Minnesota Opinion: It's on St. Paul to fix long-term care crisis

Every month in Minnesota, thousands of patients are being forced to stay in the hospital longer than necessary because nursing homes and assisted-living facilities simply don’t have the staff to take them.

“What we have in Minnesota is a long-term care crisis,” Patti Cullen, president and CEO of the Bloomington nonprofit Care Providers of Minnesota, said in an interview last week with the Duluth News Tribune Editorial Board.

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It’s a crisis state legislators are uniquely positioned to solve since the state sets reimbursement rates for care facilities. In other words, facilities’ funding levels, and ability to hire, are dependent on the Minnesota Legislature.

In spite of a record $17.6 billion state budget surplus this year, however, initial spending proposals this session are “not what we need to bridge the gap,” Cullen said. And that’s after the Legislature made no rate adjustments at all in its 2022 session. The House bill this year currently includes nothing for nursing homes.

With a little over a month of work left in the 2023 session, lawmakers have time to ensure adequate and responsible funding for long-term senior care, including the money needed to recruit, train, and then retain with respectable wages (a modest at least $25 an hour is the goal) the health care professionals nursing homes and assisted-living facilities have to have to operate fully — so patients don’t have stay any longer than necessary in the hospital or have to go to a facility hours away from their homes.

“Seniors are being denied the care they need because we can’t recruit the caregivers,” Cullen said. “So, we’re downsizing our facilities, we’re closing wings, we’re eliminating beds, and we’re denying admissions because we don’t have enough staff to take care of folks safely in our settings.”

The vacancy rate for jobs in nursing homes and assisted-living facilities in Minnesota is currently greater than 20%; there are nearly 20,000 open positions right now, according to the Long-Term Care Imperative, which is made up of Cullen’s nonprofit and the nonprofit LeadingAge Minnesota of St. Paul. A majority of nursing homes (65% of them) and assisted-living facilities 56%) have no immediate openings and have to maintain waiting lists for admissions. More than 70% of facilities are limiting admissions year-round. And, monthly, more than 11,000 referrals from Minnesota hospitals to nursing homes and assisted living are being denied due to staffing shortages.

Making the crisis worse, more than 2,500 beds were removed from availability in the past three years statewide due to staffing shortages, according to the imperative. That’s the equivalent of 50 average-sized nursing homes closing. Additionally, since 2020, 17 Minnesota nursing facilities have gone out of business entirely.

The situation with stagnant state reimbursement rates is impacting the ability of care facilities to bounce back from the financial challenges of the pandemic. Hospitals are feeling a different sort of impact: When patients ready to be discharged can’t be, it results in fewer beds available for new patients who need them.

“We’re seeing people staying in the emergency room, actually getting boarded in the ER for days, waiting for an inpatient bed,” Cullen said. “We find that our wage levels aren’t nearly competitive enough, which is why we have such a high number of open positions.”

The Long-Term Care Imperative is lobbying lawmakers for an investment of $1 billion this year. It’s a huge ask, but the crisis is also huge — and will only grow worse with Minnesota’s rapidly aging population.

“We worry about creating long-term care deserts if this situation isn't addressed,” in which entire communities could be left without nursing-home or assisted-living services, Kari Thurlow, president and CEO of LeadingAge Minnesota, told the Duluth News Tribune Editorial Board. “We fear that if the Legislature does not act again this year, we will see more closures in the months to come. … While our payment systems are complicated, one thing is certain: Lawmakers hold the keys to addressing these issues. They control our reimbursement stream.”

And with the state budget surplus and a good sense of right and wrong, lawmakers — the ones in position to take the responsible action that’s necessary — can make investment decisions that Minnesota seniors and others, and their families, need.

“We’re in the middle of the sausage-making right now at the Legislature,” Thurlow said. “While we acknowledge that the entire economy is short-staffed, we have a core responsibility to ensure that seniors have access to long-term care. That starts with taking care of our caregivers, including elevating wages so that we elevate those professions.”