Southeast Minnesota long-term senior care facilities struggle through financial crisis, staffing shortages

The COVID-19 pandemic exacerbated the money struggles already facing care centers. Now, advocates are asking for help from the state to retain workers and keep their facilities open.

Zumbrota Care Center
Jessica Lomeli, front, a certified nursing assistant at the Zumbrota Care Center, and Brianna Ryan, a basic care aid, work with residents on Tuesday, May 17, 2022, in Zumbrota.

ZUMBROTA, Minn. — The Zumbrota Health Services building is noticeably less full than it once was. Rooms down one hallway are mostly unoccupied. Residents sit in the common areas, but it just feels empty.

About four years ago, the senior care center was a 50-bed facility. Now, there’s a 40-bed capacity, but only 32 beds are full.

But the emptiness isn’t just because of a lack of residents. It’s noticeable that the staff is fairly small. And this isn’t exclusive to the Zumbrota facility: There are 23,000 open positions for caregivers across the state.

Zumbrota Care Center
A “now hiring” sign out front of the Zumbrota Care Center on Tuesday, May 17, 2022, in Zumbrota.

The staffing shortage is one domino that fell as a byproduct of the biggest struggle long-term care facilities are facing right now: the financial crisis.

Leaders in the long-term senior care industry are heavily advocating the Minnesota Legislature before the session ends on Monday, May 23, 2022, to use part of the budget surplus to ease the financial burden facing so many facilities.

It’s important to note that the financial crisis within the industry wasn’t created by the pandemic, but the associated costs with protective gear and operating COVID-19 units suddenly pushed onto facilities exacerbated the struggle. The crisis even caused five nursing homes to close in the first five months of 2022. Twelve facilities have closed since 2020.

Prior to the pandemic, nursing homes in particular were functioning under tight margins. And, according to Kari Thurlow, the president and CEO of LeadingAge Minnesota, the reimbursement rates set by the state legislature were a big reason for the financial crisis.

Nursing homes are reimbursed for residents through a daily rate set by lawmakers. In Minnesota, the Medicaid rate and private pay rate have to be the same, according to state law. Facilities submit a cost report with their total operating costs to be reimbursed.

The issue is that the expenses are not reimbursed until 27 months after the cost reports are submitted, so nursing homes right now are paid based on 2020 cost reports.

“Most of those costs are before the pandemic got really bad,” Thurlow said. “If you think about all that we’ve been through since, like the huge inflationary increases, the added cost of testing and vaccines and all of those things, none of that has been covered in cost reimbursements.”

Nursing homes, assisted living facilities and other long-term care centers are operating on incredibly slim margins because the costs they face are far more than the reimbursements they are currently receiving from the state.

The lack of money is the reason there’s also a staffing shortage across Minnesota. Thurlow and other long-term caregivers are advocating for a reimbursement rate increase not to ease the operating cost for facilities, but to increase the wages of caregivers in order to retain current workers and attract new ones.

“One of the biggest challenges we have, and you see this all over the state, is that because of inflation and wage inflation, we’re losing caregivers because we can’t keep up with wages. And when we lose caregivers, we can’t admit more residents. And it creates a financial issue,” Thurlow said. “So our theory is by immediately investing in base wages this session, we’re able to recruit caregivers and increase occupancy in our settings to help with the financial crisis.”

It would be helpful to facility leaders like Sue Knutson, who is operating Samaritan Bethany in Rochester with about 200 staff members, down from the 440 she had five years ago. Operating with half the staff means they’re “just not having people move in.”

“It’s difficult because we don’t normally say no,” she said.

Cami Peterson-DeVries, the vice president of senior services at St. Francis Health Services, the parent organization over Zumbrota Health Services, said because of the staffing crunch, the Zumbrota care center has been “very selective in who comes in because we want to make sure that we have enough staff to prepare and take care of them.”

Zumbrota Care Center
Dr. Cami Peterson-DeVries, the vice president of senior services with St. Francis Health Service of Morris, is pictured at the Zumbrota Care Center on Tuesday, May 17, 2022, in Zumbrota.

“It really is a sadness in the sense that we’re not able to take care of all the people we’d like,” she said.

