'You get what you pay for' (part 1): The underfunding of long-term care facilities
There’s a beautiful building on your way out of town. Right there on the right. Certainly you’ve seen it, whether it’s in Ellsworth north on highway 65; west on highway 29 in Spring Valley; or south on County Highway U in Plum City. It could be anywhere: Wyocena, Cottage Grove, Eagle River, etc.
Judging by the exterior, you couldn’t imagine the facility was struggling. If you haven’t been in the building you may not realize that there’s something wrong.
Long-term care facilities throughout the state of Wisconsin have reported a $331.8 million “Medicaid deficit” in 2014-15. On Sept. 13, four long-term and residential care provider associations issued a joint budget request for $91.2 million from the 2017-19 biennial budget to help overcome the challenges that come with Wisconsin’s standing in the nation as the worst state for Medicaid reimbursement.
Medicaid reimbursement for facilities is a joint effort between the federal government and the state to help facilities fund their operations. The federal government allocates a certain amount of money for each state and then the state government decides how much of the remaining costs it can afford to cover. Medicaid reimbursment is meant to help out low-income individuals so that they can afford care when they need it.
In the case of assisted living facilities and long-term care for elderly, people are living longer than they budgeted for with retirement savings, so Medicaid is a program that helps them live out the remainder of their lives with dignity.
The impact of the underfunding is being felt throughout the long-term care facilities in Pierce County and in Wisconsin.
The budget request refers to the underfunding as a crisis. Nursing facilities in the state are losing a battle against time to staff adequate nurses to take care of patients needing long-term care, whether that be a 20-year-old who sustained a brain injury, a 50-year-old with ALS, or the approaching retirements of the lauded Baby Boomer generation.
According to a news release, 1 in 7 caregiving staff positions remain vacant. Seventy percent of facilities in a survey done for the release reported having no qualified applicants for the openings.
The crisis has led facilities in Ellsworth, Spring Valley and Plum City to get creative with staffing, but they have not been able to avoid the dilemma and with it, people are going without the dignified care people hope is in store for their loved ones.
The Spring Valley Healthcare and Rehab Center is a facility that regrettably has had to divert admissions. SVHRC administrator Kevin Larson said they can only afford enough staff to fill 75 percent of its “households” (a term that describes a group of rooms in the facility instead of calling it a “wing” like hospitals do.) in a facility that was built in September 2010.
“We are diverting admissions,” Larson said. “If your parent has a surgery, we can’t take you right now. Here’s people who have been in Spring Valley forever and they need help and we can’t take care of them in Spring Valley.”
That has been a difficult realization for Larson, who expressed gratitude for all the community did to make the facility possible in 2010.
“If we get three or four people calling per week, we maybe can take one,” Larson said. “We have empty rooms in our households right now and it’s horrible.”
Facilities like Spring Valley either cannot find the caregivers trained to help or they cannot keep the caregivers that can help.
Options for people in need
The rural landscape of Pierce County along with the rural areas throughout Wisconsin make for a unique challenge in offering a diverse workforce to cover the needs that long-term care demands.
Some people demand in-home supportive care, which helps people stay in their homes and maintain a certain style of life.
Ken “Skip” Ballard is the Owner and Director of Touching Hearts in-home supportive care based out of Hudson. Ballard said that one of the bigger challenges for him was to find enough caregivers in rural areas that are willing to work the non-traditional hours the job requires.
“Typically, with our business, we're going into people's homes and it's usually shorter shifts,” Ballard said. “We have some clients who are there for a couple of hours and then clients that we are there all day with. Outside of the density it is tough to get people to commit with that flexibility.
“We get referrals in Bay City, Glenwood City, St. Croix Falls, or Diamond Bluff, or Elmwood and, the thing is, the nearest caregiver that we have is in Hudson or River Falls ... because if I do find someone in a small town, I can't give them a whole lot of hours there yet, not until we grow more and things are a lot slower in the rural areas.”
The Director of Nursing at Plum City’s The Seasons Assisted Living, Dawn Davis, said she didn’t know of any supportive in-home care options in Pepin or Buffalo counties. Davis also said that she saw supportive in-home care as a form of care that could help alleviate pressure on the Skilled Nursing Centers — a rehabilitation center for residents who need continual assistance in hopes of returning to their lives before hospitalization or a significant decline in health — and Assisted Living Centers — which are permanent long-term care options that provide regular personal care support.
Supportive in-home care similar to Touching Hearts has a variety of costs, but it cannot afford to pay full-time employees health insurance, which leads them to rely on part-time employees. If supportive in-home care had access to Medicaid reimbursement, Ballard said, it may be a different scenario; but for now, it’s his job to do whatever he can to help those in need.