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A group of employees, protesting delayed or missing paychecks, walked off the job late last month at a nursing home in suburban Pittsburgh, forcing it to abruptly transfer its residents to better-staffed facilities nearby.

Barbara Hillgartner learned of the staffing crisis when she walked into the Jefferson Hills Healthcare and Rehabilitation Center to visit her 84-year-old mother. “Lights were still on, TVs were still on. There were food trays still in rooms,” she tells CBS News. “Like The Twilight Zone, everybody disappeared in a blink of an eye.”

Her mother was gone. “There was a garbage bag by her closet,” she says. “Somebody must have taken everything that was in her closet and put it in a garbage bag.”

The facility’s owner, Bonamour Health Group, blamed a Feb. 21 cyberattack for the delayed paychecks, but management refused to say when those disgruntled employees would receive their back wages — or when the residents would return.

Welcome to the increasingly brittle, postpandemic nursing home industry.

The staffing crisis at Jefferson Hills shines a particularly harsh light on the challenges that America’s nursing home operators face four years after COVID first illuminated the industry’s incipient fragility. But, as Andrew Jacobs writes in the New York Times, a new report from the U.S. Department of Health and Human Services suggests the shuttered facility is no outlier. Nursing homes have not yet recovered from the pandemic, leaving their residents even more vulnerable than before.

The findings, released last month, noted the prevalence of inadequate infection-control procedures, poor vaccination booster rates among residents and staff, and “monumental” staffing problems. As one facility administrator put it, “We’ve done ads, Facebook, social media, referral programs, sign-on bonuses. We spend thousands of dollars a month, but we’re not hiring anybody.”

And when they do manage to lure an applicant into actual employment, retaining them becomes even more challenging: The intense physical and emotional labor triggers high rates of burnout, which the low pay and poor benefits do little to offset. Turnover is rampant.

COVID pushed a third of the staff at the nonprofit Bethany Home in Lindsborg, Kan., out the door, and the facility has been unable to replace those workers in the years since the pandemic began to wane. Forced to cut about a fourth of its 85 beds, the facility now has a waiting list for the first time in its 100-year history.

“We’re going to need [a] base rate in the $16 to $20 range if we want to compete against McDonald’s in the town next to us.”

The $13.50 hourly wage Bethany offers to entry-level nurse’s aides is simply not competitive at a time when flipping burgers pays more, explains CEO Kris Erickson. “We’re going to need [a] base rate in the $16 to $20 range if we want to compete against McDonald’s in the town next to us,” he says.

But he’s not going to be able to raise those wages unless federal and state government reimbursements — the primary sources of nursing home revenue — increase. And that’s not in the cards. In fact, the Biden Administration has responded to the staffing crisis not by proposing higher reimbursement rates, but by suggesting that the Centers for Medicare & Medicaid Services (CMS) could begin fining those facilities that don’t ramp up their labor force to meet government mandated levels.

That’s not helpful, says Katie Smith Sloan, president of Leading Age, an association of nonprofit nursing homes. Higher reimbursement rates would certainly be welcome, she adds, but even that wouldn’t be enough to heal what ails the industry. “This is bigger than CMS,” she argues. “We have to figure out how to creatively apply the things that work to this intractable workforce issue.”

Sloan argues that a more holistic, interagency approach is necessary. The Department of Homeland Security could expand its temporary worker visa program to recruit nursing aides, for example, and the Department of Education could be lobbying Congress to include nursing-assistant students and culinary worker trainees in the Pell Grants program. Some nursing homes have already used licensing waivers to offer nursing-assistant students training on the job.

There’s no question that hiring and retaining qualified staff is key to improving care at these facilities, but recent research suggests that without specialized training, secure facilities, and staff consistency, even a fully staffed nursing home may deliver less than adequate care.

“The pandemic helped highlight the challenges facing nursing homes, but it’s still the elephant in the room.”

And long-term-care expert Elizabeth White, APRN, PhD, an assistant professor at Brown University School of Public Health, argues that all these efforts fall far short of what’s really needed: the political will to address a broken system. “The pandemic helped highlight the challenges facing nursing homes, but it’s still the elephant in the room,” she says. “The financing system is broken, and the problem is just so enormous that it’s very hard to get the political motivation to do anything about it.”

It’s also difficult to determine the degree to which these nursing homes are actually strapped for cash. Researchers from UCLA and Lehigh University last week released a report showing that the corporate owners of the facilities they studied often used deceptive accounting practices to disguise a majority of their profits. This transfer of assets from nursing home operators and “related parties” to their owners through grossly inflated real estate and management costs (known as “tunneling”) occurred at more than two-thirds of the facilities, and it raises serious issues of accountability — and credibility — when these companies plead for more government help.

“Our calculations of hidden profit suggest that firms may be substantially understating their profitability,” the authors note. “The profit tunneling exhibited here may not only affect the economic viability of nursing homes but also have implications for the quality of care and the welfare of a vulnerable population.”

You can draw whatever conclusions you wish from Bonamour’s claim that some internet hacker caused the missing paychecks that led to the employee walkout that led to the closure of its Jefferson Hills facility. And you can certainly choose to ignore the similarities between the various companies that operate its six nursing homes in western Pennsylvania and the “related parties” described in the UCLA-Lehigh study. No evidence, after all, has been unearthed to suggest that Bonamour has been using accounting tricks to support its plea of insolvency.

But none of that really matters to Barbara Hillgartner and her mom, who wound up at a nursing home in McKeesport, along with 35 other Jefferson Hill residents. Hillgartner just wonders what kind of a company would move her mother without telling her and how she would’ve located her — and her belongings in that garbage bag — if she hadn’t shown up at the facility when she did.

Craig Cox
Craig Cox

Craig Cox is an Experience Life deputy editor who explores the joys and challenges of healthy aging.

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