DENVER – Faced with unmitigated financial pressures, nursing home operators might follow in the footsteps of group home providers who left the sector in droves in recent years, a LeadingAge leader warned Monday.
Board chairman Mike King, president and CEO of Volunteers of America, said nursing homes could very well be the next “loss leader” given inadequate Medicaid support in many states.
“It doesn’t look good,” said King. “It’s why a lot of us had to get out of the group home business. They were huge loss leaders. Losing millions every year and you end up having to sell to larger owners that had more critical mass. It’s an endless circle.”
King and LeadingAge CEO Katie Smith Sloan joined McKnight’s staff for an interview Monday at the 2022 LeadingAge Annual Meeting and Expo.
Sloan said the combination of payment and regulatory challenges has brought unprecedented stress for administrators and executives.
“I’ve talked to members who said ‘I’d rather have COVID than what we’re dealing with now,’ workforce and financial challenges, and the two are very related,’” Sloan said.
“Occupancy is down because there’s not enough people to take care of people and that created financial strain on the community and they’re forced to pay these crazy fees to staffing agencies and then you’ve got inflation on top of it,” she added. “‘With COVID, they knew what to do.”
Staffing is pivotal
Whether the topic was immigration or inflation, the LeadingAge duo kept returning to the sector’s staffing shortage as a pivotal opportunity to problem solve. King spoke about four immigration-related bills in Congress that LeadingAge is advocating for, all of them aimed at “trying to create more supply” of workers, said King.
Sloan emphasized that LeadingAge wants to bolster that supply with the expansion of immigration policy already in place. For instance, the Ensuring Caregivers for the Aged and Disabled Act would add a new temporary guest worker H-2 Visa Program.
“We’re not talking immigration reform, we’re talking about expanding existing channels,” she said. “And we’re also talking about legal immigration.”
“We want to get behind stuff that’s easy to sell to bipartisan groups,” King said. “Hey, I live in Texas, I see more bad press about immigration than you ever want to look at. These (bills) are totally doable.”
“It’s a workforce issue, not an immigration issue, and we frame it as a workforce issue,” Sloan said.
The pair said there would be no movement in the post-election, lameduck Congress. But Sloan was encouraged that four realistic-to-achieve bills had been introduced since LeadingAge addressed the issue in a letter to the White House last spring. Then, there were no bills linking immigration and the healthcare workforce.
“We’re making progress,” said Sloan. “Not where we want to be, but we’re making progress.”
Sloan said of all the ways there are to ameliorate the staffing shortage, immigration is “way towards the top.”
“If you think about the makeup of our workforce now, and the large number of foreign-born workers that are the backbone of our healthcare workforce, if we don’t continue to increase that supply, we’re really stuck,” she said. “It’s a math problem.”
Another part of that math problem will get worse in 2023 when the federal government is expected to enact a staffing mandate.
“The administration has been pretty clear the direction they want to go in,” said Sloan. “The question is, what does it look like? There are so many variables. Which staff is included, how do you account for acuity, what is the number and is there variability?”
