Nebraska Loses Several Nursing Homes in 2021, Reimbursement Not Sustainable

With multiple nursing homes set to close in rural Nebraskan cities, one in Arapahoe and one in Ravenna, long-term care facilities in the state face an uncertain future as revenue loss and rising labor costs continue to set a difficult path ahead for operators.

Since starting her new role as president and CEO of the Nebraska Health Care Association on Nov. 10, Jalene Carpenter has seen three skilled nursing facilities close across the state and at least six facilities close or partially close in 2021.

While proposals to improve reimbursement rates for nursing homes in the state have been announced to help with staffing challenges, it may not be enough given that statewide Nebraska is reportedly down about 10% of its pre-pandemic staffing for long-term care and assisted living facilities.

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With the National Guard already enacted in states like New York and Minnesota, it may be only a matter of time before Nebraska is next to make the call.

The Evangelical Lutheran Good Samaritan Society, one of the largest non-profit senior living and care providers in the U.S., issued a statement regarding the closures, stating that “the pandemic has put unprecedented stress on the senior care industry, which has forced us to make difficult decisions about how and where we can provide services.”

Good Samaritan said the closures in Arapahoe and Ravenna would go into effect on Dec. 31 due to a number of factors including staffing challenges, a decline in residents and increased operating costs.

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“Inadequate Medicaid reimbursement rates that do not keep up with the cost of care we provide, combined with these other challenges, have led to a situation that is not sustainable,” the statement continued.”

Nebraska’s governor Pete Ricketts announced this week that the state would be requesting the Centers for Medicare and Medicaid Services (CMS) to increase the Medicaid reimbursement rate for long-term care facilities as a way to help out with workforce shortages that many facilities are currently experiencing.

If approved, rates would increase by $20 for dates of service between Jan. 1 and June 30, 2021, providing an estimated $21.3 million of additional aid to these facilities.

“We are still at risk,” Carpenter told Skilled Nursing News. “We’ve had a lot of conversations with our providers looking at how we are going to sustain care for elders in rural Nebraska. With these closures we’re creating an access issue, not only for care of elderly, but also for access to jobs.”

She spoke to SNN in December to discuss what she’s doing to avoid more closures in the state and what she wants to see done to help operators out of this workforce crisis in the long run – in a conversation that’s been edited for length and clarity.

What is your focus heading to 2022?

The focus has to be on funding for sure and that is what I hear from my members most. Whatever I can do to make sure that we adequately equip our members with the tools and resources to do that is a big goal for me.

What is going to prevent more nursing home closures in the state?

I think it’s going to be about looking for creative ways for facilities to become community hubs. There’s also a lot of examples in other states where they’ve instituted IE-SNPs, and different models of care. [We need to figure out] how we can engage with the community to where we’re servicing elders, but also are part of the community as a whole. So there’s some exciting things there.

I’ve seen our members become more innovative by starting their own I-SNPs so that they can take on that risk in the care of their residents. That, to me, is an exciting step in the right direction. One thing that you find in the Midwest is sometimes we lag a little behind the coasts. Managed Medicare is becoming more prevalent but those plans can be somewhat difficult when you have a large rural base. Those are two areas that I would say that our members have really taken the lead.

I think we also really need to look at how we leverage technology and transportation. If we have an access to care issue, how are we adequately transporting loved ones to visit people in a facility? So there’s some things I think we need to do from a transportation and technology piece that would also help keep these facilities open.

Have you seen more skilled nursing facilities look to move away from skilled into assisted living?

We have heard these conversations happening – definitely in our rural areas. One of the closures we recently saw is a good example because they unfortunately had to close their assisted living and their skilled nursing facilities in two locations. It wasn’t due to demand, they did not have staff to care for them, even when we’re looking at the assisted living level. In our rural areas, we really have to be rethinking how we provide care. Transitioning from a nursing facility to an assisted living is really not a long-term solution when we look at the bigger picture.

How do you plan to focus your lobbying efforts in the state?

There’s really always two key areas. When we look at our short-term goals, we are still exceedingly underfunded for Medicaid rates in our state and so looking at how we can raise those rates to become competitive in the marketplace. Right now, our members are just not able to be competitive when it comes to wages.

The second step is looking at how we continue to grow people that want and love to work in long-term care.

I think there have been pockets of really successful integrations into the high school realm where they can not only become a certified nurse’s aide, but there are programs where through high school, you can become an LPN. And so that’s an exciting prospect for us. Looking at how we can get in earlier or even have a high school graduate come right into our workforce with a livable good wage and looking at that leadership track as it moves forward.

How would you like to see the workforce crisis addressed both short-term and long-term?

I think we need to be careful in understanding [the short and long-term impact] when we look at the staffing crisis. While the National Guard can be a very impactful short-term impact, it doesn’t solve the long-term problem. So I think the key component is, number one, we have to be able to have a sustainable business model where we can compete in the marketplace. If we continue to be the portion of the health care sector that’s chronically underfunded, we’re never going to be able to compete in the marketplace. So that’s the first important step. The next part is just getting people excited about long-term care.

What are you telling operators about the vaccine mandate right now?

We continue to have the message to be prepared for it to be put into place. I think the examples of those 24 states is a good reminder that members need to be prepared. We continue to help our members be as prepared as possible as if the mandate were to go into effect.

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