Nursing home closings create crisis for residents and workers

My father-in-law, Tyson, is 93 years old. He is almost totally blind, and he is hard of hearing. He spends most of his time in his wheelchair, and some days he sleeps much of the day. Although he has dementia, he can sing every word of “Let me call you sweetheart.” For the past two years, he has lived at Good Shepherd Care Center in the Dayton’s Bluff neighborhood of Saint Paul. In spite of everything, Tyson has been very happy at Good Shepherd.

Good Shepherd’s closing was announced February 19, at a meeting for family members of the 90-some seniors living there. Families were told that the closing is due to two factors: the cost to maintain and upgrade the 45-year-old building, and the state reimbursement system. Good Shepherd is managed by Benedictine Health Care System, of Duluth, and is owned by the non-profit Living Services Foundation.

Closing also hits workers hard As difficult as the closing is for the residents and their families, it also means that all of the workers will be out of a job, including some who have worked there for more than 30 years. The United Food and Commercial Workers Local Union 789 (UFCW) which represents 86 of the workers at Good Shepherd, including nursing assistants, dietary assistants housekeeping/ laundry workers, and maintenance workers. Other employees, including nurses, are represented by the American Federation of State County and municipal Employees (AFSCME.) UFCW business representative Mike Dreyer says he was not surprised to hear of the closing, saying that “all of the nursing homes are at risk” of potentially shutting down, due to current state policies. Local 789 is assisting the workers in finding new jobs, and is connecting them with the AFL-CIO Employee Liaison for the state’s Dislocated Workers Program. A job fair was also scheduled. Even with this assistance, workers face an uphill struggle to find new work. Although they may be given credit for experience, they will lose all of their seniority, and have to start all over And those workers who currently have the most seniority and are staying until the last patient leaves, will be the last to look for jobs if, indeed, there are any left.

Under state law, nursing homes must notify patients 60 days before the intended closing date. The time frame has families scrambling to find another place to care for their loved ones, not an easy task when you consider the number of nursing homes and care centers that have closed in recent years. For our family, this is the second time around. Two years ago, Tyson had to move when Saint Paul’s Church Home, also in Saint Paul, was forced to close for the same reasons.

Nursing home closings are a developing trend in Minnesota. Jeff Bostic, Director of Data Analysis for the Minnesota Health and Housing Alliance (MHHA), says that nursing home closings were not tracked until 2000, which was the first time a number of facilities were closed in the state. Over the past eight years, 48 nursing homes have closed in Minnesota, five of those (not including Good Shepherd) in Saint Paul, and a total of 29 in the metro area. The closings represent a little more than 10% of Minnesota’s 400 nursing homes.

It is easier to close facilities in the metro area than in a small town,” Bostic says, “because the small town will object.” While there is not much access to other facilities in small towns and rural areas, usually residents can find another facility somewhere in the metro area.

Bostic says the decline in the number of nursing homes is due in part to a general shift in the attitude of the consumers who are looking to alternatives to the traditional nursing home, such as assisted living or forms of in-home care.

The problem for more fragile nursing home residents is that these types of living arrangements do not have as many of the services that they need.

Some residents at Good Shepherd have lived there for as long as ten years, and have considered it their home. Good Shepherd held a “facility fair ”for families to assist them in choosing another place. With fewer nursing homes in Saint Paul and the close-in suburbs, some families are having to look to places in the outlying areas, which will make it more difficult for them to visit their loved ones.

Reimbursement for Low-Income Residents

At least some of the nursing home closures are related to state reimbursement changes. The state of Minnesota requires that nursing homes charge the same amount for private pay residents and those receiving government assistance. (A few exceptions apply – private rooms, for example, can be charged at a higher rate than semi-private.) The state pays nursing homes only for low-income residents eligible for Medicaid.

Until the mid to late 1990s, the state reimbursed nursing homes for actual costs. That is no longer true. After a three-year freeze on reimbursement levels from 2002 to 2005, nursing home representatives now must request a Cost of Living Adjustment (COLA) every year.

MHHA’s Bostic says that since that since the old system was phased out, “closures have become more of an issue.”

In recent years the COLA has been increased by a very small percentage. Last year’s COLA for nursing home reimbursement was 1.87%. In contrast, the Bureau of Labor Statistics Consumer Price Index increased by 2.85% in 2007 on top of a 3.24% increase in 2006. With the nearly $1 billion state budget shortfall, Dreyer predicts there will be no increase in the COLA for nursing homes this year.