Tim Mullaney
Tim Mullaney

Minnesota is known as the Land of 10,000 Lakes. An impressive number. But did you know that Wisconsin has 15,000 lakes?

Okay, some people quibble about that. However, I grew up on the other side of the Mississippi in the Dairy State, so I’m still a little competitive when it comes to Minnesota.

But even I have to admit, Minnesota appears to be on the ball when it comes to long-term care. It regularly rates at or near the top when states are ranked on LTC services. Recently, a Commonwealth Fund report showed it has an admirably low rate of hospital admissions and readmissions from nursing homes.

Yet, Minnesota also is on the leading edge of a more troublesome long-term care trend: nursing facility closures. The state reduced its bed capacity more than any other state between 1995 and 2011, according to a legislative report issued in October. Overall, U.S. bed capacity went down 2.7% in that time period. Minnesota decreased capacity by 28%.

The closures have occurred for a variety of reasons, none of which will surprise long-term care professionals. Take inadequate Medicaid reimbursements. The state’s daily reimbursement rate comes about $20 to $30 short of covering daily resident costs, according to Minnesota Public Radio. These Medicaid shortfalls cut into staff compensation, making it hard to attract and retain workers, and short-staffed facilities can’t fill all their beds.

“It’s kind of a vicious cycle,” said MPR reporter Jennifer Vogel.

It’s a vicious cycle that recently led to the closure of the Evangelical Lutheran Good Samaritan Society facility in the town of Hoffman. MPR’s Vogel filed an in-depth story about this closure. While McKnight’s and other news sources frequently report on the reimbursement cuts and staffing woes that threaten nursing homes, the closure of a single facility usually is not grounds for a big story. One reason is that it’s simply too common an occurrence to merit news coverage, as the statistics in Minnesota indicate.

For this very reason, Vogel’s piece is noteworthy. It takes the abstract, worst-case scenario of a facility closure and makes it very real, by describing excruciating details and incidents like these:

Faye Giese found her 87-year-old mother, Jeanne Gunderson, sitting in her room with her eyes closed. Gunderson said she was praying to die before having to leave Good Samaritan. Prior to becoming a resident, Gunderson played piano at the Hoffman nursing home as a volunteer for two decades.

With all the residents moved out, a birdcage in the dining room was empty, its canaries gone. Pushpins that once held family photos and grandchildren’s drawings were stuck haphazardly in the walls.

Nurses working their final shift cried so hard, they had to get stronger tissues. Nurse Jelene Blackman said, “It was home.”

An accompanying spread of 10 photos makes the story even more powerful. Providers might send the story to their state Congressional delegations, or print out some copies of to share with lawmakers at the next Capitol Hill event. Legislators may think twice about the human consequences of policy decisions if they have the story of Jeanne Gunderson in mind.

However, the MPR story was not framed as a call to action to save nursing homes. Healthcare reform at the state and national level has already shifted definitively toward less expensive options, and seniors largely support these moves to limit institutional care and expand home health and community-based alternatives.

Given this reality, the lessons from the Hoffman closure might be relatively modest. For example, states might want to rethink the timing of closure announcements, Vogel suggested. State statutes require that the announcements come at the last minute, to limit the time when residents experience stress and worry. But that also means towns are caught off-guard and have no chance to rally financial support for facilities or plan to mitigate the economic effects of closure.

These effects are significant in Hoffman. The nursing home was the largest employer in the town of 700, and an economic report estimates the closure could represent a $3 million annual economic loss to the county.

Even if there are no changes around the timing of closure announcements, the situation in Hoffman might serve as a warning to other towns in Minnesota and around the country. Minnesota historically has had a higher number of nursing home beds per 1,000 people than other states, according to the October report, so other states shouldn’t necessarily expect to see a comparably high number of closures. But with Medicaid underpaying at an average of $22 nationally, towns should not assume their local nursing home is an inviolate community institution, as it appears many people in Hoffman did. Local leaders and families of residents need to be aware of the enormous operational challenges these facilities face and have contingency plans in place should a closure occur.

It’s true that other states don’t necessarily have to consider Minnesota but are learning this lesson about preparedness from their own significant closures — Wisconsin being no exception. Still, I say to my fellow Badgers: Look across the river, and take heed.

Tim Mullaney is Staff Writer at McKnight’s. Follow him @TimMullaneyLTC.