Despite increased state funding that has allowed nursing homes to provide raises for existing staff and increase starting salaries, the number of Pennsylvania providers limiting census due to staffing issues grew 18% percentage points over the last six months.
That’s just one finding from a new survey by LeadingAge PA, which reported that 52% of all survey respondents were now limiting admissions. Those limits on care and mounting concerns about access to beds follow the July 1 implementation of new state staffing ratios for certified nursing assistants and licensed practical nurses.
“What this means is that, on average — and this is really the shocker — on average, that’s one of four available beds that are out of use,” Garry Pezzano (pictured), president and CEO of LeadingAge PA, told McKnight’s Long-Term Care News Monday. “So when you think about it in those terms, the situation even seems more grave. And some of these providers, some of them are telling us that it’s up to 60% of their beds that are empty. This is not for not wanting to hire staff and not wanting to pay the dollars. It’s that this is a situation where the staff is just not available.”
Pennsylvania’s staffing ratios this year call for one CNA for every 12 residents on day and evening shifts, and one CNA per 20 residents overnight. The ratio also requires one licensed practical nurse for every 25 residents on day shifts, one LPN for every 30 residents on evening shifts, and one LPN for every 40 residents on night shifts.
The rule that put those ratios into place this year also calls for providers to spend 70% of their Medicaid revenues on direct care, a caveat that Pazzano has said his members have not had trouble complying with. Instead, even after committing to higher spending and putting much of a statewide Medicaid rate increase toward higher starting salaries and retention, many providers find themselves unable to fill open positions.
After the state rule went into effect, the share of providers represented by LeadingAge using agencies to fill vacancies hit 80.8%; among those that had already been using agency staff, 56.3% increased their reliance.
And another 58% of survey respondents said they had been unable to fill some shifts despite their relationships with staffing agencies.
Pezzano said that pointed to major systemic issues. Among those are faculty and test proctor vacancies that are limiting enrollment in nursing and administrator programs in Pennsylvania. But burnout and the sector’s lack of flexibility are two major reasons that staffing mandates fail to take into account, Pezzano added.
“We don’t have enough people seeing it as a viable career,” he said of nursing.
The shortages will only get worse should a proposed federal staffing mandate come into play next year, when Pennsylvania’s new ratios grow even steeper. The federal rule would require 0.55 hours of daily direct registered nurse care and 2.45 hours of CNA care. It also adds a requirement for round-the-clock RN coverage, but leaves out the LPNs that the Pennsylvania system counts so heavily.
Pezzano said a study separate from the current staffing survey found the typical, 100-bed Pennsylvania nursing home would have to staff for 3.6 hours of direct care per patient day and a 59-bed facility would need to provide 3.93 hours per patient day to comply with the state and federal rules.
“We’ve got enough challenges in Pennsylvania,” said Pezzano, whose team was in Washington, DC, Monday to meet with federal lawmakers. “We don’t need this overlay of federal mandates.”
The new survey found 63% of LeadingAge PA respondents would be forced to further reduce the number of beds if the federal staffing rule moves forward. Nearly 16% said they would have to consider closing their facility or selling to a for-profit entity.
“We’re looking at mission driven not-for-profits being sold. The reality is, that closure means displacement,” Pezzano said. “Now, we make long-term care choices for our families based on accessibility. How can families still be of support when we’re talking about moving people out of their community and your families have to go longer distances? … I don’t know how else to fix that except to help these providers who are serving a community to stay open.”
Pezzano said LeadingAge PA has asked the state Department of Health to consider some flexibilities during this first “test” of the new staffing levels. Among those are a request to count overtime hours toward the state’s ratio requirements, given that those staff are providing care on the clock and in the “spirit of the regulations.”
The survey was sent to LeadingAge PA’s more than 400 members between Sept. 28 and Oct. 6.
