The family-owned 50-bed nursing home in rural Newport, Vt., will close its doors in March, unable to fill numerous jobs, including 10 licensed nursing assistant positions. The average age of its 43 employees is 51 years; and 17 have reached retirement age.
“Part of what helped me make the decision” to close “was knowing that I was going to lose these people and I didn’t see any way to replace them,” said facility administrator Bruce Weddington. “I don’t have anyone in this building who can do what they’re doing. I can’t find anyone to mop the floor. How am I going to fill management positions?”
Weddington’s situation is not unique. The national labor shortage in the industry has particularly affected small rural nursing homes. In Montana, at least seven rural facilities have closed since 2022. With fewer job applicants, understaffed rural facilities are more likely to limit new admissions, which reduces their revenue . Low Medicaid payment rates, rising operating costs and the upcoming federal requirement to bolster staffing only add to their struggles.
“Critical Access”
To survive, they need a lifeline; a federal “critical access” designation, like the government’s, applies to struggling rural hospitals, said Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living.
Instead of the government paying hospitals based on the cost of procedures, or per day rates, critical care hospitals “get their annual operating costs plus 1 percent,” Parkinson said.
“It guarantees that the facilities can remain open” and “they will not have a large deficit, which they would have if they were reimbursed in a normal way”.
Weddington liked the idea. “I think becoming a critical access facility” would be an excellent way to address” their financial challenges, he said.
Katie Smith Sloan, president and CEO of LeadingAge, which represents nonprofit nursing homes and other providers of aging services, was equally supportive.
“A nursing home critical access program could help level the playing field for operators and ensure that older adults and families are not forced to travel far from home for services or become stranded , without attention,” he said in a statement to Bloomberg Law. .
The current economic and labor crisis is “simply too much for some suppliers. They cannot keep their doors open,” their letter said.
It needs congressional action
The Centers for Medicare and Medicaid Services said nursing homes have specific payment rules and there is no provision in the law for critical access nursing homes. Congress would have to enact legislation to create such a designation.
Parkinson said his organization has not had formal conversations with Congress or CMS about a new critical access designation. They have focused more on getting nursing homes through the current labor crisis, the Covid-19 pandemic and the Biden administration’s proposed minimum staffing, which is expected sometime this year.
But a survey this month of 500 AHCA/NCAL facilities found two-thirds were worried about closing because of labor shortages.
Mark Bertilrud, executive director of the nonprofit Warroad Senior Living Center in Warroad, Minn., said his facility has trouble hiring and retaining staff because a local manufacturer pays higher rates. He said a critical access designation would be “a very important concept for places like us to recognize our reliance on government payment sources.”
Recently, a bipartisan group of senators, led by Republican Conference Chairman John Barrasso of Wyoming, sent a letter to CMS Administrator Chiquita Brooks-LaSure expressing concern about the effects of the proposed staffing requirements on rural nursing homes.
“General staffing standards may not provide enough flexibility for nursing homes in light of known and long-standing barriers to recruitment and retention of direct care workers, particularly in rural and underserved areas” , the letter said. Complying with these mandates “will put nursing homes in financial jeopardy,” the letter added. “This could lead to facility closures, particularly in rural communities.”
Barrasso’s office did not respond to a request for comment on the possibility of legislation to expand critical access designations in nursing homes.
“We stand ready to work with your agency on proposals to improve long-term care for patients,” the senators’ letter added. “The best way to achieve this goal is to work with Congress and stakeholders to ensure that any future action does not further exacerbate the serious challenges already facing facilities in rural America.”
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