Some care centers have navigated the staffing shortages without closing and without compromising care for residents who need the facilities they’re in. But funding is desperately needed for many facilities to continue operating.

“We do need finance. We do need funding,” Peterson-DeVries said. “We as an organization have been working together to say, ‘Okay, how do we tighten our belts? What do we do?’ But there are certain things you can’t compromise on. You can’t compromise on resident care. You just can’t.”

VACCINATION DAY!

Today was a big day at Bridges of Zumbrota and Zumbrota Care Center – We had our first round of COVID-19 vaccinations! Here are a few photos from the doings today, with Thrifty White Pharmacy administering the vaccines and some photos of staff enjoying snacks afterward (while socially distancing!).

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Falls Prevention

Zumbrota Health Services, an affiliate of St. Francis Health Services of Morris (SFHS), is pleased to announce we were recently awarded a Minnesota Nursing Facility Performance-based Incentive Payment Program (PIPP) grant by the Minnesota Department of Human Services (DHS) focused on preventing falls.  The initiative for fall prevention and fall reduction began January 1, 2021 and will continue through December 31, 2022 within our care center and related SFHS’ skilled nursing care centers.

The Falls Prevention Project will provide our care center with additional resources to make positive system improvements to prevent falls for individuals receiving services that is focused on each individual’s preferences and needs.  This program will have three components; expanding falls prevention and person centered education, implementing Safe Being technology, and increasing exercise program opportunities.

The education component of the Falls Prevention Project comes to us with a new partnership with Pioneer Network to expand our work force knowledge of Person Centered/Directed care. Pioneer Network is the national leader for culture change that advocates and builds a culture of aging where individual choices are respected and fosters care that is directed by the person receiving it.  Staff will learn how to better address needs and lifestyle choices to reduce an individual receiving services’ risk for falls. 

In the second part of our Falls Prevention Project, we will be installing Safe Being technology in our care centers.  The Safe Being system provides the capability for real time remote monitoring while respecting the person’s privacy.  Safe Being uses a watch-like device that provides data on lifestyles and daily activities and interprets gestures identifying how/when a resident is moving, eating, drinking and sleeping.  Each person wearing the device will send an alert when there is a change in status or has been identified as being at risk for a potential fall or has fallen. 

The third component of the Falls Prevention Project will be increasing exercise program opportunities such as Bingocize and Otago to improve strength, flexibility, and balance to help reduce falls. 

The Falls Prevention Project is intended to build sustainable practices throughout our care center beyond the original two year grant period.  SFHS is a faith-based, not-for-profit healthcare organization.  In addition to their skilled nursing care centers, they offer a variety of services that include customized/assisted living, a full range of therapies, senior housing, transitional and skilled nursing care, and behavioral and residential programs throughout the State of Minnesota.

Weekly Update

Since March, we have implemented aggressive proactive infection control measures and screening procedures that has prevented us from having any confirmed cases of COVID-19 in our care center. We continue to follow the recommended guidance from the Centers for Disease Control & Prevention and Centers for Medicare & Medicaid Services, and the Minnesota Department of Health, and take all appropriate measures and doing everything possible to protect the health and wellness of all who live and work here.

This week, the Minnesota Department of Health (MDH) issued guidance that outlines criteria and makes recommendations on how we our can safely re-open our care centers to visitors while continuing to protect the health of our residents and staff. MDH is allowing individual communities to make the final decision on re-opening to visitors, based on each care center’s unique situation.

Resuming visitation in our care center is a difficult decision because it will increase exposure to the virus and our residents are at higher risk of complications if exposed to COVID-19. Yet, we also know that the ongoing separation from family and friends and feelings of isolation can have a negative impact on our residents.

The threat of this devastating and deadly virus is still with us. Minnesota is experiencing an increase in the number of positive cases in areas across our state, which can pose a greater risk of exposure to both our residents and our staff.

The MDH guidance has specific criteria that we will evaluate to determine when we can safely re-open our care center to visitation. It also applies to when we may need to restrict visitation based on the status and risk of exposure to COVID-19 for our residents and staff.

