A lack of skilled staff at nursing homes and adult family homes is creating a situation in which local hospitals are filled with people who should be discharged to a skilled nursing facility or long-term care home but can’t find a bed.
The leader of the Washington Health Care Association, a trade group representing adult family homes and skilled nursing facilities, says the crisis is now a catastrophe.
Carma Matti-Jackson, president and chief executive, says her group is concerned with the vulnerable elderly who are waiting in hospital beds for openings at skilled nursing facilities.
“Staffing shortages have gotten so bad that nursing homes simply can’t provide needed beds,” Matti-Jackson told The Columbian. “Without adequate funding, directors of nursing are stretched thin trying to balance basic operations with protecting these vulnerable residents.”
The solution, Matti-Jackson continued, is to raise state Medicaid funding. It’s the largest variable contributing to staffing shortages, she said.
Funding “has not kept pace with the labor market, forcing a shortage in available beds for the elderly in our communities. We must do better,” Matti-Jackson said.
Finding qualified staff, or even finding contractors, is a struggle, particularly for smaller operations.
Beth Paul is the clinical director at In It Together RN, which supports many of the county’s small long-term care facilities and adult family homes.
These facilities run on much smaller margins than the larger nursing homes. Medicaid pays these facilities less per person than it would pay to a nursing home.
Long-term care facilities carry Medicaid contracts for skilled care. So in Paul’s business, when she had a nurse go out to help with a catheter, Medicaid would pay for it. But the Medicaid reimbursement was so low that it was costing In It Together RN more to do the work than the state was paying. So it no longer offers that service.
Paul says wages, which are largely influenced by Medicaid contracts, are a big reason that the industry is struggling to find skilled staff.
Nurses “don’t make nearly the kind of money that can be made in the hospital,” said Paul. “The pandemic caused the hospitals to be willing to pay relatively large amounts of money, and large long-term care facilities are willing to pay because they can.”
Those smaller facilities providing daily care can’t compete, said Paul.
“So, they can’t get nurses, and I think that’s a huge part of the challenge,” she added.
Adult family homes are especially affected by real estate prices, said Paul. When someone gets into the business, they are buying not just a business but also a house. Increased home prices and mortgage rates are squeezing operators and would-be operators.
“All of those things that are affecting the economy as a whole are making that form of business less and less practical,” said Paul. Topping that list have been increases in costs for equipment, supplies and insurance. Paul said many adult family home operators have either closed or sold, exacerbating the bed shortage.
It’s not just smaller outfits that are struggling, however.
Attracting skilled labor
The family-owned long-term care provider Prestige Care operates five facilities in Clark County.
“Like virtually every healthcare provider in our region and across the nation, Prestige Care has experienced staffing shortages, particularly among clinical positions including certified nursing assistants and licensed nurses,” the Vancouver-based company said in a statement to The Columbian. “While there’s no doubt that the COVID-19 pandemic has had a profoundly detrimental impact on staffing levels, our industry has long faced workforce challenges that pre-date COVID-19 for many reasons including gaps in funding, regulatory requirements, turnover rates and burn-out, among others.”
In response, Prestige Care has increased wages, offered improved health care benefits, hired corporate recruiters dedicated to hiring frontline staff, and sponsored student and work visas for eligible candidates.
Additionally, the company has made changes in an effort to retain employees it already has.
“We are also listening to the desires of those we employ and have made changes to focus more on the things skilled healthcare providers say they need to be successful,” the company said. Among other things, it has enhanced onboarding activities, developed clear career paths and provided support sessions to prevent staff burnout.
“Still, the staffing issues our industry faces cannot be overstated. More than ever, long-term care, delivered by compassionate, values-driven individuals, is needed to ensure the well-being of families everywhere,” read the statement.
By the numbers
According to the Washington Employment Security Department, there were 4,148 people employed in the nursing and residential care industry in Clark County in November 2022.
Employment in the industry dropped in 2021, hovering around 3,900 for much of the year. It’s now rebounded to just shy of pre-pandemic levels. Employment in the sector in February 2020 was 4,170.
Still, that may not be enough. Employment in the county’s ambulatory health care services and hospitals has increased since early 2020, suggesting more demand for those services.
Ambulatory health care services employed 9,627 people in February 2020 but employ 10,934 now. Hospitals, meanwhile, employed 5,033 people in February 2020 and employ 5,665 now.
Washington is still short 5,200 jobs, 8.1 percent, in the nursing and residential care sector, while the nation is down 9.4 percent from where it was in February 2020.
This is causing issues for the rest of the health care industry.
“We are boarding patients in the (emergency department),” said Mathea Christopher, manager for care management at Legacy Salmon Creek Medical Center.
At any given time at the hospital, there are many people ready to be discharged who cannot be because there are no beds at care facilities.
The phrase “there are no beds” can be misinterpreted, said Paul. A bed, she added, is worthless without a nurse to care for the person in it.
“We can buy beds. That’s not a problem,” she said. “You have to have the skilled care to care for the patient in the bed. And that’s the crisis.”
Nika Bartoo-Smith of The Columbian contributed to this story.