An increasing number of rural nursing homes in states including Iowa, Wisconsin and Montana are closing their doors because they have chronically low occupancy levels and can’t compete for scarce workers as wages rise.
The wave of closures of half-occupied skilled nursing facilities is creating a crisis in nursing home access for residents who, in a state like Iowa, are given two months to relocate when a facility closes.
The shutdowns—and the relocations that are caused by them—are exacerbating financial and operational pressures on the facilities that must absorb these high-acuity patients, according to a report in Skilled Nursing News (SNN).
Some operators in Iowa, where 19 skilled nursing facilities closed in 2022, have found themselves taking on larger amounts of debt in order to accommodate the influx of residents from facilities that have shut down, SNN said.
Five more nursing homes are scheduled to shut down this year in the Hawkeye State, primarily in rural areas. The closures thus far have resulted in the loss of 562 health care jobs and a reduction of 859 licensed beds, the report said.
From February 2020 to November 2021, the number of workers in US nursing homes and other care facilities dropped by 410,000 nationally, according to the federal Bureau of Labor Statistics. Staffing has rebounded only by about 103,000 since then.
In Iowa, 13 of the 19 nursing homes that closed in 2022 were in rural areas, according to the Iowa Health Care Association.
“In more sparsely populated areas, it’s harder and harder to staff those facilities,” Brent Willett, the association’s president, told Kaiser Health News (KHN), adding that many rural areas also have dwindling numbers of working-age adults.
The lack of open nursing home beds is marooning some patients in hospitals for weeks while social workers seek placements, KHN’s report said. More people are winding up in care facilities far from their hometowns, especially if they have dementia, obesity, or other conditions.
As skilled nursing facilities struggle to compete for workers being offered rising wages in professions where they won’t be overworked, some are keeping beds vacant because they don’t have enough workers to provide responsible care for more residents, KHN reported.
The federal standard for what constitutes responsible care at a nursing home may be about to change if a Biden Administration proposal to establish a minimum daily standard per resident, unveiled in November, is enacted.
In December, the American Health Care Association (AHCA) increased its estimates of what a staffing minimum of 4.1 hours of nursing care per resident day would cost nursing home operators and how many nurses would be needed to meet the mandate proposed by the Biden Administration last month.
AHCA now says that it will cost nursing home operators $11.3B annually to meet the proposed staffing minimum and require an additional 191,000 nurses and nurse aides to provide the 4.1 hours of care per resident each day.
In July, the association estimated the annual cost at $10B and the new nursing staff at 187K. AHCA said it is revising the estimates upward due to increased labor costs and persistent nationwide workforce shortages of nurses.
AHCA’s report was prepared in tandem with accounting and consulting firm CliftonLarsonAllen (CLA), who also wrote the group’s July report. A statement that accompanied the update made it clear that the trade association stands in opposition to the Biden Administration’s proposed minimum staffing requirement.
Despite increasing occupancy levels at nursing homes, a separate CLA report found in December that nearly 60% of skilled nursing facilities currently are operating with negative margins.
“The additional burden of meeting minimum staffing requirements with no funding mechanism will potentially increase the number of facilities operating with negative margins,” said Deb Emerson, principal of CLA, in a statement.
According to the updated AHCA report, 94% of the nation’s 15.500 nursing homes currently would be unable to comply with a 4.1-hours-per-resident-day standard of care due to inadequate staffing.