Editor’s note: This story has been updated to include more accurate budget information.
More than half of nonprofit nursing home providers have had to decline patients being charged from hospitals since January, primarily due to workforce shortages, finds a new survey taken in Pennsylvania.
In addition to staffing shortages, providers responding to the LeadingAge survey also cited major reimbursement and inflation concerns. State leaders have proposed a relatively small bump in funding for 2024 at $15.8 million.
The March survey, shared with McKnight’s Long-Term Care News on Friday, found that more than one-third of respondents reported having licensed beds offline.
It echoes concerns expressed by providers across the nation and raises red flags about future access in Pennsylvania, which has more than 700 nursing homes and is among the nation’s oldest states by resident age.
“It hits you again how fragile the long-term care system is in Pennsylvania,” LeadingAge Pennsylvania President and CEO Garry Pezzano told McKnight;s on Friday. “When you think about the pandemic effect – three years into it, we are still dealing with these issues to this extent.”
Pezzano said his organization and its members have been raising alarms about low reimbursements rates and workforce problems before the pandemic exacerbated the challenges. Continued underfunding of the sector, though, has forced other providers and patients to rely on telehealth and other services to bypass long-term care, he said. Many patients, however, rely on daily inpatient care
But more immediately, LeadingAge Pennsylvania members say that the rising cost of food and building maintenance make already tight budgets harder to manage.
“Even with the increase in Medicaid funding, we are still coming up short,” an executive director/nursing home administrator in Butler County responded in the survey. “We have a higher skilled census now than ever but are barely hitting breakeven. … We are staying afloat because of our other lines of service that pay privately … but this is not sustainable with the current reimbursement and threat of increased staffing requirements.”
A 17.5% Medicaid increase took effect in January, which boosted rates by approximately $35 per resident per day. According to the LeadingAge Pennsylvania survey, 96% of respondents increased starting wages for frontline staff after the increase went through.
“We appreciated the … increase but need significantly more as the current business model is unsustainable,” said a Lancaster County nursing home president, according to the LeadingAge Pennsylvania documents. “In less than two years, unless one lives in a retirement community, one will not have access to quality skilled nursing.”
Beginning July 1, nursing homes will have to provide 2.87 hours per day per resident of direct nursing care. That will increase to 3.2 hours on July 1, 2024, but the industry is awaiting a federal staffing rule from the Centers for Medicare and Medicaid Services that many expect will be 4.1 hours of direct care per day per resident.
Many nursing homes in the state are augmenting their full-time employees through staffing agencies with 6% of survey respondents saying at least half of their staff is from an agency. Sixty-one percent of respondents said at least 10% of their staff is from an agency, despite the high costs.
Pezzano said lawmakers fell short last year in addressing agency “price gouging.” But staffing agencies are now required to register with the Pennsylvania Department of Health, which will let the state officials monitor them. At least one survey respondent complained about the “quality of work” from staffing agencies and other disruptive factors.
“Although we are able to afford to hire agency staff to fill out positions, the quality of work is not what I would like to see from a customer-service perspective,” the respondent said. “It is also an extremely heavy burden on administration to provide orientation and ongoing education to keep the ever-changing staff competent.”
