Turning to health news, the SSM health system recently announced plans to sell
three of their nonprofit nursing homes in Wisconsin to a for-profit company based in New Jersey.
An employee at one of those facilities shared with here and now a letter from the staff to management saying
they did not lead this process with integrity or transparency and the residents, families and staff
suffered the brunt of the consequences as a result.
Now the sale may be part of a larger nationwide trend of nonprofit nursing homes being sold to for-profit entities.
The uptick is concerning for health workers and patients as the centers for Medicare and Medicaid say
for-profit facilities on average have lower staffing and worse quality of care.
Joining us to discuss this is Barbara Bowert, founding director of the UW Madison School of Nursing's
Center for Aging Research and Education and thanks very much for being here.
Sure. So what do you think about the trend of for-profit entities buying not-for-profit facilities?
Yeah, there's a lot involved in that. There's always been a majority of for-profit facilities.
But as you've said, the trend is increasing. There's more and more for-profit and fewer and fewer not-for-profit.
So one of the issues, part of the question is why the not-for-profits are getting out of the business.
And there is an issue I think with general reimbursement from state and federal agencies and that would be mostly
Medicare and Medicaid. There's simply not enough money put into the system to provide the kind of care,
both quality of care and quality of life for people. That's part of it.
So if you want to take an organization that doesn't have enough money to begin with in terms of the reimbursement
level and make a profit, you've got to get it from somewhere.
And what we've seen is that where it comes from is largely labor.
And as you've said, the staffing is lower in for-profit organizations.
And I think for the staffing level is vital, not just for the quality of care, the outcomes that we measure on a regular basis,
but also quality of life. Do you have people who answer a call light and how long does it take them?
Are there people to talk to? Are there activities that are interesting and engaging to you?
Or is it sort of the bingo for everybody every night?
So staffing shortages have been described by people, including yourself as a crisis.
How bad is it and what are the effects even over quality of life?
Yeah. Several things that contribute to this. I always say to people recruitment, which is what tends to be the focus.
We need more staff. We need to find more staff. There's not enough people available. All of that is true.
But if we retained staff at a higher rate, we wouldn't have to worry so much about recruiting.
National averages for turnover rates for the direct care workers, the CNAs, is about 70%.
For nurses, it's about 40%. Directors of nursing come and go very quickly as well.
Any business, and people out there who run businesses know that if you have a turnover rate of 70%,
your organization is in trouble. So it causes huge disruptions.
It's also a really important issue for the residents because they get to know people. They get to know the staff.
These become their surrogate families. And when it's constantly turning over, they're losing these connections, these important relationships.
So I think we need to really focus a lot more on retention. What does it take to keep staff there?
And there's actually been a fair amount of research on that, and I don't think it's very widely used.
So just late this week, Governor Tony Evers announced the state will invest nearly $260 million of COVID relief money to fund wage increases
to direct care workers in places like this. What's your answer to that?
I believe that was primarily for home and community-based services.
I think it also included nursing care.
For nursing homes. I think there is a huge, and I have to say that home care workers tend to get less pay than even the nursing home workers.
And their benefits are less, which is also another distinction between in general for profit, not for profit homes.
The for profit have generally lower levels of benefits. So that's wonderful that he's putting money into that.
If you look at the research on staff turnover, it's not exclusively or even primarily money.
I mean, people know what money they're getting when they go into it. It's not great. They could get more money probably at a fast food restaurant.
These are people who are really committed to what they're doing. They believe in what they're doing. They love what they're doing.
And so the money is not the most important thing. I'm certainly not saying they shouldn't get an increase. They certainly need a wage increase.
On the other hand, there are a lot of other things that drive people out. Part of it is supervisors, people who supervise them who don't have supervisor training.
And that doesn't sound like a big deal, but it is. I mean, I know when the research has been done on turnover in every industry shows that the direct supervisor is the most important factor for whether or not people stay in their job.
So that, I think we need more, more of, better quality. And also training to the staff. Staff are not always well enough trained to take care of the people they're taking care of.
People leave because of the low staffing level. I've had so many CNA's tell me that the reason they left is, at the end of the day when they went home, they felt really bad about, I left.
I remember one woman who said, I put Edith on the toilet and I said, I'll be back in five minutes and I never went back.
I got so busy, distracted. I never, and she woke up in the middle of the night, horrified, not knowing what had happened to this person. Those are the sorts of things that drive people out.
What is your advice to families needing long-term care in this current landscape?
I would look at turnover rates in the nursing home. If the retention rate, the turnover rates are low, the retention rates are high.
That says something about the quality of the entire environment. So I think that's really important.
So looking at the staff, and I think, you know, there's a lot of effort going on to try and improve resident councils where residents actually have a stronger voice than what goes on.
And I think that could have an impact. I think advocating with whoever their representatives are about funding, but also transparent funding.
That's part of CMS's new initiative as well, is to make, where does the money go?
If we increase the money, like, where's it going to go? Wage pass-throughs are a good idea, so look at how much the staff get.
Are they compensated fairly? I think those are important issues. And talk to residents.
Good advice, Barbara Mowers. Thank you so much.
Okay.
Living Association came out and said, yes, this is great.
But, yeah. And not enough. Right, yeah.
Yeah.
My sister's living is a whole other thing. Yeah.
It's just no man's land. Yeah. It's just unregulated. It's frightening.
I mean, it's filled with people who should be in nursing homes who don't want to say they don't want to go to a nursing home, but they're in a worse place.
They're in with people who have no training.
Yeah.
So, you know, it's going to take more money.
Yeah.
And it's, and demographics being what they are, this is not getting any easier.
I think I probably read Tony Evers' thing wrong. I thought it was mostly home and community-based care, which is a trend.
I mean, people don't want to go to nursing homes.
I know. I read you said that, and that's so real.
Yeah. And so, providing more money at home.
And people tend to stay longer in home care positions if they are hired privately.
But what organizations, home care organizations tend to do is to hire everybody part-time so that they don't have to pay benefits.
Right.
And so, here's people, low-wage workers, like trying to piece together three jobs.
Yeah.
And it's like child care.
I mean, it's the same issue.
Yeah, it is.
And who don't we care about these vulnerable people?
I guess not.
I mean, I don't think most people are, and I can't tell how many people saw I had no idea until they got a relative in a nurse.
And if I had no idea.
Or I had no idea that nobody pays for this.
Yeah.
Or that they had to sell their house to actually be there or whatever.
Right.
Yeah.
Sad surprise for most people.
Yeah.
Well, thank you.
Sure.
Very much.
Really nice to meet you.
Nice to meet you.
I enjoy watching you.
Thank you.