Montana Nursing Homes Face Financial Crisis Months After Federal Relief Funds Halt | national news
Costs incurred in battling the COVID-19 pandemic have pushed nursing homes to operate at a loss throughout the country, and Montana is no exception.
Nursing homes in particular have struggled with anemic Medicaid rates and a slowly declining resident count. But rising material costs, wage pressures and shrinking government relief funds have left more than half of nursing home administrators uncertain whether their facilities will survive in the coming months.
There are 68 certified retirement homes in Montana.
Valley View Home in Glasgow can only last two or three more months without federal support, according to facility administrator Wes Thompson. After that, Thompson said he would consider a voluntary shutdown.
“It’s awful right now,” Thompson said. “We pray for funding wherever we can get it.”
Valley View Home is a 96-bed facility with an average pre-pandemic population of around 70 residents. In 2019, the daily cost of care was $239 per resident per day. Valley View Home, along with other retirement homes across the state, remained afloat. But now nursing homes are facing the worst financial crisis yet, health experts say.
“I’ve never seen them struggle like they do now,” said Rose Hughes, executive director of the Montana Health Care Association. “They’re in crisis mode.”
In 2021, daily care rates jumped to $379 per day at Valley View Home, and Medicaid reimbursement for the year only increased by 65 cents.
Early in the pandemic, federal relief funding helped cover rising costs for personal protective equipment, and Medicaid and CARES Act funds allocated an additional $40 for Medicaid reimbursement to help offset losses. financial due to the decrease in the number of residents.
In March 2020, the daily cost of care jumped to $319 per day for each Valley View Home resident. Without the federal support, most nursing homes would not have survived the early closings when new admissions stopped.
But now, skilled nursing facilities are responsible for all additional PPE, cleaning and other infection control costs. And in May 2021, the CARES Act funding ran out and was replaced by a $15 million lump sum in American Rescue Plan Act (ARPA) funds, which breaks down into an addition of 16, $82 at the Medicaid rate through May 2022 or $40 per additional day through October 2021. Facilities have only had their regular Medicaid rate since then, which averages $211.71 per day .
At Valley View Home, the average cost of care is now $379 per day, which means the facility loses about $167 per resident, per day, in Medicaid funding. By the end of 2021, Valley View Home had lost about $1 million, according to Daryl Toews, who sits on the board.
“Lawmakers thought the pandemic was over and payments should do the same as things got better. Unfortunately things have gotten worse since the end of Parliament, not better,” Hughes said.
The average actual cost per day in 2020 was $250 per day. If costs had increased by 5% per year, the actual cost would have landed at around $275 per day in 2021 and 2022. Instead, costs have increased by 15% to 20%, according to Hughes.
Nearly 70% of all nursing home residents receive Medicaid, which is why low Medicaid rates have such a severe impact on the ability of nursing homes to recruit and retain staff and provide care.
Today, institutions are responsible for the spiraling costs of fighting the pandemic, including the costs associated with ever-changing guidelines on how to handle “outbreaks” of infections.
An outbreak is defined as a positive case of COVID among staff or residents. Some local health jurisdictions in Montana still require facilities to stop admissions in the event of an outbreak.
In epidemic mode, visitors are prohibited from entering the establishment. Although more and more seniors have chosen to age with their families over the years, the fear that a loved one could catch COVID in the collective setting and the fear of being prevented from visiting have stimulated cultural change. towards aging in place.
To add to the excruciatingly low census, many establishments limit the number of residents due to a lack of staff. While shortages aren’t a new challenge for nursing homes, the pandemic has exacerbated the problem.
The evolution of directives has led to a increased need for healthcare workers, but as wages have doubled in the past two years, nursing homes have been unable to afford more staff. And without more staff, facilities cannot accommodate more residents. Without more residents, nursing homes cannot hope to pay more staff.
“There’s no increase in reimbursement that matches increased regulation,” Thompson said. “Every rural non-profit organization (is struggling) to retain staff. So they have to go to contract nurses.
And small, rural facilities will be the first to go, Thompson said. He cares for eight residents who came from out-of-county facilities forced to limit their number of available beds due to staffing issues. Thompson has six traveling nurses to help her despite the few residents.
