Nursing and bed shortages

12 Step Hope

Although I care for my husband at home so far, I’m concerned about the shortage of nurses, aides, care facilities and most especially Medicaid beds in my area.  AL businesses commonly don’t answer their phones.  My sister waited 4 months on the 3rd floor of a hospital for a Medicaid bed, at a place 100 miles away.  At her current AL, one Sunday morning NO aides showed up to help the 52 residents.  Only two people work a shift.  Is this a nationwide trend?  What is the effect upon the Alz Community?  Are there national or state policies we could advocate for that will ensure future staff and beds for our LOs?

Jo C.

Hello Hope; it would be of assistance to know which state your sister is living in and what time frame she had those issues; and what state you are in; once we have that information it is much easier to address the issues.

Is your sister in Memory Care or straight Assisted Living or perhaps in  more intensive care setting at a Nursing Home Level?

As to your quesion; no, that is not the usual way care settings operate; in fact, IF this happened in a Memory Care facility, or in a Nursing Home facility and they did have such dynamics currently happening on the day shift, that particular facility would have to be closed and resident patients moved to a safe place where adequate care could be provided.  Fifty-two patients during the daytime with only two aides is not acceptable nor safe in such needful settings of highly at risk patients.  No aide can carry a 26 patient load on the day shift and it would also be tremendously difficult on the pm shift.  However; on the late midnight shift, if there is a licensed nurse in the facility, then there may be only two aides for the 52 patients because it is late night time and none of the daytime caregiving and feeding to be done.

If this was in an ALF where the residents had their own private apartments and were  pretty much independent and not highly compromised; then that may be a bit of a different story depending on circumstances.

Where did you get your information from and is it current to November or December 2022?   Knowing that would also be helpful.

Yes; there are national AND state regulations and laws governing care facilities and standards of care. If something like this arose with care and/or safety deeply suffering with at risk patient residents, then one needs to contact one or both of two places:  One would be the local Ombudsman Office nearest the offending facility; this can be found online - a professional Ombudsman person would go to the facility and assess  the situation.  If the Ombudsman can manage to have the facility correct the situation, then fine. If the Ombudsman person feels the situation is grave, they will report it to the oversight agency at the state/county level who will send professionals out to do an inspection. The Ombudsperson would contact you to discuss findings.

The other way it can be handled will be to skip the Ombudsman Office and make a referral to the State Oversight entity for Care Facilities.  In our state, that is the Public Health Dept. and two RNs are sent out within 24 hours to assess the situation and if problem issues are found, begin resolution in one way or another.They are strict and there are penalties for lapses in meeting care standards.

Facilities went very low in staffing during the worst prior COVID Days; it was a terrible fiasco but many facilities hung on and functioned as best could despite the challenges. Today; it is not that extreme in many if not most areas.  Some facilities may have lower staffing and cannot keep staff due to not being a good place to work. Some areas have lower staffing possibilities as staff burned out doing patient care and are working in other industries. Where I live, most of  the facilities are doing okay with some of the better run ones doing a very good job and fully staffed.  One facility where I had a LO is still running with full staff and low staff turnover rate as  they are  a very good place to work and staff is appreciated.  Others still must continue to recruit and adjust.

It has not been my experience at all that care facilites do not have their phones answered; they all seem to do that just fine.  I had four LOs in different care settings and phones were always answered.  Sometimes if a DON or other staff member was working with patients or in a meeting, I left a message on voice mail and it was always responded to.

It sounds perhaps that while you are caring for your husband, you may be concerned about the future if he needs to go into care.    The best way to go about researching would be to do just that far before the need arises.  You can do a lot of screening online and then make phone calls and once you feel you know what facilities seems most acceptable, you can make a visit to each to assess things in real time.  This way you will not have to run about trying to assess places under time constraint stresses.   One thing that helps is that IF our LO is getting to the point that we know they will soon need to go into care, if there is not a bed at a desireable facility, we can ask to be put on a waiting list for the next bed that becomes available and usually that also requires giving a deposit check which is not cashed until the patient arrives into care.  If there is a deposit check, then the facility knows that the waiting list person is serious and desires to use their services.

If you have sufficient assets to pay privately for care, that gives more options.  If you feel the care will be private pay for a few months but will eventually need Medicaid, then you need to screen only those facilities that have both private pay and also has a contract with Medicaid. Often; if a person is going into a facility needing Medicaid, IF the family can afford to pay privately for two or three months that gets a person a bed more easily. This is because if a person applies for Medicaid and does not qualify for it, then the facility is not going to be short changed and not paid.  NOTE:  In most states, if a person pays privately for care up to three months, once Medicaid is approved as the payor for the Long Term Care, Medicaid will usually refund up to three months the money paid for care as private pay.

It is a lot, but we learn as we go along.  If you have serious issues, especially financial ones, it may be a very good idea to seek the advice of a Certified Elder Law Attorney who can answer all questions factually and position you and your LO the best way possible.

J.

loveskitties

Unfortunately, staffing with any sort of medical background is hard to come by as are Medicaid beds.

My granddaughter is a CNA specializing in dementia care and she could have her pick of 20 or more places to work in our small area.

Adding to the shortage issue is that the ones who are working are often times working lots of overtime to help bridge the gap.  That can burn them out faster.

Government agencies cannot mandate people to work, they can only put lower limits of staff to patients.  If facilities fall below that number they can be forced to close or the facility can lower the number of patients...causing some patients to have to relocate elsewhere.

The lower the number of permitted beds in a facility, the fewer Medicaid beds since they bring in less revenue.

The only way I can see the government being able to impact this cycle is to offer financial incentives for the types of caregivers needed in facilities and hospitals.  It can't be out of pocket for the facilities or they will further reduce their patients to make up the difference.

With the pandemic and our aging population expanding we are in a bad way regarding good medical care on all fronts.  Many more families are being forced to bear the full burden of caregiving.

12 Step Hope

Dear J, thanks for your reply.

Sister is in regular Assisted Living, and the staff shortages occurred September-October of this year.  This happened in Boise, Idaho.

I know about the phones not being answered because I helped her try to find an AL placement after a stay in rehab.  I called 8 or 10 and was able to leave messages at only 2.

These shortages are something the public is unaware of unfortunately.