WKYT Investigates | The impacts of nursing home staffing shortages

It’s a difficult cycle. And, experts say, part of the solution has become part of the problem.
It’s a difficult cycle. And, experts say, part of the solution has become part of the problem.
Published: Feb. 17, 2022 at 3:17 PM EST
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LEXINGTON, Ky. (WKYT) - For all the concerns throughout the pandemic about hospitals filling to capacity, the worries at many long-term care facilities have often been the exact opposite.

“In our skilled nursing facility we’ve got nearly 40 beds sitting empty because we don’t have the staff to take care of them,” Karen Venis, CEO of Sayre Christian Village, told WKYT’s Garrett Wymer last month. “It’s scary.”

Since then, Venis said Wednesday, officials have had to close another unit - this time a 26-bed short-term rehab unit that facility leaders believe they could fill two to three times over given the current need for care. Instead, facilities like theirs facing staff shortages have had to settle for simply doing what they can, which, at many facilities, has also meant not taking in new patients.

“I have an admissions person that all they do all day long is field calls that, ‘Unfortunately, we don’t have availability.’ That is not the message we want to send, but we also don’t want to send the message that we can’t take care of the residents we have,” Venis said in January. “So it is a very fine balance.”

Staffing shortages have hit the long-term care/nursing home industry particularly hard at a time in which its services are critically needed, forcing cutbacks and closures whose impacts stretch far beyond only the patients themselves or their loved ones.

It is a cycle that also hurts capacity at hospitals, experts said, by keeping patients there longer.

“That impacts all of us because it clogs up the health care system,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living (KAHCF/KCAL).

But backing up hospital beds is just one impact.

[MORE: WKYT Investigates]

Lost revenue makes it harder for the facilities themselves to stay open. More than half (57 percent) of facilities said they are worried they might have to close if staffing problems continue, according to a recent KAHCF/KCAL survey.

“It’s really a perfect storm,” Johnson said. “Although I’m sympathetic to all areas of our economy and the workforce struggles, we really need to focus on long-term care.”

It is not a new problem, statistical trends confirm, but the pandemic has in fact accelerated and exacerbated it.

Nationwide, nursing homes have lost close to 238,000 workers, Bureau of Labor Statistics data shows. That is 15 percent of its total workforce, according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

The long-term care industry as a whole has lost more than 400,000 jobs.

Kentucky has not been immune. The KAHCF/KCAL survey cites low pay, burnout and vaccine mandates as some reasons workers are leaving Kentucky facilities. At one point this winter, skilled nursing facilities across the commonwealth had roughly 3,000 open positions, industry advocates said.

“It is beyond a crisis situation,” Johnson said.

Kentucky does not have a minimum-staffing rule, Johnson said. That means there is no specific staff-to-resident ratio that facilities must have to operate. But, experts say, they are checked to make sure their staffing is appropriate - information that is then reported to federal officials.

However, in some cases, staffing issues could be causing problems for the patients receiving their services, according to complaints filed with residents’ advocates.

Sherry Culp, the state’s long-term care ombudsman, said that from July to December her office received 51 complaints directly related to staffing (defined as “problems with shortage of staff, turnover, over-use of temporary agencies, etc. or complaints about the skills or training of staff”) and 88 complaints about the response to requests for assistance (meaning “failure to promptly respond to call light or call bell or request for assistance goes unanswered”).

Both of those categories are up from the first half of the year, Culp said, in which long-term care ombudsmen statewide received 36 staffing complaints and 60 complaints about response to requests for assistance.

But some experts say part of the answer has also been part of the problem.

The federal government has been asked, amid price gouging accusations, to look into the staffing agencies that many facilities have used (even pre-COVID) to help fill open positions.

In a letter to the Federal Trade Commission asking for protection from “anticompetitive and unfair practices,” Mark Parkinson, AHCA/NCAL president and CEO, mentions “countless examples...of direct care staffing agencies charging supercompetitive prices to desperate LTC centers that simply need workers.”

He goes on to write: “Our providers have little choice but to pay the exorbitant prices, and hope that the agency does not poach their staff once in the building.”

(A bipartisan group of lawmakers signed on to a similar letter urging the White House to investigate “the extreme prices being reported for nurse staffing agencies from hospitals in our states.”)

Staffing agencies have defended the rates as reasonable, given the increasing demands on workers during the pandemic. And some officials have said they cannot necessarily blame individual workers - many of whom are seen as “underpaid and overworked,” particularly through the pandemic - for taking jobs with higher pay than the nursing homes can provide (given current reimbursement rates), but they are concerned that the agencies are hiking fees in order to profit off a crisis that is leaving many facilities in disarray.

Last week, a U.S. Senate committee held a hearing on the pandemic-related workforce shortage in health care, and bills filed in the Kentucky General Assembly deal with nursing shortages and long-term care.

KAHCF/KCAL officials say they are working on recruitment/retention efforts and pushing for an increase in Medicaid reimbursement rates. They are also working with community college systems; many health care facilities offer tuition reimbursement.

But unfortunately, experts say, there is no easy, quick fix.

In the meantime, lost revenue from empty beds continues to take a toll even on non-profits like Sayre Christian Village.

“While we’re not for profit, we’re also not for loss,” CEO Karen Venis said. “And our COVID expenditures on their own have taken a significant toll on our operation, so to have beds sitting empty...”

The facility right now is at about 75 percent occupancy, Venis said, compared to the roughly 97 percent occupancy they would typically see. Yes, they are seeing an uptick in applications, but it is “nowhere near what we need,” she said.

Venis said she knows it is not unique to them - or even to their industry - but it is no less frustrating.

And it is not sustainable.

“There is a huge need for what we do in this community - now more than ever as you have folks that have been in the hospital from COVID,” she said. “There’s a lot of folks that need the services we provide. It’s just incredibly frustrating that we can’t do it - and we can, but we’ve got to have the appropriate amount of staff before we can.”

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