Admissions Backlog Hurting Hospitals
Faced with the loss of employees during the pandemic and the difficulty in recruiting replacements in a competitive market economy, nursing home administrators have been forced to limit new admissions and close off whole floors in their facilities.
This has caused hospitals to keep patients longer who are waiting to be discharged to long-term care after surgery or illnesses and has resulted in fewer beds being available for COVID-19 cases flooding hospital emergency rooms.
While the pandemic has made the staffing crisis in nursing homes more acute, the problem isn’t a new one. It’s a systemic failure in the nursing home industry that’s been neglected for years, according to long-term care experts.
Nursing home workers are among the lowest-paid employees in the U.S. economy, earning near-poverty wages, the Paraprofessional Healthcare Institute reported in 2016. With a median salary of $19,000 a year, more than a third of nursing home workers relied on public benefits like food stamps, housing subsidies and cash assistance. Given the low wages, long hours, and stressful work, keeping and recruiting nursing home workers when other jobs are available and less demanding is a challenge.
Before the pandemic, CNAs in nursing homes had an average annual turnover rate of 129 percent, according to the journal Health Affairs, with some facilities reaching a 300 percent replacement rate.
Nursing Home owners are aware of the problem but claim that they can’t raise wages for workers due to the funding that’s available to them.
While some long-term care patients pay their own way, most nursing home funding comes from Medicare and Medicaid. Medicare reimburses facilities for short-stay patients coming from hospitals for rehabilitative services, while Medicaid’s reimbursements are determined by the states, and the program pays for the majority of long-stay patients in nursing home populations.
On average, Medicaid pays half as much per day for long-term care as does Medicare ($206 v. $503), according to a 2018 analysis by the non-profit National Investment Center for Seniors Housing & Care.
"Everyone knows that Medicaid underpays," David Gifford, chief medical officer for the American Health Care Association (AHCA), which represents assisted living and long-term care facilities, told CNN. "Salaries are about 70 percent of our revenue overall and so we just can't offer competitive salaries compared to hospitals and other settings."
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