Oklahoma nursing homes limiting admissions
Facilities make difficult calls amid staff shortage
Already dealing with workforce shortages and the brunt of a pandemic, nursing homes are now facing a grim choice: limit new admissions or shut down entirely.
A new survey, conducted by the American Health Care Association and the National Center for Assisted Living, found the workforce situation has worsened over the last three months for 86% of nursing homes and 77% of assisted living providers nationwide.
According to the same survey, 58% of them are now limiting new admissions due to shortages.
“Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents,” said Mark Parkinson, president and CEO of the association that conducted the survey. “We cannot allow facilities to close because of these challenges, which will directly impact residents and their families, especially when lawmakers have the means to help solve this dire situation.”
In Oklahoma, Diakonos Group employs nearly 1,000 caregivers and operates multiple rehabilitation facilities and assisted living communities. Kimberly Green, chief operating officer at Diakonos Group, said about 60% of the provider’s facilities have implemented an admissions slowdown.
“To me, it feels almost like an emotional storm, because we couldn’t wait to get through COVID,” Green said. “A year and a half ago, we were fighting for
our lives and our residents’ lives, and it was just absolute misery. So then, we get through the vaccine, we become such a safe environment, and we’re all so excited to try to get closer back to a normal life. But then we see, even though we’re open and can start taking more admissions, there’s nobody applying (for jobs).”
‘We had tried everything’
Nursing homes and assisted living centers were hit hard by the pandemic. The first health care worker in the U.S. to die from COVID-19 resided in Washington, and one of the first known coronavirus outbreaks in the country affected a long-term care facility in the same state — a pattern that quickly spread throughout the U.S. in early 2020.
A vigorous vaccine campaign, targeting both patients and staff, did temporarily reverse the brutal tide of COVID-19 at many long-term care facilities, but by spring 2021, nursing homes everywhere realized they no longer had adequate staffing.
Green said she saw the issues of burnout and turnover most acutely at the Servant Living Center, a Diakonos Group-owned nursing home in Medford that provided specialized care for older adults with mental health needs.
“The people that we did have were working every single day,” Green said. “They weren’t getting any days off. The staff — that was really great — burned out. After COVID, they were just saying, ‘I can’t do this anymore,’ and they walk out, and they don’t want to come back.”
“Looking at that, I knew that was not fair to any of them, wasn’t fair to their families, and that we were just waiting for a crisis. It just got to where we could not staff it.”
By summertime, Diakonos Group moved most of the 44 residents over to its other senior mental health facilities within the network, while nine of them opted to stay elsewhere in the local Medford community. In June, the Servant Living Center permanently closed.
“We just didn’t have any other options,” Green said. “We had tried giving raises. We had tried other bonuses, benefits, marketing techniques and social media. We had tried everything, and nothing could get people there.”
Green said workers who have been dedicated to the nursing home industry for many years are now leaving to pursue better pay elsewhere.
“Whenever we are competing with wages up to $25 an hour, there’s no way that we can do that, so who’s going to choose us?”
Limiting admissions did not save the Servant Living Center and, according to the survey, more than one-third of nursing homes are concerned they might share the same fate as the Medford facility.
“We have these families who are calling, and they’re trying to go down the list of places they want their loved one to be, and everybody’s saying they don’t have a bed,” Green said. “And that’s extremely scary because limiting their options makes them feel like they’re not putting their loved one in the place that they wanted them to be. And it may mean that they might not even have them placed close to them.”
‘We all have a limit’
Mary Peacock Smith took the position of administrator at St. Ann’s Skilled Nursing & Therapy in Oklahoma City during January 2020, right as the coronavirus outbreak began.
“I can say we had a fantastic staff during that time,” Smith said. “They really went above and beyond, and we took care of COVID residents in-house because the hospitals had no beds. That’s a really high-acuity level of care, but the staff members really stepped up to the plate, took really good care of them, and we did make it through.”
By early 2021, most of the staff and residents had been vaccinated, and the facility was seeing fewer COVID-19 cases, but staffing issues had worsened.
