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Pending closure, poor care at Ipswich nursing home latest outcomes of staffing crisis

A shortage of staff was given as one reason that officials for the Avantara Ipswich nursing home said they will close the 40-bed nursing home on May 31, 2022.

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Stock image courtesy of South Dakota News Watch
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Pending closure and poor care at Ipswich nursing home latest outcomes of staffing crisis

A crisis at the nursing home in Ipswich, S.D., illustrates the two worst potential outcomes of staffing shortages affecting long-term care facilities across the state: possible nursing home closures and troubling incidents of inadequate resident care.

A shortage of staff was given as one reason that officials for the Avantara Ipswich nursing home said they will close the 40-bed nursing home on May 31, 2022. Challenges related to COVID-19 were also listed.

The closure would leave residents and families searching for new care options, potentially 25 miles away or more. Employees would also face job uncertainty, and the Edmunds County community of 1,000 people about 27 miles west of Aberdeen would see a loss of economic activity. Local municipal leaders have called a public meeting for April 18 to discuss ways to keep the Ipswich home open.

Staffing problems were also identified by the South Dakota Department of Health, which sent inspectors to the Avantara Ipswich nursing home in April 2021. The state compiled a list of 13 code violations in that inspection that required 104 pages to document. Four violations were listed as “Quality of Life and Care Deficiencies.”

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According to records from the state health department and the federal government, which were reviewed by News Watch, the April 2021 inspection revealed a facility short on staff, with inexperienced, inefficient management and oversight, and numerous errors or omissions in regard to how residents were cared for.

“The provider failed to ensure the facility was operated and administered in a manner that ensured the safety and overall well-being for all 28 residents in the facility,” the state report concluded.

Legacy Health Care, the Illinois company that operates Avantara Ipswich and 12 other nursing homes in South Dakota, did not return a call or email requesting comment for this story, and the director of Avantara Ipswich told News Watch he was unable to comment. A state health department licensing official also declined an interview request from News Watch.

The 2021 inspection report gave examples of serious deficiencies in resident care at Avantara Ipswich. Some residents lost large amounts of weight; others were found by family members to be frequently soaked in urine; some had injuries or ulcers that were not documented or treated; and one elderly man had catheter problems that caused his penis to begin “eroding away.”

The pending closure of the home in Ipswich is an ominous sign for the state’s nursing home industry, which is a critical component of the healthcare continuum in South Dakota and a basic necessity for many of the state’s oldest and most vulnerable residents, said Mark Deak, director of the South Dakota Health Care Association.

Beyond staffing challenges, providing consistent, adequate funding of nursing homes remains a related and ongoing issue. For each resident on Medicaid, the federal health plan for low-income residents, nursing homes lose more than $50 per day, according to state and federal documents. That equation means the roughly 100 nursing homes in South Dakota lose about $56 million a year combined in unreimbursed care provided to Medicaid recipients, who make up about 55% of the overall residents in nursing homes.

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This report from an April 2021 state inspection of the Avantara Ipswich nursing home explains 13 operational deficiencies, including an overall lack of ability to properly care for residents.
Bart Pfankuch / South Dakota News Watch

The South Dakota Legislature, recognizing the funding crisis, allocated in the 2022 session about $30 million in one-time funding to temporarily boost the bottom lines of nursing homes. The funding, which will reach nursing homes before June 30, 2022, equals about a 20% bump in annual state funding to nursing homes, according to a legislative budget memo.

Despite the one-time state funding bump, and incremental increases in Medicaid funding in recent years, South Dakota remains near the bottom of all states in regard to state Medicaid reimbursement levels.

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South Dakota saw a handful of nursing home closures, mostly in rural areas, over the past five years.

Each time a home closes, it upsets the lives of many people, said Erica Larson, a city council member in Ipswich.

“That will definitely hurt our small town, for those employees and those families that have loved ones in our facility,” Larson said.

Deak said the combination of insufficient workforce, rising business and personnel costs and stagnant or barely rising revenues could lead to serious repercussions in the long-term care industry in South Dakota.

“What’s been happening, and this is a very tough situation, is they don’t take new admissions; they simply do not have the staff to take on new residents that need their care,” Deak said. “And without taking on enough residents, obviously that hurts the viability of their operation, so it really catches them that way and makes it very difficult.”

A survey of South Dakota nursing homes in 2021 showed the average pay for a CNA was $14 an hour, or $29,000 a year. Many fast-food workers are being hired for higher pay in the current employment market, and they don’t have to manage elderly residents, provide them food, bathing and bathroom assistance, or go through the extensive training required of CNAs.

To become certified, CNAs must be at least age 16 and complete 75 hours of classroom and clinical instruction. They then must pass a written or oral final exam and complete a competency evaluation that includes performing at least five nursing tasks on a live person.

CNAs must be proficient in medically sensitive skill areas, including: infection control; overseeing range of motion and use of prosthetics or orthotics; using mechanical lifts; caring for patients lacking bladder or bowel control; and handling patients with dementia or cognitive decline.

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The Evangelical Lutheran Good Samaritan Society, which runs 23 housing campuses in South Dakota, many of them with nursing homes, is taking aggressive steps to recruit and retain more healthcare workers, said Rochelle Rindels, vice president of nursing and clinical services at the agency.

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Rochelle Rindels
Courtesy photo

As of mid-April, Good Sam had about 1,000 nursing employees but about 250 open positions in South Dakota, including 65 openings for licensed nurse positions and about 180 CNA openings.

Working as a CNA is a difficult job that requires a great level of caring and commitment, Rindels said.

“If somebody comes into the position and doesn’t really expect what the work would be or look like, it can lead to burnout.”

Good Sam is working to become more competitive on pay, especially for CNA positions, recently investing $15 million targeted at raising pay for healthcare employees. Last year, the agency developed a new program to recruit and pay to train people interested in the CNA position, Rindels said. So far, about 600 students have entered the program and more than 90% have made it through and passed state certification exams.

Rindels said additional training programs, new funding sources and expanded employee-support systems are needed on the federal and state levels to stabilize staffing at nursing homes in South Dakota.

Deak suggested that perhaps immigrants from Ukraine, fleeing the war in their country, could help fill employment gaps at South Dakota nursing homes.

Followup reports from the state indicate that the deficiencies found in the April 2021 inspection had been fixed.

Legacy Health Care official Connie Ortega said residents and their families will be given individual plans to relocate and continue their care, the release said.

Other Avantara nursing homes operated by Legacy Health Care in South Dakota are located in Arlington, Armour, Clark, Groton, Huron, Lake Norden, Milbank, Pierre, Rapid City, Salem and Watertown.

This article was produced by South Dakota News Watch, a non-profit journalism organization located online at SDNewsWatch.org.

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