Needs of nursing homes need more attention from Legislature

Editor’s note: In this second segment of a five-part series, a legislative perspective on elderly care will be provided by Rep. Jim Abeler, Anoka, past chairperson of the Health and Human Services Finance Committee, and by Rep. Patti Fritz, Faribault, a licensed practical nurse who has served on the Health and Human Services Finance Committee. Other perspectives on senior care will be provided by Aging Services of Minnesota and by other lobbying groups.

Underfunded nursing home care has been a major challenge to the state in recent years and will continue to be addressed in the future, many legislators and health care professionals predict.

Kayla Miller, coordinator for the Guardian Angels Wellness Center in Elk River, presents a wide smile and a professional background in developing, implementing and facilitating senior wellness programs. She helps seniors make healthy lifestyle choices based on their wellness needs.
Kayla Miller, coordinator for the Guardian Angels Wellness Center in Elk River, presents a wide smile and a professional background in developing, implementing and facilitating senior wellness programs. She helps seniors make healthy lifestyle choices based on their wellness needs. Photo by Howard Lestrud, ECM Publishers

During the last session of the Minnesota Legislature, nursing home legislation was adopted, creating a 5 percent across-the-board increase.

That action by the Legislature represented the first increase in funding in the past five years. Nursing home workers have had their wages frozen since 2008 and are seeing an increase in wages effective Sept. 1.

Rep. Jim Abeler, R-Anoka, said, of the $83 million it will cost for four years, $74 million was recycled out of the nursing home industry.

“Workers will see a raise, but it will come out of the other nursing home money that was recycled,” he said.

“It’s like taking your wallet out of your right pocket and putting it into your left pocket and saying, ‘I’ve got some money now.’ The system is starving for money, and we can’t give the people a good raise because of the pressures about minimum wage.”

Abeler last session served as the ranking Republican on the Health and Human Services Finance Committee. He chaired the committee the two previous years with Republicans being in leadership control.

Gayle Kvenvold, president and chief executive officer of Aging Services of Minnesota, said needs of nursing homes have not been adequately addressed by the Legislature and by others. The action by the Legislature “was a step in the right direction and we are grateful for it, but our job is not done,” Kvenvold said.

On average, the difference between what it costs to take care of a senior is a shortfall of $28 per day, Kvenvold said. She said it will take more than one legislative session to make up that difference.

Aging Services of Minnesota is the state’s largest association of aging services organizations. Its membership encompasses more than 1,000 member organizations including 700-plus provider member sites.

In concert with its members, the association works with more than 50,000 caregivers throughout the state and serves more than 100,000 seniors each year in settings across the continuum from their home to congregate housing to assisted living to care centers.

Patti Cullen, president and chief executive officer of Care Providers of Minnesota, said the legislative action in 2013 represented a significant increase and is a “good start.”

“With years of no increases and growing mandates, we have a ways to go before this profession is on financially sound ground,” Cullen said.

The wage gap between staff in nursing homes and similar positions in hospitals is dramatic and with the job market picking up, “we will have a hard time keeping our positions filled,” she said.

According to Cullen, the wage gap for registered nurses is more than $35,000 per year.

“The Legislature heard our message about the need to give increases to our workers,” she said of the last session.

Care Providers of Minnesota is a membership association responding to the ever-changing needs of its customers. As a supportive partner to senior care providers since 1947, Care Providers is committed to excellence in services provided.

Its mission is clear, Cullen said “to empower our members to excellence through the programs, staff and services we develop and provide on an ongoing basis.”

Rep. Patti Fritz, DFL-Faribault, who served on the Health and Human Services Finance Committee with Abeler, said the 2013 Legislature made it a priority “to invest in better care for our seniors who were cut deeply by the previous Legislature.” In many areas, nursing homes don’t pay enough to keep employees around, she said.

Fritz worked 30-plus years at the St. Lucas Care Center in Faribault as a licensed practical nurse. As a legislator, she is serving her fifth term and has made it her focus to improve senior and nursing care statewide.

“It’s critically important that we improve care as we prepare for the impending ‘age wave,’” Fritz said.

Minnesota, like states across the nation, will experience a significant demographic shift during the next 20 years as baby boomers enter retirement, she said.

Minnesota’s population of adults over age 65 will increase from 12 percent to 20 percent by 2030, according to Fritz.

“The policy implications of this demographic shift are substantial,” Fritz said. “We need to ensure that our nursing homes have adequate funding to provide care for seniors and people with disabilities who are no longer able to live independently, and in addition, we need to recognize that many older Minnesotans prefer to remain in their own home, with adequate in-home care support.”

Care for the elderly has changed considerably during the past decade, Abeler said.

“It’s moving more toward assisted living and keeping people in their homes, and so the need for nursing home beds is reducing,” he said.

“Nursing homes are struggling to stay full.”

Some are closing where they are needed, Abeler said.

Abeler praised the construction of a new nursing home and elderly living complex called The Homestead of Anoka. It features a 120-bed Anoka Rehabilitation and Living Center, along with 59 apartment units, a mix of independent and assisted living.

The move to keep people in their homes at an older age “is really smart and is a good value,” Abeler said.

“This represents a better life for the people and the system has to change to evolve into places like The Homestead where people can age in place,” he said.

During his chairmanship of Health and Human Services in 2011-12, Abeler said he learned about life and death.

“I didn’t sleep well for four months” when working on the health and human services budget, Abeler said.

If he did it wrong, someone could die, according to Abeler.

After months of negotiation, Abeler said he was assured by the budget settlement, which saw more than $1 billion in cuts, that no lives would be jeopardized. “I slept for eight hours that night,” he said.

Looking at his area of expertise, Abeler said a large amount of money was invested in health care for poor people and programs for the disabled were starved. That includes nursing homes, he said.

