Negotiations that are expected to wrap up at the end of the month with adoption of the state budget may ease Pennsylvania’s nursing home funding crisis.
The talks — involving SEIU Healthcare PA, Pennsylvania Health Care Association, LeadingAge PA and government officials — are focusing on increasing the Medicaid reimbursement to nursing homes while easing minimum staffing requirements that were to go into effect in 2023, people involved with the discussions said Monday. Some Western Pennsylvania nursing home operators were predicting the closure of one-third to one-half of nursing homes if the funding crisis was not resolved.
Nursing home operators say they are being hammered by inadequate Medicaid reimbursement and inflationary labor costs, which has forced some facilities to close beds and restrict admissions. The COVID-19 pandemic combined with eight years of flat Medicaid reimbursement is pushing skilled nursing facilities to the edge, operators say.
“In the near future, it’s going to start to restrict access for low-income folks as facilities downsize,” said Jim Pieffer, president and CEO of Presbyterian SeniorCare Network, which cares for about 6,500 people in 10 counties of Western Pennsylvania. “We’re just not able to pay our staff what they deserve. Starbucks can raise their prices five times in a year. We can’t do that.”
Seventy percent of the 6,500 or so residents of Presby SeniorCare’s nursing homes are on Medicare or Medicaid, Mr. Pieffer said, each costing the center between $100 and $150 a day in losses, depending on the facility, because of Presby SeniorCare’s staff-to-patient ratios, he said. Overall, the shortfall has driven Presby SeniorCare into the red the past two years by 2% to 5% while some colleagues in the industry have talked about closing their doors.
“Without a doubt, these have been the toughest two years of my 37 years in long-term care,” Mr. Pieffer said. “It’s just really bad circumstances.”
One Butler County operator predicted that a third of Pennsylvania’s 700 nursing homes could be pushed out of business by the crisis.
“In 39 years, this is the worst staff crisis I’ve seen, the worst economic crisis,” said Keith Frndak, president and CEO of Concordia Lutheran Ministries, a Butler County-based long-term care provider that employs 3,100. “This trend cannot continue.”
In addition to his role at Oakmont-based Presby SeniorCare, Mr. Pieffer chairs the board of LeadingAge PA, a Harrisburg-based trade group.
In December, the Pennsylvania Health Care Association, a Harrisburg-based trade group, requested a one-time payment of $200 million from the state’s share of American Rescue Plan money for senior facilities to spend on staff recruitment and retention, said Zach Shamberg, president and CEO. In addition, PHCA, SEIU and LeadingAge are seeking to increase Medicaid reimbursement — an extra $35 per resident per day was being considered.
“This is the solution, working together,” he said. “This is a first step, but an important first step.”
A PHCA survey found that the average daily cost of caring for a person with Medicaid coverage in a nursing home was $247.62, which compared to an average Medicaid reimbursement of $199.96. Other surveys have found wider disparities between actual costs of care and reimbursement.
In July 2021, Gov. Tom Wolf introduced nursing home regulations that would increase direct care for residents to 4.1 hours per day from 2.7 hours per day, an increase which dismayed many nursing home operators who were already struggling to find enough staff. In the current discussions, the new standard would be phased in over a couple years instead of going into effect in 2023 as scheduled, Presby SeniorCare’s Mr. Pieffer said.
State Sen. Jay Costa, a Democrat from Forest Hills, was confident that a package of reforms addressing Medicaid reimbursement, minimum staffing requirements at nursing homes and an American Rescue Act grant, would be worked out by June 30 in time for adoption of the state budget.
“Increasing Medicaid rates is essential,” Mr. Costa said. “A final number hasn’t been reached, but a consensus is building around rates and staff retention.”
Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699
First Published: June 20, 2022, 9:23 p.m.
Updated: June 21, 2022, 10:23 a.m.
