Rural nursing homes face a daunting challenge of caring for an increasingly aging population without an equivalent workforce, according to a leading provider advocate in Nebraska.
“The rural parts of our state are aging, but there are no young people essentially living there to take care of them,” Jalene Carpenter, president and CEO of the Nebraska Health Care Association, told McKnight’s Long-Term Care News on Monday, following a report that some hospital patients are waiting up to a year for a long-term care bed.
In 2021 and 2022, the state lost 10 SNFs with a combined 472 beds, all of which were in rural areas, Carpenter said. She added that it’s not just nurses, though — facilities can’t find enough cooks, housekeepers, activity directors or other workers to fill all of the needed roles.
The state’s demographic trends don’t help the situation.
The two largest cities are Omaha and Lincoln with populations of, respectively, approximately 500,000 people and just under 300,000, according to census data.
When someone in a rural area becomes ill, she first goes to a nearby critical access hospital but then must travel to Omaha or Lincoln for more acute care. That can be as far as six hours away. When it comes time to discharge to a skilled nursing facility, Carpenter said there are significant barriers to finding a placement, including lack of a payor for medical transport back to their hometown.
Costs also continue to add up and make it more challenging for providers to care for Medicaid patients.
Nursing home providers got a much-needed 20% boost in Medicaid reimbursement rates, but that wasn’t enough for them to break even with the costs of care, Carpenter said. They’re asking for approximately 8% more in rate hikes, she added.
SNF advocates also are hoping to push through legislation that eliminates buyout costs for nursing homes that want to offer full-time employment to agency nurses and aides. That bill does not put a cap on what agencies can charge but does ensure that workers are properly licensed and carrying the correct insurance.
These challenges are not limited to just the rural areas, added LeadingAge Nebraska CEO Kierstin Reed. Nursing homes across the state are losing 20% or more per day on every Medicaid resident, and there are approximately 240 people waiting in hospitals for skilled nursing beds to open up, she said.
That creates a logjam at hospitals, but staffing issues have nursing homes either halting or limiting admissions, according to Reed.
“This is a difficult decision because they depend on having a full census for financial viability,” she added.
