Rural health care facilities are suffering. They’re closing amid depopulation, where the young leave for college and never return. Left in the community are those with less education and those who have aged out of the workforce. There are also fewer people with private health insurance and more on Medicare or Medicaid. Government health care programs pay less than private insurance and the fees paid by Medicare are often much lower than urban hospitals receive.
It’s not just hospitals that are closing. So are nursing homes in rural areas. Owners say the closures largely stem from a shortage of workers, including nurses, nursing assistants, and kitchen employees.
From February 2020 to November 2021, the number of workers in nursing homes and other care facilities dropped by 410,000 nationally, according to the federal Bureau of Labor Statistics.
Staffing has rebounded only by about 103,000 since then.
It’s not just those who move away for college who don’t want to work in rural areas. Doctors, nurses, physical therapists and so on find metropolitan areas more exciting and lucrative. Experts say that many sparsely populated areas simply have fewer working-age adults with which to staff facilities.
Lori Porter, chief executive officer of the National Association of Health Care Assistants, said nursing home staffing issues have been building for years. “No one that’s been in this business is in shock over the way things are,” she said. “The pandemic put a spotlight on it.”
MarketWatch even compared being a nursing home staffer to walking dogs for a living. Its conclusion was that dog walking is more rewarding, both financially and in terms of job satisfaction.
It’s really not complicated.
Right now, in America, you can earn more money per hour looking after someone’s dog than you can looking after their elderly or dying parent. And no, I’m not kidding.
Meanwhile a nurse’s aide in a skilled nursing facility is making on average $14.50, according to Uncle Sam.
It gets worse, much worse.
One of these is a tough, demanding job involving significant training, long hours, frequent medical emergencies, deaths, and heroic levels of commitment. You have to take incapacitated elderly people to the toilet and clean them afterward.
The other involves playing with Poochie the pandemic sheepadoodle in a park.
And Poochie’s owner pays better. By about $1 an hour, apparently.
Rural nursing homes are especially vulnerable and there are probably more reasons for this than just staff shortages. Along with fewer nurses, nursing assistants and personal care aides, there is probably less money to support long term care facilities. Medicaid pays for two-thirds of long term care and rural areas tend to be less wealthy than metropolitan areas. Fewer people able to pay market rates in cash for their own care means many of these facilities are depending on Medicaid for well more than two-thirds of long term care residents. The combination of staff shortage and low reimbursement are taking its toll.
In Iowa, 13 of the 15 nursing homes that closed in 2022 were in rural areas, according to the Iowa Health Care Association.
In Montana, at least 11 nursing homes — 16% of the state’s facilities — closed in 2022, the Billings Gazette reported.
Colorado’s executive director of health care policy and financing, Kim Bimestefer, told a conference in November that the state recognizes it needs to help shore up care facilities, especially in rural areas. “We’ve had more nursing homes go bankrupt in the last year than in the last 10 years combined,” she said.
I recently wrote about a program in rural Colorado to train people to work in nursing homes.
As a result of shifting demographics, rural areas have an abundance of seniors with health needs and a dearth of health care workers to care for them. Kaiser Health News reported on a unique apprenticeship program in Colorado to train the low-skilled workers who remain in rural areas to be personal care aides and nursing assistants.
More apprentice programs like the one in Colorado need to be developed. Yet, Grand Junction, Colorado (highlighted in the aforementioned blog post) may have an advantage over other areas. Compared to the farming community where I grew up, Grand Junction seems cosmopolitan. It’s a tourist attraction in its own right and from Grand Junction it’s only 87 miles to the resort town of Glenwood Springs, 125 miles to Aspen and 150 miles to Vail. Ski resorts like Crested Butte, Beaver Creek, Breckenridge, Keystone and Arapaho Basin are all within 200 miles of Grand Junction. That sure beats living in Western Kansas or the panhandles of Oklahoma and Texas!
The need for nursing homes is expected to climb as Baby Boomers succumb to old age. Both my mother and grandmother were in rural long term care facilities the last several years of their lives. These were nice facilities, owned by the respective counties where they were located. I often wondered why more people don’t escape the high prices of urban areas for the lower cost rural long term care facilities. Apparently, I was wrong about that being a viable strategy.