Shortfall remains despite recent funding increase; major challenges lie ahead
Editor’s note: This is the second article in a three-part series on elderly care in Minnesota. The first installment ran Sept. 5 and the final installment will focus on facilities and programs in the Forest Lake area.
ECM Political Editor
Underfunded nursing home care has been a major challenge to the state in recent years and will continue to be addressed in the future, many legislators and health care professionals predict.
Nursing home legislation was adopted during the last session of the Minnesota Legislature, creating a 5 percent across-the-board increase.
That action by the Legislature represented the first increase in funding in the past five years. Nursing home workers have had their wages frozen since 2008 and are now seeing a wage increase that began Sept. 1.
Of the $83 million it will cost for four years, Rep. Jim Abeler, R-Anoka, said, $74 million was recycled out of the nursing home industry.
“It’s like taking your wallet out of your right pocket and putting it into your left pocket and saying, ‘I’ve got some money now,’” Abeler said. “The system is starving for money, and we can’t give the people a good raise because of the pressures about minimum wage.”
Last session, Abeler served as the ranking Republican on the Health and Human Services Finance Committee. He chaired the committee the two previous years with Republicans being in leadership control.
Gayle Kvenvold, president and chief executive officer of Aging Services of Minnesota, said needs of nursing homes have not been adequately addressed by the Legislature and by others. The action by the Legislature “was a step in the right direction and we are grateful for it, but our job is not done,” Kvenvold said.
On the average, the difference between funding and what it costs to take care of a senior is a shortfall of $28 per day, Kvenvold said. She said it will take more than one legislative session to make up that difference.
Patti Cullen, president and CEO of Care Providers of Minnesota, said the legislative action in 2013 represented a significant increase and is a good start.
“With years of no increases and growing mandates, we have a ways to go before this profession is on financially sound ground,” Cullen said.
Cullen said the wage gap between staff in nursing homes and similar positions in hospitals is dramatic, and with the job market picking up, “we will have a hard time keeping our positions filled.” She said the wage gap for registered nurses is more than $35,000 per year.
“The Legislature heard our message about the need to give increases to our workers,” Cullen said last session.
Rep. Patti Fritz, DFL-Faribault, who served on the Health and Human Services Finance Committee with Abeler, said the 2013 Legislature made it a priority “to invest in better care for our seniors who were cut deeply by the previous Legislature.”
In many areas, nursing homes don’t pay enough to keep employees around, Fritz said.
Fritz worked for 30-plus years at the St. Lucas Care Center in Faribault as a licensed practical nurse. As a legislator, she is serving her fifth term and has made it her focus to improve senior and nursing care statewide.
“It’s critically important that we improve care as we prepare for the impending ‘age wave,’” she said.
Minnesota, like states across the nation, will experience a significant demographic shift during the next 20 years as baby boomers enter retirement. Fritz said Minnesota’s population of adults over age 65 will increase from 12 percent to 20 percent by 2030.
“The policy implications of this demographic shift are substantial,” Fritz said. “We need to ensure that our nursing homes have adequate funding to provide care for seniors and people with disabilities who are no longer able to live independently, and in addition, we need to recognize that many older Minnesotans prefer to remain in their own home, with adequate in-home care support.”
Care for the elderly has changed considerably during the past decade, Abeler said.
“It’s moving more toward assisted living and keeping people in their homes, and so the need for nursing home beds is reducing,” he said. “Nursing homes are struggling to stay full.”
Abeler praised the construction of a new nursing home and elderly living complex called The Homestead of Anoka. It features a 120-bed rehabilitation and living center, along with 59 apartment units, a mix of independent and assisted living.
The move to keep people in their homes at an older age “is really smart and is a good value,” Abeler said.
“This represents a better life for the people and the system has to change to evolve into places like The Homestead where people can age in place,” Abeler said.
During his chairmanship of Health and Human Services in 2011-12, Abeler said he learned about life and death.
“I didn’t sleep well for four months” when working on the Health and Human Services budget, Abeler recalled, pointing out that if he did it wrong, someone could die. After months of negotiation, Abeler said he was assured by the budget settlement, which saw more than $1 billion in cuts, that no lives would be jeopardized. “I slept for eight hours that night,” he said.
