Sue Johnson, administrator of New Richland Care Center, made a trip last month to the Capitol with hundreds of other long-term care advocates.

Sunday, April 01, 2001

Sue Johnson, administrator of New Richland Care Center, made a trip last month to the Capitol with hundreds of other long-term care advocates. It’s a trip Johnson has made before – in fact, the trip has turned into an annual event as the industry seeks funding and reform for nursing homes.

Johnson said the situation gets more grave every year, and this year, during a time of record surpluses and revenue, nursing homes are deep into a crisis.

Governor Jesse Ventura’s budget proposal, as with public schools and higher education, gives only a tiny increase in long-term care funding, Johnson said. In the next biennium, the governor’s budget recommends no increase in funding the first year and 2 percent the second.

&uot;Of course I’m worried. I’m worried about keeping our staff intact and the ability to offer quality care to our residents,&uot; Johnson said. &uot;The governor’s budget isn’t even close to offering us some help.&uot;

Struggle for funding

Johnson said the battle with the legislature for funding began in the late 1980s when the state established a policy for reimbursement called &uot;equalization pay.&uot; The policy limits care facilities to charging the same rates to all residents whether they rely on public assistance or private insurance.

To make up the revenue discrepancy, the state offers reimbursement, but not enough to rescue the industry from ever-shrinking budgets, escalating operating costs, labor shortages and punitive regulators, Johnson said. The rates established in the equalization pay policy are simply not keeping up with costs, she said.

According to Rick Carter of the Care Providers of Minnesota, the typical nursing home in the state is losing more than $148,000 annually.

&uot;There’s no margin for error. Minnesota is seeing a huge increase in the elderly population while the state is pushing more and more care facilities into bankruptcy,&uot; Carter said.

Carter said the population of elder Minnesotans over age 85 will grow 27 percent in the next decade.

&uot;If legislators don’t make the investment in long-term care, who will take care of this aging population?&uot; Carter asked.

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Looking for workers

Tim Samuelson, CEO of St. John’s Lutheran Home in Albert Lea, knows first-hand the problem of labor shortages in the industry. Running the area’s largest nursing home means a perpetual search for workers – nurses, nursing assistants and support staff.

&uot;The issue boils down to one thing: There’s less people around to do the job,&uot; Samuelson said. &uot;It’s compounded by the fact that we can’t offer top wages. We try to stay competitive as much as possible, but we need the state to help.&uot;

The situation has created extreme competition for staff between facilities, Samuelson said, adding that it’s not uncommon for a qualified worker in Albert Lea area to have worked for three or more facilities over a few years.

&uot;There aren’t many people who are cut out to do this kind of work. It takes a very special person,&uot; Samuelson said. &uot;Some of our most loyal employees have been retiring, and replacing them is extremely difficult.&uot;

Randy Parks of Thorne Crest Retirement Center in Albert Lea cites turnover at 60 percent or higher among the caregiver staff. He said the governor’s budget will only worsen the situation.

&uot;The governor’s proposed budget is a slap in the face to anyone who lives or works in a nursing home,&uot; Parks said.

The typical nurse’s aide is paid less than $10 per hour in Minnesota, and that figure can get much lower in rural areas, said Carter. Starting wages range from $8 to $9.

&uot;I think fast food restaurants are offering those kinds of wages in the Twin Cities,&uot; Johnson said. &uot;There’s something wrong with that.&uot;

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Regulations galore

Much of Johnson’s time at New Richland Care Center is spent paging through The Really Big Book of Nursing Home Regulations, a huge binder that outlines every federal and state guideline and rule.

&uot;We always used to hear that nursing homes were second only to the nuclear industry in government regulation. I hear now that we’ve taken over first place,&uot; Johnson said.

Johnson says the intent behind the regulations is important – to ensure quality care. But the enforcement of the regulations is the problem, she said. When a team of surveyors descends on a facility, the situation can be intimidating, and the attitude of the surveyors is often punitive.

&uot;It’s as if there is a no-tolerance policy, and it’s impossible to live up to it. If we have a weakness, we want to know about it,&uot; Johnson said. &uot;But issuing deficiencies can mean huge amounts of paperwork, fines, and losing workers who don’t appreciate being made to feel like they’re bad at what they do.&uot;

Johnson would like to see broad policy changes to not only improve reimbursement, but also make nursing homes easier and friendlier places to work.

&uot;It’s an employment issue. Wages and benefits are one thing, but the a good environment is also important. We don’t want caregivers to be operating in fear,&uot; Johnson said.

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No solution in sight

A pile of letters has been steadily growing on the desk of Rep. Henry Kalis. The letters are from nursing home workers and elderly constituents who are concerned about the future of care facilities, he said.

Kalis, DFL-Walters, said he is frustrated by a lack of action at the legislature. He said it’s always the same story every biennium: Pass a bill that only addresses the short-term.

&uot;The problem in rural nursing homes is only getting worse,&uot; Kalis said. &uot;There’s no way around it. We need to make the long-term investment. We have to spend the money and work with insurance companies to manage this situation.&uot;

Though a number of bills are floating around the Capitol, a 3.5 percent increase in funding over two years is likely, according to the latest information from the Minnesota Health and Housing Alliance. Proposed by Sen. Linda Berglin, DFL-Minneapolis, the bill would dedicate most of the increase to wage increases, excluding administrators.

The bill has cleared the Senate Health and Human Services Policy Committee last week, and should advance to the floor soon.

Samuelson said the bill basically represents a cost-of-living adjustment.

&uot;If this bill does end up passing, and is signed, which certainly isn’t guaranteed, it only delays the problems for another couple of years,&uot; Samuelson said. &uot;We’ll end up doing this again in two years, hoping to see some long-term solutions.&uot;

In the meantime, Johnson and her colleagues will have to make do, shifting their budgets around to pay for higher utilities, higher insurance and higher wage demands, she said.

&uot;Minnesota has always been a leader in health-care standards and caring for our elderly. Hopefully, we can stay the leaders and address these problems,&uot; Johnson said.

Johnson said the need for nursing homes will always be there, even as alternatives such as transitional living, adult day-care and outpatient services continue to expand.

&uot;There’s always going to be a place for long-term care. We just have to stay open until we find a solution to these problems,&uot; she said.