Seniors displaced by home closures
Hundreds of nursing facilities in US struggle to remain in operation
A 99-bed nursing home in one of Cleveland’s poorest neighborhoods will close its doors in less than two months.
Like many nursing homes, Eliza Bryant Village has struggled to maintain operations during the COVID-19 pandemic. Costs are too high and reimbursement isn’t enough. The home loses more than $100 each day for every resident covered by Medicaid, which represents about 95% of the home’s population.
The home that describes itself as the oldest, continually operating, African American-founded nursing home in the U.S. will close June 8. Most elderly residents, some having lived there for several years, have found new facilities. As of April 15, 17 residents were searching for their next home.
Danny Williams, president and CEO of Eliza Bryant Village, said the nonprofit home’s financial pressure is emblematic of what ails many nursing facilities. “It’s a result of the values of our society – we just don’t value taking care of old, poor people,” Williams said. “If there’s anything good that comes from this, it shines a light on the inequities in the system and may influence policymakers to take some action.”
Eliza Bryant is among more than 300 homes that closed or are winding down operations since 2020, according to an analysis of federal data by the American Health Care Association and National Center for Assisted Living, an industry group that represents for-profit nursing homes.
Casting further uncertainty are sweeping proposals by the Biden administration that would require minimum staffing levels and improved oversight of infection control.
On April 11, the Centers for Medicare and Medicaid Services proposed a $320 million pay cut that nursing home operators said will exacerbate the industry’s challenges.
“Nursing home closures are devastating to residents, their families, staff and the entire health care system,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living. “The chronic underfunding of nursing homes combined with the ongoing toll of the pandemic and a historic labor shortage has been too much to bear for many facilities.”
A 577-page report issued by the National Academies of Sciences, Engineering and Medicine on April 6 cited decades of underfunding and a lack of accountability on how those funds are spent. One result has been low staff salaries and benefits that made nursing homes a “highly undesirable place of employment,” the report said.
The industry’s workforce problems accelerated when the pandemic caused lockdowns, inflation and an ultra-tight job market in which workers became more selective about jobs. Others quit positions to take higher-paying gigs with staffing agencies that charged homes up to three times the PRE-COVID-19 rates.
Nursing homes probably will continue to shut down, close wings or scale back operations, experts said.
Last fall, the Arapahoe, Nebraska, assisted living home where Heidi Thomas’ husband, Alan, lived for five years announced it was shutting down Dec. 31.
She could find a new nursing facility in a neighboring town, but it would mean driving 30 to 40 miles several times each week to see him.
So she outfitted their home for Alan, who has Parkinson’s disease and Lewy body dementia, a disease that leads to irreversible mental decline. He does not require complex machines or devices, but he needs constant supervision.
Thomas hired two caregivers from the closed assisted living and nursing facility who watch him during the day while she works as a teacher.
“He doesn’t have a lot of words anymore,” Thomas said. “But he did say that he was really happy to be home.”
The Arapahoe home was operated by the Good Samaritan Society, which merged in 2019 with the Sioux Falls, South Dakota-based Sanford Health. Good Samaritan shut down nursing facilities last year in two other Nebraska towns, Ravenna and Valentine.
Homes that closed in rural Nebraska before the pandemic typically did so because they didn’t have enough patients or residents, said Jalene Carpenter, CEO of the Nebraska Health Care Association. Since the beginning of the pandemic, “it has really been the reverse,” Carpenter said. “They have residents to care for, or they have (people) they would like to accept. They simply do not have the workforce.”
Arapahoe Mayor John Koller said the Good Samaritan Society’s closing was “devastating” for the town of about 1,000, where one-quarter of residents are older than 65 and often lived their entire life in the community.
Many residents moved to homes in neighboring towns, making it more difficult for their Arapahoe family members to regularly visit. Twenty-five to 30 employees had to seek jobs at facilities as far as 60 miles away, Koller said.
The community was notified 60 days before the facility closed, the minimum under federal and state law, Koller said.
“In a town this size, if you lose any employment opportunities, it’s difficult to recover,” Koller said. “It’s this common story for rural America. It just continues to erode.”
In Wisconsin, a dozen nursing homes have closed during the pandemic, and three are winding down operations, according to Leading Age Wisconsin.
The industry’s workforce shortage has rippled beyond closed homes. Dozens of homes reduced the number of beds they operate because they don’t have enough workers.
Homes can’t handle everyone who seeks care, said John Sauer, president and CEO of the Wisconsin chapter of Leadingage.
“It really is a herculean task to achieve higher staffing than we have now,” Sauer said.
Williams, of Eliza Bryant Village, said more equitable funding will be key for homes that serve a larger share of poor residents. His group will maintain other services on its 17-acre campus, including an adult day program, at-home care, transportation and a center for seniors suffering physical, emotional or financial abuse.