Looking at his area of expertise, Abeler said a large amount of money was invested in health care for poor people and programs for the disabled were starved. That includes nursing homes, he said.
Abeler said more could have been done this past session to help nursing homes. He said he would have preferred a funding total closer to $100 million.
“There’s nothing but challenges with costs going up, the demand increasing with Obamacare, and Export Credit Agency insurance requests have not been addressed,” Abeler said.
He said that becomes a big burden on the system and some people think it could be a $100 million impact with the penalty for not having insurance.
Abeler pointed out that a third to half of the population does not have insurance for nursing homes and cannot afford to pay it.
“The decade of 2000 has not been friendly to nursing homes in terms of getting large increases,” Abeler said.
He said the new, purported 5 percent increase is only about 0.6 of a percent of real money.
The rate increase is “something workers can be happy with, but it doesn’t go anywhere near solving the problems,” Abeler continued.
Care for the elderly has shifted downstream, Cullen said.
“Those seniors whose frail conditions required hospitalizations in the past are not being cared for in skilled nursing facilities; most of the former skilled nursing facility residents are receiving services either in assisted living settings or at their family home with services being brought in.
“The seniors currently residing in nursing homes are more frail than in the past and stay for a much shorter period of time. The median length of stay in a nursing home today is under 30 days.
“Today nursing homes tend to serve seniors who fall into a few categories: those requiring post-hospital care, such as rehabilitation after surgeries; those with advanced dementia; those receiving end-of-life care; and those with multiple clinical conditions.”
How can nursing home care be improved? Because the state controls nursing home budgets, many facilities reduced staff benefits or wages to balance the budget.
“We believe that paying solid wages and benefits to retain good staff is the biggest improvement we can make – consistent, quality staff makes all of the difference in our high-touch profession,” Cullen said.
Kvenvold said state nursing homes do a fine job, especially in light of the economic challenges the country has faced.
“We can hold our heads high with any state in the nation,” Kvenvold said.
AARP, formerly known as the American Association of Retired Persons, almost two years ago released a national report card on nursing home and home-based community care showing Minnesota ranked No. 1 in the nation for quality of care providers. The report examined nursing homes on quality of life, quality of care, support for family caregivers and choices available for seniors.
The biggest change in elderly care, according to Kvenvold, relates to seniors having “a lot more options where they can receive care and support.”
Seniors now use nursing home care less with shorter terms of stay and more than 50 percent of the people in for rehabilitation being discharged.
“This is very different than 20 to 30 years ago when a nursing home resident stayed until the end of life,” Kvenvold said.
There is more of a trend toward wellness services than ever before, she said. Lifestyle practices affect healthy aging, for example an exercise regimen, no smoking, following good dietary practices and a trend toward wellness, she said.
A whole new array of services is available for seniors in nursing homes, assisted living or in their homes. Nursing homes are also now working more closely with hospitals and physicians. Readmission rates are now lower because nursing homes do a good job of discharge planning and sustaining themselves in a community setting, Kvenvold said.
Due to the explosion of the senior population, “we’re going to be stretched to find caregivers,” Kvenvold said. Those who are making caregiving their career are seeing lower-paying jobs, which tend not to have preferred benefits. The challenge then becomes how to raise benefits for caregivers to attract younger people into the vocation.
“We must make caregiving the best career choice possible,” she said.
Another challenge, Kvenvold said, is underfunding. Going without an increase in wages over four years is not a good long-term formula for quality care, she said.
A state initiative, Own Your Future, is currently educating people on the risks of meeting long-term care.
“When we are in our 30s, 40s and 50s, we must plan how we are going to pay for our health care in our 70s and 80s,” Kvenvold said.
It’s a stunning fact, she said, that only 12 percent have long-term insurance and over half of Minnesotans have no plan at all.
“We must help people become aware that Medicare does not really cover long-term care,” Kvenvold said.
The majority of Minnesotans support investment in senior care, Kvenvold said, emphasizing independence.
“Our seniors want to stay home as long as possible, and they tend to view access to quality of senior care as a right, not a privilege,” she said. “As Minnesotans, we have the responsibility to provide dignified, good quality care to seniors as they age.”
It must be impressed on our legislators, Kvenvold said, that senior care is responsible for 100,000 jobs and $4 billion going to the economy.
“The quality of persons delivering care is amazing and really inspiring,” she said.