Montgomery Place Oktoberfest

Oktoberfest at Montgomery Place, 5550 S. Shore Drive, Oct. 15. CEO Deborah E. Hart said the facility's staff vaccine mandate has improved residents' morale during the continuing pandemic: "It's starting to lift the cloud."

A state report released on Oct. 13 says staffing shortages at nursing homes in Illinois have reached crisis proportions and that people of color are most at risk of suffering the consequences.

That’s because those individuals are more likely to live in understaffed facilities or in “ward” rooms with three or four beds per room, the report notes, a fact that became tragically evident during the COVID-19 pandemic when Black and brown Medicaid patients in nursing homes were 40% more likely to die of the disease than white patients.

The report by the Illinois Department of Healthcare and Family Services calls for a dramatic overhaul in the way the state Medicaid program reimburses nursing homes to reward those that improve their staffing levels and quality of care.

“This is not a report that can sit on a shelf and collect dust,” Kelly Cunningham, DHFS’s deputy director for long-term care, told a legislative panel on Oct. 13. “The need to take action is now. The issues we're dealing with are urgent. Continuation of the status quo is not acceptable. And we must hold long-term care providers across Illinois to a higher standard.”

Deborah E. Hart, CEO and president of the nonprofit Montgomery Place assisted living facility and nursing home in Hyde Park, 5550 S. Shore Drive, said her facility is advantaged over others in Illinois by only having two Medicaid beds.

"We're not as dependent on that revenue stream," she said. "When you have a revenue stream that is not being adjusted for the impact of cost increases associated with wage increases in real time as well as all of the regulatory elements associated with COVID, the industry in general is suffering."

DHFS is proposing a $345 million increase in nursing home reimbursement rates, with increases tied to a facility’s staffing and other quality and safety improvements. That money would come from a combination of streamlining billing procedures and an increase in a tax the state levies on each nursing facility occupied bed in the state, a pool of money that also draws additional federal Medicaid reimbursements.

That would translate to an average payment rate increase of about 13%, although the amount for any given facility would vary. Funding increases would be based on a formula that also takes a facility’s profit margin into account so that profitable nursing homes that do not adequately staff their facilities would not see their reimbursements increase on par with those that do.

Hart, for her part, said the state and federal monies, provided through the CARES Act, the March 2020-passed federal stimulus bill, are not enough.

"We're lucky at Montgomery Place, because we don't have to rely as much on those government funds, because that's not the majority of our patient base," she said. "We operate a location that is historically in the four- and five-star range. We have good staffing levels. And people who work in the industry who come here see that, appreciate it and want to stay."

Andy Allison, DHFS’s deputy director for strategic planning and analytics, said space and staffing shortages had tragic consequences during the COVID-19 pandemic.

“Imagine ourselves in the year or two prior to COVID, and if we had known it was coming, whether we would have considered resident safety, room crowding and staffing to have been urgent issues,” he said. “We lost — this is hard for me — thousands in our nursing homes. I don't think there's anyone in the country who would not at that point have said, this is urgent. And I think the point is nothing has changed, except that now we know just how bad it can be.”

Allison also said increased funding alone will not solve the staffing shortage in nursing homes. He said the industry itself also needs to make fundamental changes to address its workforce challenges.

“We are in an urgent race to strengthen that labor market – not to capture them, but to entice them to stay in the serving profession that they've chosen,” he said. “And one of the ways to do that is to make it more of a profession, to give it a pay scale, to allow for promotion, to provide a payoff to staying with it, which is actually one of the principal policy objectives that HFS, the department, has had for years, which is consistency of the relationship between a staff and the residents that they serve.”

The recommendations came as welcome news for some in the nursing home industry.

Angela Schnepf, executive vice president of LeadingAge Illinois, an association of nonprofit aging service providers, said the policy changes DHFS recommends are long overdue and should have been part of the plan when Illinois first adopted its nursing home assessment in 2011.

“As many of you know, 10 years ago, the General Assembly by a thin margin passed the bed tax for a $105 million increase to support the staffing ratios passed in the spring of 2010,” she said. “The rate increase funded the status quo with an assumption that understaffed nursing homes would apply the money to increase their number of staff. One would have thought this made sense. However, the data shows that did not happen.”

Schnepf went on to say that a survey of nursing homes just before the pandemic showed that the 120 facilities with the lowest staffing levels had actually reduced their staffing hours per resident day by 5.8% since 2010, the year before the assessment went into effect, while the statewide average for all nursing homes in the state increased 4.5%.

“As you may or may not know, LeadingAge Illinois opposed the bed tax in 2011 because we anticipated the tax would shift money from well-staffed nursing homes to the pockets of owners of understaffed nursing homes because of the zero requirement of accountability to apply the new money to increasing their staff,” she said. “As a result, over 40% of Illinois nursing homes were losers or lost money, and over 60% of our LeadingAge Illinois members were losers. That means good providers bore the tax burden to fund the failed attempt to increase staffing in understaffed nursing homes, all to no avail.”

But Matt Pickering, executive director of the Health Care Council of Illinois, which represents for-profit nursing homes, criticized the plan for reinforcing what he called a “punitive relationship” and called for an across-the-board rate increase, especially for those with high percentages of low-income residents.

“These facilities face the most challenges to providing care due to the state paying among the lowest Medicaid reimbursement rates in the country,” he said. “We must prioritize quality health care for low-income residents and not jeopardize the stability of our long-term system.”

In Hyde Park, the pandemic has impacted Montgomery Place's staffing. Hart said the departures have been due to its vaccine mandate and burnout, but the majority of staffers who quit have been replaced. Residents' physical and medical needs are being met, she said — patient volume has actually increased in recent months because the facility has enough core staff to do so — but they may be waiting a little longer than normal for certain non-medical services and amenities.

But at any rate, Hart expects the staffing issues are not going to be a short-term issue.

"My concern as a business operator is that wage pressures — not just in nursing homes, but wage pressures in all areas, including accounting services and other service industries — are going to have to get countered someway, because the rate of increase in wages is far exceeding what is currently listed as the consumer price index increase, even with seniors getting their 5.9% increase in Social Security coming up."

Hancock reported from Springfield. Capitol News Illinois is a nonprofit, nonpartisan news service covering state government funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.

(0) comments

Welcome to the discussion.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.