Creative ideas to entice more workers to Iowa’s nursing homes will not solve the labor shortfall and wage issues unless lawmakers increase funding to match the cost of care, providers and advocates said. 

And regulatory mandates such as staffing minimums that could coming down soon from the Centers for Medicare & Medicaid Services will only further decimate a “fragile” sector, according to LeadingAge of Iowa and members. The advocacy group hosted a webinar Thursday on the first State of Aging Services, which did not pull punches on how bad things have become post-pandemic. 

National leaders view Iowa’s challenges as a microcosm for many other areas in the US.

“We really worked hard to save for a rainy day,” said Paula Geise, president and CEO of Bartels Lutheran Retirement Community in Waverly, IA. “But we are burning through our savings to trying to offset the additional costs.”

Geise was one of three nursing home representatives who participated in the webinar. She also was featured in a video produced by LeadingAge aimed at lawmakers and regulators who control the purse strings and make the rules. 

In 2021, the average nursing home in Iowa lost $50.19 per patient per day on resident care compared to $14.46 per day in 2019, according to LeadingAge Iowa. Operating costs per resident per day for the average facility grew by 15% between 2019 and 2021 while revenues for that same period grew by 6.7%, the organization said.

As of Feb 2, there were more than 5,800 direct care positions across state open, and 1,238 beds have been taken offline as of November 2022, according to LeadingAge Iowa. In 2022, 17 providers closed with another six already announcing plans to shutter this year. And more than half of the providers in the state report limiting new admissions, the organization said. 

On top of those challenges, CMS is preparing to roll out a staffing mandate that could require nursing homes to provide 4.1 hours of care per resident per day. 

“We’re already losing so many people in this field,” said Matt Jahn, director of Health Services at Stonehill Services in Dubuque. “Adding more rules and regulations and requirements that really have no solutions or a path on how that can be accomplished isn’t setting us up for success and can lead to more closures.”

Higher operational costs coming

Julie Thorson, president and CEO of Friendship Haven in Ft. Dodge, said her company has offered “thank you” and COVID bonuses to staff in addition to raising wages, but it’s still not enough. 

“We really are doing everything and have tried everything we possibly can, but all of that comes with a cost, too,” Thorson said. “When you have a 50% Medicaid population in your health center, creativity just isn’t enough. Reimbursement has to be increased to even come close to covering just the actual cost of care.”

Geise said her company raised wages twice last year. Jahn said he speaks to middle- and high school students about careers in long-term care to create early interest for potential employees in addition to other efforts to boost hiring.

Providers are also looking ahead to the official end of the public health emergency, which federal officials said will occur on May 11. Emergency funds that may have kept some facilities afloat are either running out or already gone but additional costs still exist, call participants said.

“Long after the official end of the pandemic, we are still going to be doing and using and practicing exceptional infection control practices,” Thorson said, adding that her company continues testing and continues managing COVID cases. “We are going to live at a higher operational cost of providing care because infection control has taken on a new hyperfocus. Our costs aren’t going away — they’re increasing.”

Jean Moody-Williams, deputy director for the Center for Clinical Standards and Quality at CMS, said that the waivers extended to nursing aides to begin working before achieving their certifications will expire in September, which adds another layer of training, cost, and staffing problems for facilities if non-certified aides are unable to pass the state exam by then. 

Moody-Williams’ comments came during a webinar last week hosted by federal health officials to start rolling out their end-of-pandemic plans so providers and others in the health sector can prepare. 

Other information presented in the State of Aging Services report:

•  Since the start of the pandemic, the residential care workforce in the state is down 11.83% while labor costs are up 8.1%.

•   83% of nursing homes are struggling to recruit or retain nursing staff, and 89% are having trouble finding non-nursing staff workers. 

•   71% of workers who leave their jobs blame burnout, 65% are looking for better wages, and 54% are leaving the sector entirely, according to a provider poll.