COURT HOUSE – Nursing homes and assisted living communities nationwide are in the midst of a battle against the effects of Covid that is far from over, and those facilities in Cape May County are no exception.
A recent report released by the American Health Care Association (AHCA), produced by CliftonLarsonAllen LLP (CLA), a U.S. Securities and Exchange Commission-regulated investment advisor, highlights the unprecedented economic crisis in nursing homes.
Their findings, which include increased costs due to labor and inflation, unsustainable funding levels, increased risk for closures, and challenges with access to resources will require “significant support from federal and state lawmakers,” according to the AHCA.
AHCA and LeadingAge released a comprehensive reform proposal, Care For Our Seniors Act, that includes proposals to address long-standing challenges for the profession, such as staffing.
Additionally, AHCA President and Chief Executive Officer Mark Parkinson sent a letter to Congressional leadership, requesting additional resources for long-term care residents and staff.
Specifically, AHCA calls for replenishment of the Provider Relief Fund, with $20 billion allocated to long-term care, and an extension to the current delay of Medicare sequestration cuts, as well as the recoupment of Medicare Accelerated and Advance payments.
Efforts for comments from U.S. Rep. Jeff Van Drew (R-2nd) were unsuccessful.
Cape May County Facilities
A random survey of facilities in Cape May County found similar issues to the nationwide report. Representatives from Cape May County, which operates Crest Haven Nursing and Rehabilitation Center; Genesis HealthCare, one of the nation’s largest post-acute care companies that now operates only one facility in the county; and CompleteCare, a family-owned and operated New Jersey-based company that operates two facilities in the county, are all seeing the same nationwide trends locally.
According to Denis Brown, a spokesperson for the county, the Board of County Commissioners “continues to recognize the need in the county for quality long-term care and continues to support the Crest Haven Nursing and Rehabilitation Center.”
They have placed a new management team at the center and Brown said, “We remain optimistic about the future and are always looking for strategies to improve and deliver the most efficient, quality of care.”
The facility has fewer numbers of patients today compared to pre-pandemic, according to Brown, and has seen rates for nursing staff increase.
“We are hovering in the 80s, the total number of patients,” Brown said. “Pre-pandemic, we were averaging in the 90-105 range.”
Registered nurses (RNs) are hired at $60,000, while licensed practical nurses (LPNs) are hired at $41,473 today, according to Brown.
He said that “nothing has changed (in terms of pay for RNs and LPNs) except for agency nursing and there being supply/demand issues.”
“Because of Covid, we did have to open contracts for the agency nurses and the rates doubled,” he added. “These contracts expire in 2022 and a new request for proposals (RFP) will be issued. We anticipate some leveling of rates.”
The county’s wage experiences are reflected nationwide. According to the ACHA report, the average increase in wage rates for nurses at all levels doubled from 2020 to 2021. Rates for contracted and agency nurses are also two to three times higher than pre-pandemic rates.
The report projects the median 2022 year-end operating margin to be -4.8%, with a median occupancy of 77.3%. This projection is based on maintaining the current Patient-Driven Payment Model through Medicare and state public health emergency (PHE) funding levels. The report emphasizes that any reduction in reimbursement could deepen financial issues for the long-term care sector.
Another finding in the report is that 32-40% of residents (as many as 417,000 residents) are currently living in nursing homes that are considered financially “at-risk” – including buildings with five-star quality ratings.
Genesis HealthCare now provides services to nearly 250 skilled nursing facilities and assisted/senior living communities in 22 states, and has 1,100 locations in 43 states, including the District of Columbia.
They previously operated four facilities within Cape May County, but today, only operate the North Cape Center, in North Cape May, which is approximately 76% occupied, compared to 80% prior to the pandemic.
In January 2021, in the midst of the pandemic, they provided services to 325 skilled nursing facilities and assisted/senior living communities in 24 states and had 1,100 providers in 44 states, including the District of Columbia and China. Those numbers are down from April 2020, just at the start of the pandemic, when they had nearly 400 skilled nursing facilities and assisted/senior living communities in 25 states and had 1,200 providers in 44 states, including the District of Columbia and China.
“North Cape Center’s wage rates are competitive for the market and have increased since the pandemic,” said Lori Mayer, spokesperson for the North Cape Center. “The center also supplements staffing with agency labor as needed. Those wage rates have also increased since the pandemic.”
She did not provide any specific numbers.
CompleteCare, which bought two of the facilities previously owned by Genesis, is a leading provider of subacute and long-term care, operating more than 40 subacute rehabilitation and skilled nursing and assisted-living facilities throughout the state.
“We are committed to the health and welfare of our residents, and we take that responsibility extremely seriously,” said a spokesperson for CompleteCare. “We take whatever measures necessary to ensure that we have proper staffing to meet the needs of those in our care, including bringing in agency staff and offering bonuses as needed.”
CompleteCare is “fortunate” to be able to meet all staffing needs, according to the spokesperson.
They operate CompleteCare at Court House, in Court House, and Complete Care at Victoria Commons, in North Cape May.
The census in their Cape May County facilities reflects the national trends.
“With New Jersey’s aging senior population and the specialized services offered in CompleteCare’s skilled nursing facilities, we expect occupancy will rise over time,” said the spokesperson.
They provided no specific numbers.
“As outlined by the recent report commissioned by the AHCA, the long-term care industry faces a number of economic and related challenges, which have been exacerbated by the Covid pandemic,” the spokesperson said. “CompleteCare is a member of Health Care Association of New Jersey (HCANJ), which is working closely with state officials and policymakers to address these complex issues at a statewide level, with a goal to enact meaningful change.”
Medicare and state public health emergency-related funding provided help and support throughout 2020 and early 2021, according to the report’s findings, “but potential cuts to these programs pose risk to nursing homes, as they continue to face financial challenges such as occupancy decline, staffing shortages, and increased labor costs.
“These findings underscore the need for additional support and resources for nursing homes to withstand the ongoing pandemic,” according to a March 3 AHCA press release on the report. “Together, Congress, the Biden administration, and the long-term care industry will be able to make lasting change, so America’s elderly will continue to have access to the high-quality care they deserve.”
To contact Karen Knight, email kknight@cmcherald.com.
