Recent announcements of three nursing home closures in Maine since the end of August have put a spotlight on what some have called the worst staffing shortage the sector has ever seen, as operators and advocates in the industry alike fear it could be just the beginning.
While the announcement of the incoming fourth wave of Provider Relief Funds should help pump some much needed federal funding into the sector, some see it as being nothing more than a stopgap for the crisis.
“Obviously having more money makes things easier, but it doesn’t solve the root of the problem,” Israel Nachfolger, CEO at Pinnacle Group of Hudson Valley, told Skilled Nursing News. “Once the money is used up you’re in the same situation. PRF should help, but six months down the road I don’t see that anything is going to be different.”
To help with the staffing crisis, Nachfolger would like to see temporary nurse aid programs that reduce training requirements for nursing home staff and are being utilized in states across the country, implemented long-term by the Centers for Medicare & Medicaid Services (CMS).
The eight-hour training program is permitted under special waivers, exceptions or flexibilities for temporary nurse aide in several states, such as New York and New Jersey, and is designed to meet the critical staffing staff shortages, according to the American Health Care Association/National Center for Assisted Living.
“We’ve had a lot of success with that temporary program to get people onto the floor quickly and that’s the immediate thing that needs to be done on a national level,” he said. “If there was a national initiative from CMS I think that would go a long way. The six months training requirement is not going to work in this environment.”
Nachfolger said that hospitals in the state are becoming overloaded, a byproduct of the fact that nursing homes cannot accept residents due to staffing shortages, leaving patients lingering in acute care.
In recent weeks Island Nursing Home in Deer Isle, Country Manor in Coopers Mills and Somerset Rehabilitation & Living Center in Bingham announced they would have to close due to inadequate staffing, Angela Westhoff, president and CEO of the Maine Health Care Association, told SNN.
Matthew Trombley, senior executive director of Island Nursing Home, spoke with the Island Health & Wellness Foundation podcast on the closure in an episode released Wednesday and said that the facility had few options left with many staffing contracts up at the end of next month.
He said that once the contracts end on Oct. 26, the facility would have seven people among its nurses, medical technicians and CNA staff on the nursing side to cover three shifts seven days a week.
“We’re falling short about $640,000 per year if we try to keep the residential care side open and would still need to accrue roughly 18 and a half more full-time equivalents to make that plan work,” Trombley explained.
He said the facility has looked into implementing temporary holds and incorporating hospice into the facility, but the finances and staffing didn’t line up.
“For this fiscal year we were budgeted to lose $860,000 with over $1.2 million in contract staff,” Trombley said on the podcast. “Since 2019, we’ve spent $2.3 milllion on contract staff.”
When asked why the facility didn’t raise wages for its staff, Trombley said that contract staff are only supposed to be temporary and a permanent adjustment would not be feasible.
“If I were to put our own staff up to $35 a hour for frontline staff, we would need millions of dollars of donations every single year from the community to sustain that,” he said. “Our hands are really tied, it’s not something that we can ask the community for more money. We can’t just shut off a piece of our business to keep the rest going. There’s no magical solution other than that we need people.”
Jess Maurer, executive director with Maine Council on Aging, doesn’t expect the workforce challenges to get better anytime soon, even with an infusion of federal funding.
“I am extremely worried that our entire system across the long-term care and long-term support services continuum is going to fail,” she said. “I am very concerned that additional facilities will close and that we have no meaningful plan in relation to where we’re going to house these folks. We have whole wings of nursing homes offline right now, not because there isn’t demand, but because we don’t have enough staff to adequately staff them.”
Maurer felt the reason that Maine is getting hit so hard in particular with the staffing shortage is simply a demographic issue.
“It’s simple math. We’re at the leading edge of the aging population in this country, Maine is the oldest state in the country,” Maurer said. “We have not had an adequate birth rate for the last 40 years.”
“There’s no way for any provider in Maine that is tied to a reimbursement rate, which hasn’t been increased to address the competitive nature of Maine’s workforce, will be able to compete with fast food, retail, hospitality and other segments of the economy for entry level workers,” she added.
For the Maine Health Care Association, the staffing shortage has been an issue it’s been dealing with since before COVID-19 and the pandemic has only exacerbated the problem.
“Our state’s Medicaid rates haven’t kept pace with the increases in wages and benefits for direct care workers. We’re starting to pass some legislation now to address wage increases but in the past it hasn’t kept pace,” Westhoff said.
A recent survey from the Maine Health Care Association showed that among responses from 122 provider members, 94% said they are experiencing a staffing shortage and 49.5% said it was at a crisis level.
“We’re looking forward to the PRF portal opening on September 29 and hope those funds make a difference for our providers,” she said. “I don’t have a crystal ball. I don’t know if that will prevent future closures but we are encouraged by those relief dollars being made available.”
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