![Despite Illinois Law Increasing Nursing Home Staff Levels, Severe Shortages Continue Despite Illinois Law Increasing Nursing Home Staff Levels, Severe Shortages Continue](https://i2.wp.com/bloximages.chicago2.vip.townnews.com/heraldbulletin.com/content/tncms/assets/v3/editorial/7/d2/7d2accb6-1a06-11ef-8faa-0bbf041333ac/6650eefc947bd.image.jpg?crop=1140%2C599%2C0%2C28&resize=1140%2C599&order=crop%2Cresize&w=1200&resize=1200,0&ssl=1)
Two years ago, Illinois lawmakers passed landmark legislation aimed at increasing nursing home staffing, including funneling more than $700 million annually to Medicaid-funded facilities.
Susan Real, executive director of the East Central Illinois Agency on Aging,
photo from facebook
But if you ask nursing home residents if those efforts have helped, most will say it’s business as usual, according to Susan Real, executive director of the East Central Illinois Area Agency on Aging, which includes Danville.
“They’re seeing this in real time and saying, ‘Well, there are still staffing challenges that are impacting my life,’” he said. “They conclude that there is very little improvement.”
ADVANTAGES AND INCENTIVES
House Bill 254 came after the COVID pandemic devastated the state’s nursing homes, which were already facing severe shortages before the outbreak. At the time, Illinois had nearly half of the 100 most understaffed facilities in the country.
That led lawmakers to take an innovative approach to solving the problem: rewarding nursing homes for increasing staffing levels and providing additional money to boost salaries for certified nursing assistants.
The state approved $360 million to go to nursing homes that met certain staffing goals. Those goals were determined by what’s known as the Staff Time and Resource Intensity Verification, or STRIVE, study, conducted by the federal Centers for Medicare and Medicaid Services.
Incentive payments begin when a facility reaches 70% of its STRIVE goal and increase progressively with each full percentage point increase a facility achieves.
Another $85 million was approved to subsidize pay increases for CNAs based on their years of experience, starting with a $1.50 per hour increase for those with one year of experience. Salary incentives increase annually to a maximum of $6.50 per hour for those with at least six years of experience.
The bill also approved another $202 million in combined state and federal funding to increase by $7 the base daily reimbursement rate the state pays nursing homes. Another $4 per day is added for facilities that serve a higher than average percentage of Medicaid patients.
GOOD NEWS, BAD NEWS
Fast forward to today, and the incentive package and increased funding have, in fact, led to more staff in nursing homes.
Matt Hartman, president and CEO of the Illinois Health Care Association
Photo provided by the Illinois Health Care Association.
The state witnessed an 11% increase in nursing home staffing ratios, outpacing improvements in other states, according to a December review by the Illinois Department of Health Care and Family Services. The most significant improvements occurred in facilities with severe staffing problems and high Medicaid populations.
The number of installations that fell below STRIVE’s target of 70% fell sharply from 154 at the beginning of 2022 to just 53 in the second quarter of 2023, a decrease of two-thirds. This was largely due to an overall increase of almost 14 per cent in nursing staff’s working hours, the review found.
Now, instead of having nearly half of the nation’s most understaffed nursing homes, there are only 18, according to Matt Hartman, president and CEO of the Illinois Health Care Association, which helped draft the law.
But the good news ends there. Even with the injection of dollars, Illinois still ranks among the bottom 10 states for the worst senior care staffing, according to Seniorly, an online resource for people seeking long-term care. The state ranks even lower in the ratio of nursing home providers per occupied bed.
This doesn’t surprise Angie Baker, ombudsman for the East Central Illinois Area Agency on Aging, who serves as an advocate for nursing home residents.
“Staffing remains our biggest issue at the facility,” he said. “We have a lot of good people working with and for residents, but staffing levels have not stabilized.”
To meet the need, many facilities are turning to high-cost nursing agencies to provide them with enough workers to keep their doors open. That typically leads to a constant turnover of nursing providers that can affect resident care, Baker argued.
“It’s better than nothing, but it’s certainly not ideal from the residents’ perspective,” he said. “You’ll still have a warm body in the facility, but they don’t know the residents.”
‘THERE IS NO MAGIC BULLET’
Hartman said that while the initial dollars approved two years ago helped boost the industry, more money is needed to keep incentive programs and wage increases funded.
Staffing is the biggest cost for the facility, he said. As things stand, there is still a $500 million gap between overall costs and the amount Medicaid reimburses facilities. Meanwhile, state agencies and industry groups continue to modify the new funding model, she said, to create the best outcomes for residents.
Hartman said he recognizes that Illinois does not have the millions of dollars available needed to fully fund nursing homes, but steps must be taken now to budget and plan for more funding in the future.
“We will work with them to improve it gradually, but we would like to see sooner rather than later,” he said.
However, providing more funding cannot be the only solution. Other major obstacles that make it difficult for Illinois to find sufficient numbers of workers must also change, Hartman argued.
That includes a state licensing agency with a huge staff shortage that sometimes takes more than a year to approve and issue licenses to nurse practitioners, he explained. That led many to move out of state or look for other jobs.
Many community colleges have stopped offering nursing programs because of state regulations that limit CNA classes to eight students, Hartman said. Colleges can’t afford to hire a full-time registered nurse to teach only eight people because tuition doesn’t cover it.
“We need to create some relief in a lot of places,” he said. “There is no magic formula for this. “There are a lot of things that need to happen.”
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