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Access to long-term care becoming difficult

Submitted by Bill Ward, former administrator of a senior living facility in Dassel

Earlier this year the people in Glenwood and St. Peter each saw one of their community’s care centers close. In 2013 the people in Hoffman and Lewiston saw the closure of their towns’ only senior care facilities. In that same year Willmar lost one of its facilities. In 2012 the people in the Ottertail area had the same experience.

These are only a few of the 68 Minnesota senior care centers to have closed since 1990. While most have been in the Twin Cities metro area, more recent closures have been in rural Minnesota. Since 2000 the list of cities with closures also includes Tracy, Pipestone, Northome, Pelican Rapids, Cosmos, Paynesville and many more. Rural closures total 33 in all. Many other facilities, while not closing, have experienced significant downsizing, as was recently announced by a facility in the Alexandria area. In total, 30 percent of Minnesota’s care facility system has closed since 2000, a loss of about 16,300 beds.

Some of the reasons for closures and downsizing have been positive, as the market has been served by newer apartment and assisted living facilities offering better amenities and living conditions. Others have been the result of high vacancy rates, poor finances and aging buildings. However, the common theme recently is one long warned of, that being shortages of staff.

A licensed care center is mandated by regulation to provide adequate staffing to all residents. While no formal ratio is defined, the standard is generally that enough staff are present on a continuous basis to meet all resident care needs in a timely fashion. A facility or agency that is unable to meet that subjective standard has little choice but to cease operations in all or a portion of its facility. When that happens, the issue often transfers directly to the person or family who needs the care but is unable to access it.

Providers of all types of older adult services are reporting a growing challenge finding and retaining staff in adequate numbers. Shortages exist in most positions, but especially direct caregivers in nursing and registered nurse’s aide roles.

Information obtained from LeadingAge Minnesota, a trade association of service providers, indicates there are currently an estimated 1,800 open positions in Minnesota’s senior care system. An inspection of one west central Minnesota care organization’s website identified 40 open positions, just in one community.

The issue is not going to be one that solves itself with time. The demographics indicate that we are just barely seeing the beginning of the care staffing problem. In fact, a study at George Mason University predicts that by 2030, the U.S. will have 35 million more jobs in older adult care than we will have people to fill them.

Rural Minnesota families are already experiencing the fallout from this first hand. At one hospital in west central Minnesota, finding appropriately located services for discharging patients has become a significant challenge. At times the closest open beds are found 50-80 miles away. Hospital discharge staff there report this is very upsetting to families. It creates travel barriers to visiting the patient and also takes the patient away from his or her primary physician and health service network. In the case of a terminal patient, the distance away can completely change the quality of the end-of-life experience as family members may be unable to be present.

At a medical center in southwest Minnesota, staff say they are on the edge, with an occasional discharge that requires out-of-town placement. Another medical center in central Minnesota says they are in the same boat.

In the U.S., 90 percent of older adult care is still provided by family members. This is the encouraging news, at least for those with lighter care issues, as families themselves are still the front line in serving seniors. However, this group, like the professional agencies, is not immune to the very same demographic trends. Today the caregiver ratio, caregivers being identified as all women ages 45 – 64, stands at 4.5 to each older adult. By 2030 that drops nearly by half, to 2.8 to each older adult.

The result is a growing pressure to shift the care load away from families and onto institutional providers. However, this is against the grain of the very same trend of institutional providers shifting in the opposite direction, to families. It is a collision of two significant demographic forces, with huge economic, social and political ramifications.

The reasons all this is occurring are multiple. The core is the large wave of baby boomers just now moving into their senior years. By 2020, Minnesota will have an estimated 800,000 seniors compared to 640,000 in 2010. That is more seniors than school-age children. By 2030, the number goes to 1.5 million.

They are not just more in number; they are, as a group, healthier than ever. That means more survive into their 80s, 90s and even to 100, years in which they also experience a heavier care need.

This trend has the potential to impact a lot of older adults. Data shows that for a person who reaches age 65, there is a 70 percent chance of ultimately needing some form of late-life care. For a married couple, the odds climb to 91 percent that at least one of them will have the need.

In stark contrast to the growing number of elders, in rural Minnesota the population of younger people is declining. The west central and southwest sections of Minnesota show the greatest drop. Those declines are in the younger populations, as people move for better economic opportunities. Typically, a community’s older population stays home, becoming a larger percentage of the remaining population.

Finally, while we all like a healthy economy, service providers generally struggle most with staffing when the economy is healthy and other industries and businesses are hiring. That is the case driving today’s staff shortages, as potential employees seek opportunities with greater pay, fewer night and weekend shifts, and less stress on the body. That same demographic group that filled the roles in care centers and home care agencies yesterday, today is filling jobs in the service and retail sectors.

In an odd twist, providers are also facing competition from state and federal social service agencies. Many of the potential employees are receiving low-income related-financial help which limits their earned income potential, or in some cases, outpays the care facilities. Most providers have stories of losing staff who faced loss of government benefits if they continued working. One west central Minnesota facility administrator shared that 12 recent nurse’s aide losses were due to government agency mandates to employees to limit their income.

These competing factors will be the case until care providers are able to pay wages that sufficiently exceed those of other sectors and begin to be employers of choice for both men and women looking for adequately paying career jobs. Virtually every facility manager contacted for this article focused the conversation on the need for improving wages and benefits of employees. The income that providers need to accomplish that goal is tightly controlled by the State of Minnesota, so any solutions to care access must go through the state legislature.

For now, access to care for rural Minnesota families will remain challenging in many areas. For people in areas that do still have easy access, the trend will ultimately be moving toward more limited access and longer wait lists.

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