STATE NEWS (PA)- Despite major Medicaid boost, lack of staff still limits nursing home admissions


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[MM Curator Summary]: How much of a rate increase is needed to deal with nursing facility challenges in PA? The answer is not 17%.



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Tine Hansen-Turton, president and CEO of the Woods in Pennsylvania, discusses workforce solutions at a summit Tuesday. Credit: PHCA

Months after a 17% Medicaid increase kicked in, hundreds of Pennsylvania nursing home beds remain empty because facilities can’t hire enough staff to provide care, a new survey finds.

The Pennsylvania Health Care Association released its 2023 State of Nursing Facilities Report Tuesday showing that 57% of responding members have beds they cannot fill due to a lack of staff.

Thirty-one percent of respondents said they have 21 or more direct care positions open but cannot find certified nurse aides, licensed practical nurses or registered nurses to fill them.

The association held a Long-Term Care Policy Summit Tuesday in the state capital to bring together lawmakers, providers and others to brainstorm and share workforce solutions.

The PHCA survey showed:

  • The average facility denied 17 admissions because of a lack of staff between November 2022 and February 2023.
  • 81% of respondents are using staffing agencies to fill open positions.
  • 93% of respondents anticipate either needing to use or increasing their use of agency
  • Facility labor costs increased an average of 20% from 2019 to 2022.
  • 93% of respondents anticipate either needing to use or increasing their use of agency workers to meet the new state staffing minimum that will begin in July.

In related news, LeadingAge Pennsylvania on Wednesday sent a letter to US Sen. Bob Casey Jr. (D-PA) outlining members’ concerns about the looming federal staffing requirement.

“We must recognize that providers are in crisis and residents’ access to care is at risk, due in large part to historic underfunding and a workforce crisis that predated the pandemic,” wrote President and CEO Garry Pezzano. “As we get back on our feet after the pandemic, we need to [give] common sense approaches a chance to make an impact before jumping to arbitrary staffing mandates on a national level. Common themes worthy of support include efficient and accessible training and competency programs, workforce immigration pipelines, faster turnaround times for staff licensing and test center coordination, and developing and incentivizing modern career pathways.”

New resources haven’t turned tide yet

Pennsylvania increased its Medicaid reimbursement rates by 17.5% last year after nearly a decade with little to no increases. That boosted rates by approximately $35 per resident per day. Association President and CEO Zach Shamberg said survey respondents “overwhelmingly” plan to use those extra funds to recruit and retain staff.

Despite that, nursing homes in the state continue to struggle.

“The problem is, we’ve made a promise to [aging] Pennsylvanians that we will care for them and that care, the availability of that care, and the accessibility to that care is very much at jeopardy today,” Shamberg said in opening remarks at the summit. “There are providers … who are having real difficulty keeping that promise.”

Pennsylvania has relied heavily on temporary nurse aides during the pandemic, giving frontline staff key training opportunities even as the state saw significant certification delays.

Joseph DeMattos, president and CEO of Health Facilities Association of Maryland, also attending the summit and said the tens of thousands of temporary nurse aides in his state during the pandemic played an “incredibly critical role” in caring for residents.

Shamberg said Pennsylvania facilities that used temporary aides each converted an average of eight into full time CNAs over the last few months, which has resulted in approximately 4,500 new, full-time workers.

But Centers for Medicare & Medicaid Services TNA waivers in all remaining states expire along with the public health emergency on May 11.

“The pandemic may be over but if we don’t get on the right track — if we don’t start addressing this today, then the challenges will be long lasting,” Shamberg said, noting that the association plans to make approval of nursing home medication aides a legislative priority this year.