“We’re not seeing a lot of applicants,” she said. “And as an administrator, I have some hospitals that are getting full, and they want us to help them out as one of their healthcare partners and take these high-acuity residents, so they can have more room for the COVID patients. But we’ve had to restrict admissions, because I can’t control that no one’s coming to apply. The only thing I can control is how many residents that we currently take into our building.”
The number fluctuates, but St. Ann’s is currently tending to about 90 patients. Smith said the facility can hold up to 120 residents, but a lack of new hires complicates her staff ’s ability to meet every patient’s needs.
“It’s scary to think that, you know, if we can’t admit them, where are these vulnerable Oklahomans going to go?” Smith said. “But we are seeing that higher acuity. … When you compound all these issues together, and then you also don’t have enough staff, it just makes it very difficult.”
Much like what Green attempted at Medford’s Servant Living Center, Smith said St. Ann’s has tried attracting applicants with paid educational opportunities, in-house certified nursing assistant programs, job fairs and sign-on bonuses.
But new workers are still hard to come by, and Smith has cross-trained St. Ann’s 15 managers to give direct assistance when labor is short. That includes herself. Smith said she works 40 hours a week, is on call 24 hours a day, and often works overtime shifts when no other help is available.
“It’s a problem, and I can do that for a while, maybe, but at some point we all have a limit, and I think our nurses all have a limit,” Smith said. “It’s a lot to be a caregiver. It’s hard to cry with these residents. It’s hard to cry with these families when they’re scared and they don’t know what’s going to happen. All of those processes and the aging and the end of life — it can take a toll on a person.”
Smith said she does not blame those who leave the profession to pursue a better-paying job with less stress, but she does worry about not being able to meet the regulatory criteria and care needs at her facility if funding isn’t there.
‘Lawmakers have the means to help’
Steve Buck, president and CEO of Care Providers Oklahoma, the state’s largest organization representing longterm care facilities, said numerous proposals have been made to address the workforce shortage in the nursing field.
As Oklahoma’s population continues to age, Buck said the state needs to inspire young people and mid-career people to choose a health career. But, as Green and Smith noted, the absence of a living wage is a major part of the problem.
“It’s a reimbursement challenge that we have to continue to wrestle through,” Buck said. “If I’m making $11 to $15 an hour working in health care, we know that Target has established a new floor wage of $15 themselves.“
In Oklahoma, Medicaid accounts for about 75%, if not the entirety, of an average bill at long-term care facilities. Its current wage model structure, set around a minimum of $12 an hour, is what many member organizations of Buck’s association use. Many long-term care providers feel their professional appeal is hindered by this floor wage, which cannot match hourly wages offered by larger hospital systems.
Mercy Health, for example, announced in August it would raise its hourly minimum wage to $15. Sisters of St. Mary (SSM) Health, another major competitor, announced Thursday it would begin implementing a $15 minimum wage as well.
Because of the public insurance program supporting his members’ facilities, Buck said meaningful and effective funding can come only from action by state and federal lawmakers.
“You know, the state of Oklahoma has about $1.8 billion at its disposal in American Rescue Plan dollars,” Buck said. “We are specifically asking for targeted investment into healthcare. That can include loan forgiveness programs, that can include scholarships, that can include paying for that basic frontline certification“
Parkinson echoed calls to bolster the workforce with higher investment and better incentives.
“Our caregivers are the backbone of long-term care, and they deserve the full support of our lawmakers,” Parkinson said.
The Care for Our Seniors Act, advocated by the American Health Care Association and the National Center for Assisted Living, lays out proposals to reform the nursing sector and address key issues, Parkinson said, “but without the help from Congress and state legislators, this will not be possible.”
Green, who has worked in nursing since the age of 14, said help for her employees and their patients can’t come soon enough.
“My entire life has been devoted to these people, and I don’t want them forgotten,” Green said. “This isn’t just a job; this is a mission. Think about who the people are that we’re caring for. We’re caring for the people that fought the wars, that built Oklahoma. These are the people that taught us in school, our doctors, the people from our childhood. They deserve to live great lives. And right now, we’re circling the drain. It’s devastating.”
“(People) remembered us during COVID, you know? They were all great, painting our windows and things, calling us ‘essential,’ and I said, ‘this is fantastic!’ But I wondered, ‘Will they remember us after?’”