerable citizens,” the letter said.

The long-term care industry lobby said the proposed measures will do more harm than good by requiring facilities to hire more staff who don’t exist.

The American Health Care Association estimates facilities nationwide will need to hire 102,154 additional full time workers under the mandate–80,077 nurse aides and 22,077 registered nurses.

“A mandate is not going to create another single worker, it simply creates a path to closure for more nursing homes who can’t meet this mandate,” Brent Willett, the president and CEO of the Iowa Health Care Association, said.

Instead, lawmakers should focus on policies to help increase the workforce, he said.

“We should be talking about legal immigration reform. We should be talking about tax credits for health care workers, and other strategies to find ways to fund apprenticeship programs,” Willett said.

But some nursing home workers say they’d not only like to see the requirement in place, but also see facilities held more accountable for keeping staff properly trained and safe.

“Unless it’s forced, it will not happen,” Savannah Hinze, a registered nurse who worked in nursing homes for a decade, said. “The nursing home world is a self-reporting body.”

Hinze said she loved working in long-term care because it was an environment where she could get to know her patients.

She left the industry several years ago and became a real estate agent because she felt the for-profit facilities where she had worked kept prioritizing their bottom line over patient care and worker safety.

It’s no surprise staff turnover is so high, she said.

“They’re dealing with people who have dementia or strokes. These are adults who are physically strong, and the training isn’t there,” Hinze said. “Instead of these companies investing in dementia training, they are just putting it elsewhere.”

She said she’d like to see policymakers make sure direct care staff get the support they need.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis.

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10 thoughts on “Indiana among states urging feds to reconsider nursing home staffing requirements

  1. Why would Indiana wade into this debate?

    Simple: follow the money. Since Sen. Richard Miller wrote nursing home rules during his reign, and re-demonstrated during the pandemic, that industry owns IN regulators.

    Old folks pay the price with sub-standard staffing levels at these facilities. Without a mandate to increase staffing, the operators won’t do a damned thing.

    In the end, it’s mostly about Medicaid dollars, which will have to increase.

  2. Hmmm… $10/hour means that the person with this job will make $20K a year (before taxes) working full time AND will most likely qualify for state assistance. I guess it’s just a question of where you want to hide the real cost not paying somebody enough to want the job.

    1. Corporate profits play big into this equation as well. In Indiana the Marion County Health and Hospital Corporation might not be able to suck off enough profits to justify owning so many nursing homes.

  3. If there is no room at the inn, the only option is to do what was done back in the 50’s, bring them home and take care of them at home. Uncle Joe can’t pull trained workers, or any workers for that matter, out of thin air.

  4. Have any of our legislators or Governor ever visited, or had a mother or father in a nursing home? Not a high-end retirement community, but a true “Nursing Home”. Some are very good, and others are mediocre, but many are very bad. Many times, there are very few RNs or Registered Nurses, but there are aides, CNAs (Certified Nursing Assistant) who get paid little and carry the load. RNs who work for large hospital systems can make good money, some upwards of $80,000.00 a year. Nursing home Rn’s salaries are all over the place, from $50,000 to $90,000.00. CNAs, who outnumber RNs are lucky to make $20.00 per hour, roughly, $40,000 per year. CNAs are definitely needed, but they can’t carry the responsibility of RNs.

    OWNERS OF NURSING HOMES NEED TO LOWER THEIR OWN EXPECTIONS OF GETTING RICH WHILE OUR OLDEST AND DEAREST OF CITZENS, and HEALTHCARE WORKERS SUFFER!

  5. Perhaps it would be better to start with closing the loophole that is allowing County hospitals to “own” nursing homes on paper so that the two can split the additional revenues. The Indianapolis Start offered a great article regarding the IGT (Intergovernmental Transfer) debacle in April of 2020 but the misdirection of funds continues. Instead of improving care, literally hundreds of millions of dollars have been used for property acquisitions, capital projects and more.

    1. David has the correct answer.

      It’s pretty rich of Indiana to complain about his matter given we take the money intended for the care of the elderly and spend it on shiny new hospitals and CEO pay while the old rot to death.

      Pro-life state, indeed.

  6. Governor if you would like to sit down an have a discussion with families who loved ones have been killed in a facility due to low staffing, please contact me.! My mother was one of those patients.!
    Stop letting Hospitals own the licenses so buildings can be paid higher, then do not turn around and pay employees a working wage, let alone competing wage.! Yet again unless it happens to you or your family you don’t care.! I can bring several families to chat with you, just let us know where and when.!!!
    Notice only ones opposing the bill are Nursing Home Owners who line the Republicans pockets w campaign money? What happen to what is best for the patient?

  7. Well, Holcomb, why aren’t there enough nurses to fill the positions if that’s your excuse? How about paying them a decent wage and giving them a doable work load? Better still, get off your ass and go to a regular nursing home for a day and see what really happens. You will be there one day. It’s all about the benjamins as usual. Corporations are people, after all, aren’t they?

  8. Every bit above is true. And most folks would bring family home with them if they didn’t have to quit their jobs to care for them, or if there were support for home care staff or if they had an accessible bedroom and bathroom for said family member.
    Make all these places non-profits, boost the staffing and stop the drain to the hospital systems that are paying their administrative leaders (CEOs, VPs, etc)huge salaries and bonuses and instead, boost the pay of the people actually doing the work.

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