Rural Nursing Homes Hope To Stem Losses With Funding Change
ST. PAUL, Minn. (AP) — In tiny towns across Minnesota, nursing homes are stretching limited state funds until it comes time to cut some service or shut down entirely.
Lawmakers and industry groups are moving to replace a decades-old funding mechanism for nursing facilities they say falls far short of the actual cost of caring for seniors. It's an emotional issue that combines caring for the elderly with a sharper interest on rural Minnesota, where facilities are losing millions of dollars, and politicians are taking notice.
All eyes are on Gov. Mark Dayton's revised budget proposal this week, as nursing home administrators hope the Democratic governor taps a larger-than-expected budget surplus to cover part of the estimated $200 million cost over the next two years. Care associations leading the charge have their fingers crossed, but they're not optimistic — the governor largely left nursing homes out of his first budget, they note. The governor has signaled he may include extra funds for nursing homes.
Still, Patti Cullen from Care Providers of Minnesota said momentum is on their side in the Legislature, where Republicans who took back control of the House made the underfunding of nursing homes in greater Minnesota a major campaign issue. Rural lawmakers from both parties can quickly point to a struggling or shuttered facility in their district.
"We need to have some help or who knows what's going to happen," said Barb Atchison, who runs two nursing homes in Worthington. "We can't survive on what we're getting for much longer."
The state's reimbursement rates haven't kept up with increasing costs, and that's hurting some metro-area nursing homes too, Cullen said. But most facilities in rural Minnesota receive 10 percent to 12 percent less on average from the state's Medical Assistance reimbursements.
The result? Rep. Joe Schomacker, R-Luverne, called it "a vicious cycle" of low wages, high employee turnover and operating losses — to the tune of more than $6 million in 2013, according to the Department of Human Services. And in small towns where nursing homes are among the largest employers, closures hit hardest.
Schomacker's bill would move the state back to a reimbursement system tied to nursing homes' expense reports, rather than pleading for an annual rate increase. It would also allow facilities to pay their staff more.
"Making the individual adjustments year after year is what has kind of got us to this point, where there are real disparities across the state," said Sen. Tony Lourey, a Kerrick Democrat who authored the bill in the Senate.
Paying staff has been a constant struggle in Worthington, where Atchison has fought a losing battle to retain employees with the hospital, Veterans Affairs clinics and even gas stations who offer better pay. She shut down a 25-bed wing at South Shore Care Center due to lack of staff and dropping demand.
Atchison and her employees sent Dayton a letter last month pleading with the governor to get on board with the reimbursement switch. In it, they noted the hundreds of millions of dollars the governor had set aside for new education programs.
"Considering that by 2020 there will be more seniors than kids in school, shouldn't seniors be at the top of your list of priorities as well?" the letter asked.
Twenty-one nursing homes in rural Minnesota counties have closed in the last decade, compared with 19 in metro counties, according to state records. Those closures have brought the state's nursing home count down to 370 and driven a perilous decline in beds even as a "silver tsunami" of retirees approaches — a drop exacerbated by a shift toward assisted living and in-home care.
Atchison said she realizes those alternatives have a place in how the state cares for the elderly. But if Minnesotans want to maintain care for the sickest seniors at nursing homes, the Legislature needs to step in, she said.
"There's always going to be a need for what we do. But something is going to have to change or there are going to be a lot of nursing homes that are going out of business," Atchison said.
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