Female doctor consoling sad family at hospital
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Access to long-term care in Minnesota is in a “dangerous decline,” as evidenced by a recent survey revealing that older adults were turned away from assisted living communities and nursing homes 11,000 times in October due the state’s workforce crisis, according to provider groups in the state.

The Long-Term Care Imperative, a collaboration between the state’s two largest senior living and care provider associations — Care Providers of Minnesota, the state affiliate of the American Health Care Association / National Center for Assisted Living, and LeadingAge Minnesota, the state partner of the national LeadingAge organization and Argentum — conducted a survey of 425 providers on their status. The survey revealed access to care is declining, leading to patient backlogs at hospitals and “causing families to suffer.”

LeadingAge Minnesota CEO Kari Thurlow told McKnight’s Senior Living the results were not surprising, but the magnitude of the declined referrals was “eye-popping.”

“We see a direct line between denied referrals and staffing in our settings,” Thurlow said. “Staffing adequacy is a key reason why admissions are being turned away. For assisted living, 41% cited it as a key driver to determining whether to take an admission or not.”

According to the survey results, assisted living communities turned away an average of three referrals from physicians, families and home health agencies. More than 60% of assisted living communities reported turning down one to five admission referrals during October, with 13% turning down six to 10 referrals.

The survey also found that 37% of assisted living providers placed a complete hold on admissions at some point during the pandemic, and almost 70% of assisted living providers that placed holds on admissions reported turning away more hospital admissions than before the pandemic.

The situation was even more severe at nursing homes, which turned down an average of 14 referrals each. Statewide, 35% of nursing homes denied more than 20 referrals each in October. Seventy-nine percent of nursing homes placed a complete hold on admissions at some point during the pandemic.

Staffing shortage impacts admissions

Statewide, the Long-Term Care Imperative said, more than 20,000 vacant caregiver positions exist, representing 20% of the long-term care workforce. The crisis has led to waiting lists for admission at 56.5% of assisted living communities and at 65.2% of nursing homes in the state. 

Thurlow said the industry will use the data to bolster its argument with lawmakers that the long-term care staffing shortage is a crisis, affecting older adults and their families in “every corner of the state.” 

“For assisted living settings, we see the state as being a significant partner in helping us solve our workforce crisis, in helping us bolster the wages to recruit and retain the sheer number of caregivers needed to take care of seniors today, and those who will need care in the future,” Thurlow said.

Waiver program needs additional funding

That means a state investment in the Medicaid Elderly Waiver program. One-third of assisted living residents are enrolled in the Elderly Waiver program in Minnesota. The waiver program provides home- and community-based services for people who need a nursing home level of care but choose to live in the community. Improving waiver rates would grant more older adults access to settings such as assisted living, the organization said.

Thurlow said that the Elderly Waiver program has not received significant funding increases for “some time.” As the pandemic progressed and costs increased, the gap between the waiver reimbursement rates and the actual cost of care has continued to widen she said.

“That has a direct impact on assisted living settings being able to recruit and retain the workforce they need,” she said, adding that the coalition proposed a significant increase to the waiver last year. She said the coalition’s proposal for the new Congress is to fully fund the program.

“This is not a one-solution problem, but we really view ensuring every caregiver has access to family sustaining wages as foundational to addressing recruitment and retention needs,” Thurlow said. “The workforce supply is too tight and competition too fierce. Until we address this issue, it makes many other tools and resources and good ideas about bringing potential people into this field very difficult to be optimally successful.”

The online survey was conducted between Oct. 31 and Nov. 7, with 262 assisted living provider participants and 163 nursing home provider participants.