How Rural Nursing Homes Are Managing To Survive Amid Worries Exacerbated by the Staffing Mandate

As rural nursing homes face an ongoing battle for survival, the finalization of the nursing home staffing mandate has only served to instill more anxiety among caregivers and providers in these communities.

Some approaches from the rural Midwest, from higher wages to educational training to becoming a nonprofit nursing home, look promising in improving staff retention and keeping nursing homes intact.

The final staffing rule mandates a minimum of 3.48 hours per resident per day (HPRD) of total staffing, with specific allocations for registered nurses (RN) and nurse aides.


Some local nursing home associations have called the legislation a “death star” for the industry, and believe that the staffing minimums will promote predatory staffing agencies..

Jalene Carpenter, president and CEO of the Nebraska Health Care Association (NHCA), also expressed serious concerns about the impact of the mandate on Nebraska’s health care landscape. The state is already grappling with a health care workforce crisis, and implementing these mandates could exacerbate the situation, leading to the closure of many rural facilities, she said.

“I believe in Nebraska that a one-size-fits-all approach to staffing is not a good path to quality, that individualized care for facilities is able to staff to meet their resident need, which is how it is today is a better path forward,” Carpenter told Nebraska Public Media.


According to the American Health Care Association (AHCA), since 2020, 13 nursing homes in Nebraska have closed down. Over the same period, 25 nursing homes in Kansas, 27 in Missouri, and 36 in Iowa also shut their doors.

The Center for Medicare Advocacy (CMA) reported that in 2022, 22 nursing homes in Iowa closed due to subpar care and low occupancy rates. However, amidst these challenges, some rural nursing homes are finding innovative ways to stay afloat and continue serving their residents.

Nebraska Public Media reported that Burwell Community Memorial Health Center in Nebraska turned around its operations by focusing on local services, strong management, and a focus on staff well-being and benefits.

Administrators played a crucial role in revitalizing the center, which was previously in debt and outsourced management services. Through effective management and investment in a new facility designed with nursing care in mind, the center has managed to survive, Administrator Tim Groshans told Nebraska Public Media.

“I think it goes back to the idea of that not-for-profit model,” he said. “We kept our vision on three things: salaries, benefits and physical plant. And so if we’re top-notch in all three of those areas, from a not-for-profit definition, I think we’re doing the right thing”.

Nursing assistants earn $20 per hour, while registered nurses can earn up to $40 an hour, significantly above the state average, he said. The center also provides housing options for employees, reimburses mileage, and fully pays for health insurance, demonstrating a dedication to attracting and retaining skilled staff.

Other efforts are underway to address the staffing crisis at its core, Nebraska Public Media reported. The University of Nebraska Medical Center (UNMC) is investing in a new health care education facility to train more nurses and healthcare workers, aiming to bolster the workforce in rural areas.

Legislators are also stepping in with proposals to support senior care facilities. While recent funding boosts are a step in the right direction, stakeholders like the NHCA are advocating for further investments to improve staffing levels and ensure quality care for residents.

In Grant, Nebraska, efforts for a new nursing home are underway as the community is rallying to restore care with plans for a new non-profit facility operated by the Western Sky Community Care Center, with a goal to open in fall 2025.

After Western Sky changed to nonprofit status, it raised $2.5 million for a new nursing home. The group also applied for a potential $13.4 million grant and loan package from the U.S. Department of Agriculture to help build the new facility.

Meanwhile, on the training and educational front, states like Nebraska are ramping up efforts to increase the number of nurses.

To that end, the University of Nebraska Medical Center (UNMC) at Kearney is building a new health care education facility, with college officials hoping the total number of undergraduate nursing students will jump from 56 per year to 88, Cathrin Carithers, assistant dean for the Kearney Division of UNMC’s College of Nursing, told Nebraska Public Media.

“We have learned in health care, where students are educated, many times they stay,” Carithers said.

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