MPR: Toward a Better System

Toward a Better System
By Tom Scheck, Minnesota Public Radio
March 2001

Every year, Minnesota spends $850 million caring for the state's elderly in nursing homes. As baby-boomers approach retirement, long-term care experts worry that unless changes occur, those costs could skyrocket. A tripartisan task force studied the issue last summer and wants the state to meet consumer demand by creating a better system of home and community-based care. But the transformation will not be cheap. A legislative task force, the governor and the industry all expect the state to spend over a $100 million in the two-year budget to start this system.

At the Capitol in early March, industry representatives protested the plight of long-term care workers. Nine of the state's 433 nursing homes closed in the past year, and owners are telling lawmakers that other homes will shut their doors if their demands aren't met.

FOR THE PAST FIVE YEARS, a growing number of seniors has been choosing options to the traditional nursing home, such as home health care or apartment complexes that provide limited nursing care. The Department of Human Services says construction of assisted-living facilities has more than doubled from 1997.

Human Services Commissioner Michael O'Keefe chaired the Minnesota Long-Term Care Task Force. He says the group recommends the state downsize nursing homes, build more assisted-living facilities and provide additional home care services to seniors who want to live in their homes.

"What most of us want for ourselves or for our parents is care in our home as long as possible and if that isn't possible, then in a setting that is as home-like as possible," says O'Keefe.

O'Keefe says Gov. Ventura's proposed budgetwould eliminate 4,500 unused nursing-home beds and shift the savings to home care programs. O'Keefe says ideally the state would like to see complexes that provide housing with assisted-living services and full-scale nursing home care under one roof.

The Walker Methodist Health Center in Minneapolis is what elder care experts envision as the future of long-term care. The Walker campus encompasses a city block. On the seventh floor of the complex, nursing-home residents practice their putting techniques from wheel chairs and walkers.

On the first floor, there's assisted-living apartments for seniors and there's elderly housing down the block. A resident can move from senior housing to assisted living to a nursing home as an illness progresses.

The nursing-home industry agrees that a long-term care system with a variety of options is Minnesota's future. Rick Carter with CareProviders of Minnesota says the governor's budget focuses on the shift to home health care and assisted-living facilities by compromising state's present nursing homes. He says nursing homes need $500 million to give long-term care workers a raise, to help nursing homes renovate their buildings and to transform certain portions of their buildings into assisted-living facilities.

"If we just improve salaries, for example, that will not solve our problem. If we just improve buildings, that will not solve our problem," Carter says. "We really need to do it all and that's why we need as a comprehensive approach."

But while the industry is calling for a comprehensive approach, nursing home owners and workers are focusing their efforts on staff salaries and the recent closure of nursing homes.

At the Capitol in early March, industry representatives placed life-sized cardboard cutouts of the long-term care workers they said were too busy to attend. Nine of the state's 433 nursing homes closed in the past year, and owners are telling lawmakers that other homes will shut their doors if their demands aren't met.

Human Services Commissioner Michael O'Keefe chaired the Minnesota Long-Term Care Task Force. He says the group recommends the state downsize nursing homes, build more assisted-living facilities and provide additional home care services to seniors who want to live in their homes.

The group says the industry already has high turnover and that senior care would be in jeopardy if the state doesn't increase Medicaid reimbursement rates to nursing homes. Eighty-percent of the reimbursements pay the salaries of long-term care workers.

At Walker Methodist, Eunice Jenkins shuffles from room to room delivering meals to residents unable to get out of bed. Jenkins has worked as a nurses aide at Walker since she moved to Minnesota 20 years ago. Over those years, she says the residents have changed.

In the past, she says residents had many physical problems, but now more often have to live with Alzheimer's or other forms of dementia. While Jenkins says she cares deeply for the residents and enjoys the care she provides, she wouldn't do it again if she had the choice. After 20 years, Jenkins makes $11.80 an hour.

"I can't think of any other job that's compatible to this that you could compare and use as an example of being on the job for 20 years and what they're making and here, being a nursing assistant for 20 years and what I'm making. It doesn't give other nursing assistants who are coming into this now incentive," she says.

State lawmakers are looking at ways to create incentives to attract and retain workers like Jenkins. There are recommendations for a cost-of-living increase and loan-forgiveness programs for nursing students if they go into the business.

Sen. John Hottinger, DFL-Mankato, hears about many of the problems from his wife who works in a nursing home. Before the state starts working to invest in the buildings and services that will serve future seniors, Hottinger says it needs to spend money on the workers who will care for the elderly today.

"As we double the number of seniors as the percentage of the population in the future years, we're just not going to be able to afford to pay for the level of care that we now are providing. Unfortunately the governor's budget is getting us there way too quickly as it underfunds the needs of the current crisis," Hottinger says.

Since Ventura's proposal calls for the closure of 4,500 beds, Commissioner O'Keefe says the state can address the shortage by having displaced workers move to community-based health care and assisted-living facilities. He also says Ventura is not opposed to a cost-of-living increase as long as the Legislature doesn't exceed his overall spending request.

Rep. Fran Bradley, R-Rochester, says he's going to do that by cutting other funds from Ventura's health budget. Bradley is the chairman of the House Health and Human Services Policy Committee and says he'll find $90 million to give long-term workers a raise.

"The House is not going to be inclined to make the pie bigger. I've told them (they) created a $90 million hole; we're going to find $90 million and we're going to find it in (their) budget proposals," Bradley says.

Bradley says Ventura's spending proposals to eliminate racial health disparities and other programs that lack specific spending proposals will be shifted to long-term care in his committee.

Over the next two months, Bradley expects every state lawmaker to carefully examine all of the long-term care proposals. Since there's at least one nursing home in each legislative district, he says lawmakers will want to make sure their district's homes are adequately funded while the state decides how quickly it wants to prepare for a tripling of the population over age 85 during the next 20 years.

Part Three: Solutions from Rural Minnesota

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