The pandemic, traditionally low wages and low reimbursement rates from Medicaid have created a crisis for Pennsylvania seniors and the disabled needing round the clock care.
Long-term care facilities are faced with reducing the number of patients they can care for because caregivers are just not there, said President and CEO of the Pennsylvania Health Care Association Zach Shamberg.
All of this on the eve of the Silver Tsunami, when Baby Boomers, in the next two-to-three years, will be ready to move into such living arrangements, he said.
“Providers from across the state have had to close their doors to critical care patients,” Shamberg said. Those that can find a bed often have to travel a lot farther from home to get one.
“We have a lot of work to do to sustain (the industry) moving forward,” Shamberg said.
Pennsylvania is in the top four states in the country for its aging population and fastest growing segment is those 85 and older.
The association conducted a survey of its members which showed nearly 60% of respondents have declined potential new admissions due to workforce shortages. Providers shared the average amount of referral declines per facility was 20 per month from December 2021 through February 2022, as a direct result of not having enough staff to care for new residents.
The lack of space in long term care facilities also burdens hospitals, Shamberg said, because many patients must stay in the hospital longer than necessary until space is available.
The shortage of workers was an issue before COVID-19 hit, Shamberg said. “When the pandemic hit, the situation became critical as workers left the field to take jobs at places like Wawa and Walmart, which were offering higher wages.”
The Pennsylvania Health Care Association is looking to the state legislature to fix the problem.
“For nearly a decade, Pennsylvania’s elected officials have failed to make meaningful investments in the state’s Medicaid program, which is directly tied to the care of tens of thousands of nursing home residents. That failure has created the situation long-term care finds itself in today,” said Shamberg.
“Providers can’t recruit and retain enough workers because they’re unable to properly invest in their staff. Now, they’ve been forced to diminish their mission of caring for others because their workforce has been lured away to other high-paying jobs,” he said. “With an insufficient Medicaid reimbursement, providers can’t compete for workers, and if they try, they jeopardize the operational viability of their facility.”
PHCA is actively advocating for a Medicaid reimbursement increase in this year’s state budget to allow providers to increase wages, recruit more caregivers and invest in the infrastructure necessary to provide care.
Shamberg said it is time to “think outside the box.”
One thing that did help was a 2020 law that allowed for temporary nurse aids. “This brand-new position allows people to begin working after a few hours of training,” he said.
There was also a shift to blended learning for Certified Nurse Aids (CNAs) that allowed for virtual and in-person training.
And the Nurse Licensure Compact allowed facilities to bring nurses in from other states without waiting for their license to transfer to Pennsylvania.
Still, he said, compensation for these positions must improve.
Another issue that arose during the pandemic was the staffing agencies providing nurses. Shamberg said in the beginning, it was a resource that helped keep staffing up.
“There was no oversight or accountability for staffing agencies,” he said. As a result, some took advantage of the situation and began price gouging.
However, on Nov. 3, Gov. Tom Wolf signed House Bill 2293 into law creating oversight and accountability for agencies operating in long-term care facilities.
Another issue Shamberg cited is the negative stigma that can come with working in long-term care. “We are working to erase that by showing the career ladder that is possible, but it will take others, like legislators, to continue to work and create resources.”
Shamberg said now is the time to build the pipeline for five years down the road. “We need to get into the schools and let students know about jobs that show compassion for people. More kids are being raised by grandparents, so we hope they will see the need for this work.”