Missouri ranks second to last in the nation in the hours of care nursing home residents receive from nurses per day, according to an independent analysis of federal data.
A report by the Long Term Care Community Coalition found that Missouri nursing home residents on average receive about three hours of care a day. That's slightly more than last year but still well below the national average of 3.61 hours of care per day and below the minimum four hours of care that the federal Centers for Medicare and Medicaid Services say is needed for residents.
The data reflect a history of staffing issues in long-term care facilities across the state, said Marjorie Moore, executive director of VOYCE, a statewide nonprofit that advocates for nursing home residents.
“We're still seeing a lot of [certified nursing assistants] with loads of residents that are completely and totally unrealistic,” Moore said. “People that are tired and overworked tend to make more mistakes, they burn out, and that's really hard for residents.”
Nursing facilities have tried to handle staff shortages by signing contracts with staffing agencies that provide workers, but Moore said that when facilities rely too much on agencies, it can lead to a revolving door of workers who don’t form connections with patients and don’t know their specific needs.
The high number of people nurses often need to care for, low wages and the inability to advance in career paths also have led to a large exodus of workers, Moore said.
“You can't expect somebody to come in at just above minimum wage pay and expect for them to stay in that position for a career,” Moore said. “I think that's one of the big challenges that we're going to have is making sure that we give those pathways to folks.”
Nursing home staffing has dropped across the country while other health sectors are rebounding, according to a recent report by KFF, a nonprofit organization that studies health care policy. Using data from the U.S. Bureau of Labor Statistics, KFF researchers found skilled nursing care staffing nationwide dropped by 11% between February 2020 and June of this year. Missouri saw an 8.5% drop, or about 6,000 fewer workers at nursing and residential care facilities during the same period.
“If there aren't enough workers providing the needed care, that means residents are put at risk,” said Krutika Amin, a co-author of the KFF report. “Not having enough workers could make these facilities dangerous for the residents. With an aging population and more people needing long term care, it's hard to imagine how the need is being met here.”
Nationwide, staffing at skilled nursing and elderly care facilities is still below pre-pandemic levels, but it has started to increase. Last year, the Biden Administration announced it would set minimum staffing standards for nursing facilities across the country. The proposals are aimed at ensuring that facilities have adequate staffing and that those that don’t hire more employees or lose taxpayer funding. Some facilities have said they need more government funding and higher budgets to offer raises for staff. But advocates for people in nursing facilities say nursing facility leaders aren’t using the funding they have to offer better pay.
Moore said she hopes the Biden administration announces rules on minimal standards of care in coming months. She said Missouri nursing homes will have to make serious investments in workers to retain and hire more.
“There does have to be some sort of a balance between making sure that we're able to get those folks in, figuring out a way that facilities get the money they need to pay those people,” Moore said. “Although in a lot of ways, we think a lot of that money is already there. We just see it getting hauled away through related party transactions and into owners' pockets instead of in the hands of the workers.”
