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Nursing Homes
By Mark Steil
June 2001
Most people would rather avoid them, but nursing homes are still the place many elderly live their final days. Rural nursing homes are having problems hiring workers. Sometimes it's so bad they turn prospective residents away. Critics say the state's rural nursing homes are so understaffed, patient care can suffer. Nursing home administrators say the problem lies with government regulations.
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"For us it was last fall. Probably September, October in through that area. And it was some very trying times for us," says John Davidson, who manages Colonial Manor in the southwest Minnesota community of Balaton.
The workers in short supply were nurses aides - the people who feed, bathe and clothe residents. Things got so bad that Davidson had to dig out his nurses aide license and help with the chores. For a time, the home did not accept new residents.
Nursing home resident Caroline Ryberg, 93, praises the care she receives, but says she can tell when there's a shortage of workers. "They get pretty busy and then some of them have to holler and beg for half an hour before the help comes. It's not really good that way," she says.
Colonial Manor administrator John Davidson says while worker shortages cause problems, residents receive the care they need. But, he acknowledges the work is more demanding because nursing homes have become the final option in caring for the elderly. Many residents use wheelchairs and some are unresponsive. Davidson says incentives have helped attract workers. "We have sign-on bonuses, we offer finder's fees to current staff who bring in new staff. We have quarterly drawings of those people who have been referred over the past three months," he says.
The drawings offer prizes ranging from $1,000 to a trip to the Mall of America. Davidson says hiring picked up toward the end of last year and has improved even more since. He says a downturn in the local economy along with recruitment efforts helped bring in new employees.
"We interviewed directors of the state agencies that license and certify nursing homes, and more than 80 percent of them said staffing shortages was the most critical quality of care problem they faced," says Catherine Hawes of Texas A & M University. She has studied nursing home issues for more than 25 years.
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There is a moratorium on new construction and a voluntary state program encourages reduced services. About 3,000 nursing home beds have been idled under the program. The phenomenon of a worker shortage, even as the demand for nursing home beds dwindles, troubles nursing home administrators.
"The people who work here are not paid enough for what they do, " says Balaton's John Davidson.
That may seem like an odd statement for a manager to make; usually they're the ones fighting to hold down wages. Nurses aides in southwest Minnesota are paid about $8.70 an hour, the statewide average is about $1 more.
"The amount that we are able to pay people to work here is limited by state and federal rules and regulations," he says.
He says Medicare and Medicaid regulations are so stringent they control not only how much revenue he generates in the nursing home, but also how many workers he can hire and what they're paid. He says unless those regulations change, he's not able to pay his workers what they're worth.
Down the road - 35 miles from Balaton - a group of residents at the Maple Lawn Nursing Home in Fulda holds a sing along session. Among the group is Twylah Dorpinghaus, 90. "I know all the girls here and they're wonderful. And they do things to keep us busy and try to keep us well," she says.
Nurses aide Sue Klein says some days get very hectic, especially if a worker fails to show up. She's worked for 18 years at the Fulda nursing homes and she's noticed some changes. "The workload has increased. The residents that do come in now require more work," she says.
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Catherine Hawes of Texas A & M believes staff shortages cause nutrition problems because workers don't have enough time to make sure everyone eats what they're supposed to eat. She researched data gleaned from 170,000 nursing home residents. "When I ruled out people who had terminal illnesses or conditions that could cause weight loss, what I found is that between a quarter and a third of the residents appear to have a significant weight loss with no readily apparent clinical cause," according to Hawes.
Fulda nursing home administrator Arlan Swanson doubts the accuracy of those figures. He says there are a host of reasons old people don't eat, and most don't have anything to do with staff. He says even those without terminal illness usually have health problems which inhibit eating.
"It's a battle we actually have here, (trying) to make sure that we do well with people's nutrition. Some of the disease processes make them either not hungry or, if they have poor sight or smell or taste, food doesn't interest them. So we're always trying to get more calories into everybody all the time," Swanson says.
Not that Swanson couldn't use more staff. He says the Fulda nursing home is one of the lucky ones; he hasn't had major problems hiring workers. But he says if government regulations changed allowing him to hire more workers he could put them to good use.
Up the road in Balaton, nurses aide Verlane Ross says an important part of her job is often overlooked. Set aside the feeding and washing chores, she says nursing home workers also have an important social role. "Some families are very good at visiting, but other people have maybe been single or have lost their family or never married or had children. So we really are all the family they have," says Ross.
But the demands of the job limits the time Ross can spend with residents. Usually conversation occurs when she is helping someone dress or bathe or eat. But it's these bits of conversation, Ross says, that underline what her job is really about: to bring as much dignity and companionship to someone's final years as she can muster.
Next: The Price of Staying Put
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