We will be evaluating this guidance and our commitment to protect our residents and staff and will keep you informed of our progress. Please know there are several key factors to consider and requirements that we must meet before we can open our doors and welcome visitors again. This includes ensuring adequate personal protective equipment and staffing, a testing plan, diligent infection control practices that includes facemasks and social distancing for all staff, residents, and visitors, and the status of COVID-19 in our building, our community and our county.

We deeply appreciate the sacrifices you have made to limit the impact of COVID-19 on our community and your patience as we prepare our care center to host safe visitation and other activities. Our entire team looks forward to seeing you again as families, friends and volunteers are the foundation of what makes our community so special.

If you or someone you know are interested in becoming a healthcare hero, visit www.jobswithus.org, and search “Zumbrota.” We have a variety of positions to start or continue your career in senior care. Plus enjoy flexible scheduling and compelling benefits including a sign-on bonus, as you care for our seniors on the front lines of this pandemic.

Residents continue to enjoy one-on-one activities with staff as well as small group activities while socially distancing and wearing surgical face masks. Visiting with your loved one can be done virtually, open or closed window, and outdoor patio visits. We ask that you schedule your visits ahead of time due to high demand, staffing and the safety of our residents. Thank you again for partnering with us in fighting the COVID-19 virus. Please do not hesitate to contact Laura, Administrator, at 507-732-8132 or lerickson@zhs.sfhs.org if you have any questions or concerns.

Renee Thompson attends Kind Dining Training as part of Nutrition and Optimal Weight (NOW) Grant Implementation Renee Thompson attended Kind Dining training April 9-11 facilitated by Cindy Heilman, CEO of Higher Standards and Creator of Kind Dining. Kind Dining is a meal service method based on hospitality and “bringing warmth to the table.” This program will provide staff the knowledge and tools necessary to enhance the dining experience for residents by promoting person-centered care and nurturing a healthy sense of community and service. Renee will train the staff of Zumbrota Health Services in the concepts, practices, and standards of Kind Dining. Zumbrota Health Services is committed to improving the dining experience for our residents to reduce the number of residents experiencing unintended or unexplained weight loss.

ZUMBROTA HEALTH SERVICES RATED 26 OUT OF 358 NURSING HOMES IN THE STATE OF MINNESOTA IN RESIDENT SATISFACATION AND QUALITY OF LIFE

4/18/18

Zumbrota Health Services (ZHS), a long term care facility in Zumbrota, MN was recently ranked 26th out of 358 nursing homes in the State with regards to Resident Satisfaction and Quality of Life.  The survey is based on face to face interviews of residents in each nursing facility in the state by trained interviewers from Vital Research, a research firm in collaboration with the Minnesota Department of Health. Standardized questions are used to interview a sample of residents in each facility in regard to issues important to their quality of life.  There are eight domains in the satisfaction survey; Meaningful activities, food enjoyment, environment, dignity, autonomy, relationships, caregiving, and mood.  ZHS also scored as the 5th best nursing home in the state for staff/resident relationships.  To learn more about the survey and results visit http://nhreportcard.dhs.mn.gov.

Zumbrota Health Services Continues to Expand Antibiotic Stewardship Program

Zumbrota Health Services has made the commitment to use antibiotics responsibly by putting an Antibiotic Stewardship Program in place. Zumbrota Health Services has been actively working to establish a culture that embraces the proper use of antibiotics in the treatment of infections. By doing so, Zumbrota Health Services hopes to reduce the adverse effects associated with antibiotic use and to minimize the risk of antibiotic resistance (the development of bacteria that are resistant to antibiotic medication). Antibiotic-resistant bacteria are harder to kill and can cause harmful complications and untreatable infections. Using antibiotic medication only when truly needed preserves the power of antibiotics and allows for better outcomes. Zumbrota Health Services has put evidenced based practice guidelines in place and has provided education to staff on their Antibiotic Stewardship Program and Infection Prevention and Control Program. Educational resources and materials have been developed for residents and families too. Zumbrota Health Services will continue to work with their medical providers, pharmacy consultants, and entire healthcare team to expand the program and aim for excellence in care.