Finding a safe, affordable and accessible nursing home or assisted-living center for sick or elderly South Dakotans has become more difficult in recent years but is getting harder than ever due to a shortage of facility workers and financial losses suffered amid the COVID-19 pandemic.
The labor shortage affecting businesses across South Dakota is hitting long-term care facilities particularly hard, with the COVID-19 pandemic exacerbating historic challenges in hiring workers at nursing homes and assisted-living centers.
The inability to fill open positions and keep up with patient care has led some facilities to turn away new residents even though most have open beds. The labor shortage has caused burnout of overworked employees and reduced the level of patient care at some facilities.
During the COVID-19 pandemic, long-term care facilities in South Dakota saw payrolls rise by almost $30 million overall but lost about $60 million in revenue due to reduced resident admissions, according to the South Dakota Health Care Association.
Faced with the need to raise wages and offer hiring bonuses to attract workers or hire expensive traveling nurses, some facilities already beset by high operating costs and thin profit margins could eventually close, making it harder than ever for families to find a home for their loved ones, industry experts say.
“Access to care could look very different in the future if our funding mechanisms and funding infrastructure don’t change in South Dakota,” said Nate Schema, vice president of operations for the Evangelical Lutheran Good Samaritan Society, which operates long-term care facilities. “You’re going to have to move your loved ones further and further away from the communities they may have called home for 50-plus years.”
The workforce shortage has created new obstacles and worsened ongoing challenges for Good Samaritan, one of the largest long-term care providers in the nation. The group, based in Sioux Falls and now operating under the umbrella of the Sanford Health Group, has more than 200 current job openings.
“It’s stretching us and it’s taxing us to a place we haven’t been in quite some time,” Schema said.
The inability to hire workers has forced Good Samaritan to turn away some prospective new residents, including at its 19 facilities in South Dakota, at a time when new revenues are greatly needed.
“We have had to limit some admissions in some communities in South Dakota and throughout our organization,” Schema said.
Schema said he is aware of about 70 long-term care facilities that have closed across the country in the past year and as many as 200 that were shuttered over the past two years. South Dakota saw a handful of facilities close in 2017-19, but has not had closures since.
Working in one of the 104 nursing homes or 163 assisted-living facilities in South Dakota can be gratifying but also grueling. Meeting the daily physical, mental and health needs of elderly or infirm residents has always been a tough job, but the positions have become more taxing during the COVID-19 pandemic as safety precautions have increased and the risk of illness for residents and employees remains nearly constant.
Meanwhile, the long-term care industry remains hampered by low wages.
Facilities in South Dakota have boosted wages slightly to attract more workers in the past six months, with registered nurse pay rising by 12%, and pay for licensed practical nurses and certified nursing assistants by about 7%, according to a recent survey by the state health care association.
However, that same survey found that the average pay for certified nursing assistants, the most common front-line, patient-care position in long-term care facilities, averages only $14 an hour, or $29,000 a year.
The low wage makes it difficult to hire CNAs when the job requires training and certification and McDonald’s restaurants in Rapid City, for example, are offering no-experience-required crew positions starting at $16 an hour.
The mounting stress of caring for residents while almost constantly short-handed is putting severe pressure on existing employees, said Ryan Brinkerhoff, administrator of the Five Counties Nursing Home in Lemmon, S.D.
“They’re tired and getting burned out; their quality of life is being affected,” Brinkerhoff said. “I see it in their body language, and just looking at them, you can see the stress.”
The position of evening nurse has been open for nearly a year at Five Counties, a publicly run nursing home with 45 beds that has five open positions in its workforce of about 45 employees.
Brinkerhoff has had to hire expensive temporary nurses from a traveling nursing agency to maintain quality of care and that expense has limited his ability to pay for some needs within the facility.
Brinkerhoff said he worries that the level of care of elderly or ill residents may have already decreased, but like other administrators, he has great praise for his staff.
“I think in general, patient care has probably suffered,” Brinkerhoff said. “But here it hasn’t because my staff members are amazing and have stepped up and sacrificed a lot.”
The recent pay hikes were needed to compete for workers, but that expense and an increase in overtime and incentive payments to new and existing employees came at a time when fewer people were entering long-term care facilities, according to the state health-care association.
Some prospective residents found other options as long-term care facilities endured significant COVID-19 outbreaks among residents and staff, while some facilities turned away new residents due to staffing shortages. Facility spending increased to accommodate 192 new patient safety regulations added during the pandemic, according to the South Dakota Association of Healthcare Organizations.
Jobs in the long-term care industry are available almost anywhere across the state and nation and at every skill level.
“You would be hard-pressed to find a nursing home or assisted-living center in South Dakota that isn’t experiencing significant workforce challenges,” wrote Mark B. Deak, director of the South Dakota Health Care Association, in an email to News Watch.
EmPres Healthcare Management, a Washington state-based firm that operates 82 properties in nine states, is one of many ownership groups offering signing bonuses of up to several thousand dollars for new hires, especially nurses.
On its website, the company lists 80 open jobs at its seven South Dakota facilities, including six openings in Flandreau, seven in Sturgis, nine in Britton, 11 in Mitchell, 13 in Woonsocket, 15 in Rapid City and 19 in Garretson. Jobs range from nursing to cooks to janitorial.
A national survey of long-term care providers, conducted by the American Health Care Association in September, revealed more than half of nursing homes are turning away new residents because they cannot hire enough workers.
South Dakota has a long history of funding the Medicaid program at a low rate compared with almost all other states. The state Medicaid reimbursement rate does not come close to covering the cost of housing each Medicaid patient.
According to the state association of healthcare organizations, the money long-term care facilities lose each day for each Medicaid patient housed has increased in the past three years, from $47.14 lost per day in 2019 to $51.95 lost per day in Fiscal Year 2020-2021.
South Dakota pays long-term care facilities about $158 per day for each Medicaid patient; for comparison, the rate is $174 per day in Iowa, $187 in Wyoming, $203 in Nebraska, $211 in Montana and $270 in Minnesota, according to the association.
In South Dakota in 2020, about 54% of patients in long-term care facilities were on Medicaid, according to state Department of Social Services data.