Gallatin Rest Home, a county-owned skilled nursing facility in Bozeman, closed the rehabilitation portion of the facility due to staffing shortages, according to facility administrator Darcel Vaughn.
Without rehabilitation services, hospitals have few options for patients who need specialized therapy following a procedure.
The 69-bed facility only supports 31 residents.
To fill staffing gaps, three traveling licensed practical nurses (LPNs) and six traveling certified practical nurses (CNAs) are working at Gallatin Rest Home. Before COVID, Vaughn paid traveling CNAs less than $30 an hour. Now, the average cost of a traveling CNA in Montana is $60 to $150 per hour, according to data provided by Hughes.
Agencies that provide traveling staff to nursing homes in Montana charge for a traveling registered nurse $105 to $250 per hour and for an LPN $75 to $250 per hour. The establishment also pays the workers’ travel, accommodation and meal expenses.
Comparatively, the base salary of an employed RN is $32 to $41 per hour; the salary for an LPN is $24 to $34 per hour and the base salary for a CNA is $16 to $23 per hour.
The salary imbalance has had an impact on morale. Vaughn even had employees leave the facility, returning as expensive travelers.
“We wouldn’t be in business if we weren’t owned by the county,” Vaughn said, adding that last year the facility was short by nearly $1 million, but the loss was covered by county funds.
“It would have been worse without $1 million in federal COVID relief funds,” Vaughn said.
The combination of low Medicaid rates and limited staff makes it difficult to care for residents in need.
“Someone can be turned away because they’re too expensive…it’s hard because it’s a service we should be providing to the community,” Vaughn said. “On calls with other administrators, I can hear the stress in their voices. There is no doubt that facilities across the state are at risk of closing.
Even with its diverse model, Immanuel Lutheran Ministries in Kalispell has felt the effects of limited funding and stifling guidelines.
When emergency funding stopped for nursing homes, “they made us the lowest priority,” said Jason Cronk, CEO of the Kalispell facility. “(Nursing home funding) is not something they thought was important.”
Cronk also points out that House Bill 702 is severely hampering the retirement home industry in Montana. The bill prevents employers from requiring healthcare workers to be vaccinated against COVID-19 or the flu.
When COVID transmission is high in a community, nursing homes should routinely test unvaccinated staff. Asymptomatic staff became the reason Cronk was unable to take a new admission for more than two months.
“We’re taking care of the most vulnerable population and we’re not as safe as we were a year ago,” Cronk said.
About 90% of nursing home residents are fully vaccinated, but only 65% of staff are vaccinated according to the AARP Dashboard.
The state and “hero pay”
Hughes pushed the Montana Governor’s office, ARPA’s Economic Transformation Commission, and ARPA’s Health Care Commission to provide assistance in two main areas: funding to provide staff bonuses and oversight. infections.
She asked for funds to provide “hero pay” for direct care staff who worked during the pandemic, signing bonuses and retention bonuses.
A push for infection control was also a focus of discussion. Hughes applied for facility grants to improve ventilation systems, acquire portable systems and take other steps to improve infection control.
“There is no indication that we will receive the help we have requested,” Hughes said. “We need direct subsidies for our workforce to recruit or retain.”
The state Department of Public Health and Human Services is aware of the nursing home argument, but has no plans to provide additional emergency relief, according to DPHHS Director Adam meer.
“There’s a lot more that goes into revenue (than Medicaid funds),” Meier said. “Sometimes what is said is not accurate.”
Meier added that most nursing homes receive a large portion of funds from other sources.
Meier and Barb Smith, senior and long-term care administrator for the state, pointed to government relief funds issued in fiscal year 2020 that temporarily brought nursing homes out of the red. A report that analyzes Medicaid nursing facility rates for fiscal year 2021 will not be available until May.
Smith added that not all nursing homes participate in Medicare, which would add more funding.
Gov. Greg Gianforte has no plans to direct ARPA funds toward nursing home rescues, according to Meier.
“This is an evolving industry…we don’t want to keep kicking the road,” Meier said.
Instead, the state is looking for ways to make long-term care a more sustainable model by identifying ways for the industry to be more profitable.