Abeler said more could have been done this past session to help nursing homes. He said he would have preferred a funding total closer to $100 million.

“There’s nothing but challenges with costs going up, the demand increasing with Obama Care and Export Credit Agency insurance requests have not been addressed,” Abeler said.

He said that becomes a big burden on the system and some people think it could be a $100 million impact with the penalty for not having insurance.

According to Abeler, a third to a half of the population does not have insurance for nursing homes and cannot afford to pay it.

“The decade of 2000 has not been friendly to nursing homes in terms of getting large increases,” Abeler said.

The new, purported 5 percent increase is only about 0.6 of a percent of real money, he said.

The rate increase is “something workers can be happy with, but it doesn’t go anywhere near solving the problems,” Abeler said.

Care for the elderly has shifted downstream, Cullen said.

“Those seniors whose frail conditions required hospitalizations in the past are not being cared for in skilled nursing facilities; most of the former skilled nursing facility residents are receiving services either in assisted living settings or at their family home with services being brought in,” she said.

“The seniors currently residing in nursing homes are more frail than in the past and stay for a much shorter period of time. The median length of stay in a nursing home today is under 30 days.

“Today nursing homes tend to serve seniors who fall into a few categories: those requiring post-hospital care, such as rehabilitation after surgeries; those with advanced dementia; those receiving end of life care; and those with multiple clinical conditions.”

Care Providers offers information, resources and networking to nursing homes across the state to help them succeed, Cullen said.

How can nursing home care be improved? Because the state controls nursing home budgets, many nursing homes reduced staff benefits or wages to balance the budget.

“We believe that paying solid wages and benefits to retain good staff is the biggest improvement we can make – consistent, quality staff makes all of the difference in our high-touch profession,” Cullen said.

Kvenvold said state nursing homes do a really fine job, especially in the light of the economic challenges the country has faced.

“We can hold our heads high with any state in the nation,” she said.

AARP, formerly known as the American Association of Retired Persons, almost two years ago released a national report card on nursing home and home-based community care showing Minnesota ranked No. 1 in the nation for quality of care providers. The report examined nursing homes on quality of life, quality of care, support for family caregivers and choices available for seniors.

The biggest change in elderly care, according to Kvenvold, relates to seniors having “a lot more options where they can receive care and support.”

Seniors now use nursing home care less with shorter terms of stay and more than 50 percent of the people in for rehabilitation being discharged.

“This is very different than 20 to 30 years ago when a nursing home resident stayed until the end of life,” Kvenvold said.

There is more of a trend toward wellness services than ever before, she said.

Lifestyle practices affect healthy aging, for example an exercise regimen, no smoking, following good dietary practices and a trend toward wellness, Kvenvold said.

A whole new array of services is available for seniors in nursing homes, assisted living or in their homes. Nursing homes are also now working more closely with hospitals and physicians. Readmission rates are now lower because nursing homes do a good job of discharge planning and sustaining themselves in a community setting, Kvenvold said.

Due to the explosion of the senior population, “we’re going to be stretched to find caregivers,” she said. Those who are making caregiving their career are seeing lower-paid jobs, which tend not to have preferred benefits. The challenge then becomes how to raise benefits for caregivers to attract younger people into the vocation, according to Kvenvold.

“We must make caregiving the best career choice possible,” Kvenvold said.

Another challenge, she said, is underfunding. Going without an increase in wages over four years is not a good long-term formula for quality care, Kvenvold said.

A state initiative, Own Your Future, is currently educating people on the risks of meeting long-term care.

“When we are in our 30s, 40s and 50s, we must plan how we are going to pay for our health care in our 70s and 80s,” Kvenvold said.

It’s a stunning fact, she said, that only 12 percent have long-term insurance and over half of Minnesotans have no plan at all.

“We must help people become aware that Medicare does not really cover long-term care,” Kvenvold said.

The majority of Minnesotans support investment in senior care, emphasizing independence, she said.

“Our seniors want to stay home as long as possible and they tend to view access to quality of senior care as a right, not a privilege,” Kvenvold said.

“As Minnesotans, we have the responsibility to provide dignified, good quality care to seniors as they age.”

It must be impressed on our legislators, Kvenvold said, that senior care is responsible for 100,000 jobs and $4 billion going to the economy.

“The quality of persons delivering care is amazing and really inspiring,” she said.

Next in the series: Part 3 – This story will focus on a faith-based nursing home care center, Elim Rehab & Care Center in Princeton, that has adapted its traditional services as needs have increased in elderly care. 

Howard Lestrud is at
[email protected]

  • Janms

    The nursing home industry
    has increasingly shifted to the for-profit marketplace, driven by its investment
    potential. Nursing home stocks have risen 415 percent since 2003, more than
    twice the pace of the Dow Jones Industrial Average for the same period,
    according to the investment research firm Morningstar. This funneling of money intended for elder
    care is the primary reason for poor staffing and poor care in nursing homes.

    • KT

      In Minnesota, the majority of nursing homes are actually owned and operated by nonprofit organizations, not for-profits. The primary reason for their inability to recruit and retain staff is the state’s failure to fully fund the cost of care. For years the payment rates have consistently fallen below the actual cost of care Minnesota lawmakers set both private pay and Medicaid rates, so nursing homes lack the ability to raise revenues to cover the shortfall. Because over 70% of their operating budgets relate to staff wages and benefits, it is the staff that are bearing the burden of the underfunding. Despite these challenges, Minnesota still ranked #1 in long term care in a recent study by AARP and the SCAN foundation. If you want better care in senior care settings, tell lawmakers to fully fund senior care.

  • Janms

    Some recent CMS data analysis by Families for Better Care revealed that Minnesota ranked 18 in nursing home quality. Much better than most but not number 1.