Nursing home operators, battered by years of stagnant reimbursement for patient care, are scrambling for ways to cope with labor shortages and escalating costs.
For busy moms like Kayse Reitmeyer, of McCandless, those efforts have included yummy suppers for her family.
The made-from-scratch meals with locally sourced ingredients are prepared by Vincentian Collaborative System in a repurposed convent kitchen. The meals are ready for pickup at Vincentian’s McCandless day care center, where Ms. Reitmeyer drops off her daughters, Isabel, 3, and Roslyn, 8. They’ve even ordered the meals for family camping trips.
“It’s right there ready when you go to pick up your kids,” said Ms. Reitmeyer, a business administrator at Highmark. “We really enjoy the taco kits.”
Vincentian is a nonprofit senior care services community founded in 1924 by Catholic nuns. All of the proceeds from the community’s new Unconventional Kitchen catering business support the system’s mission. In addition to busy moms, the service, which began in January, is marketed for weddings and other events.
The money won’t replace Medicaid reimbursement shortfalls, but executives say it’s a creative way to soften the losses while supporting Vincentian’s nonprofit mission.
Financially speaking, things are not likely to get better soon for U.S. nursing homes.
Like similar facilities, Vincentian is facing spiking labor costs with new staffing requirements, exacerbating an industry crunch for nurses that grew acute during the COVID-19 pandemic outbreak.
The cost of uncompensated medical care at Vincentian, which operates nursing homes in McCandless and Banksville, exceeds $11 million annually, according to president and CEO Dean Owrey. Since the pandemic, skilled nursing care costs have jumped 40% while reimbursement ticked up just 4%.
On any given day, up to 75 nurses at Vincentian are hired from temporary staffing agencies, which compares to a total direct care center staff of about 200. Temporary staffing costs the system $2.2 million annually.
Nurses are simply not available to hire, Mr. Owrey said.
“Caring for people is dependent upon people,” Mr. Owrey said. “It assumes that people are available. And our experience is they’re not available.”
At the same time, new nursing staff requirements on the horizon for nursing homes will worsen labor shortages, further driving up costs, officials say.
The Biden administration recently introduced a new national staffing rule that would require most nursing homes to provide a daily minimum of .55 hours of care from a registered nurse and 2.45 hours of care from a nurse aide. The proposed standard, which has been hailed by the AFL-CIO and other labor unions, exceeds those existing in nearly every state.
A 60-day comment period on the new rule by the Centers for Medicare and Medicaid Services ends Nov. 6.
In the meantime, effective July 1, Pennsylvania began enforcing a requirement that every nursing home patient receive 2.87 hours of direct care per day at a time when Kaiser Family Foundation estimated that fewer than 1 in 5 nursing homes would meet the proposed federal standard.
An estimated 81% of U.S. facilities would have to hire more nurses, KFF found.
Hardship exemptions would be available for nursing homes to maintain lower staffing standards, providing they met certain requirements, but the staffing mandates are coming when there’s “an almost historic crisis on the labor front,” Atul Gupta, a University of Pennsylvania Leonard Davis Institute of Health Economics Senior Fellow, wrote in a July blog post.
The Bureau of Labor Statistics projects 203,200 openings for registered nurses every year through 2031, fueled by retirements, continuing demand and other factors.
“Everyone’s chasing the same people,” Keith Frndak, president and CEO of Concordia Lutheran Ministries, said about the challenges in hiring nurses. “Somebody skipped math class, despite the rule being well intentioned.”
Concordia operates an array of senior living centers, including eight skilled care facilities — six in the Pittsburgh area. The proposed federal nursing time with patient requirement of 3.48 hours is 20% higher than the 2.9 hour staffing average for nursing homes, which would further stress the market for nurses, Mr. Frndak said.
At Concordia, where hourly rates for registered nurses rose to $38 to $40 from $29 before the COVID-19 pandemic, the system loses between $72 and $75 a day on Medicaid patients, despite a bump in government reimbursement last year, Mr. Frndak said. Many facilities will be forced to turn away Medicaid patients, who are the lowest paying.
“The richest facilities will survive, but the poorest will fail because they can’t keep up in the bidding wars,” he said. “If facilities are pushed to survive or go bankrupt, they will not be able to take low-end payers.”
Cabot, Pa.-based Concordia chose another tack to nursing labor shortages and escalating costs in 2021 with an initial $1 million donation as part of a 10-year financial commitment to Butler County Community College. With the money, the college started a licensed practical nurse program, with Concordia offering full-tuition scholarships for LPNs and RNs, providing that students work at Concordia for a period after graduation.
Concordia employs about 700 nurses throughout its system, but has about 60 nursing vacancies at any given time. Ten nurses have received free tuition so far through the BC3 program and Concordia has another 63 students in line for scholarships.
“We’re pulling out all the stops,” Mr. Frndak said.
Kris B. Mamula: kmamula@post-gazette.com
First Published: September 28, 2023, 9:30 a.m.
Updated: September 28, 2023, 6:12 p.m.
