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New survey finds N.H. nursing homes closing beds amid staffing shortages, rising costs

photo of empty nursing home bed
Maplewood Nursing Home
At Maplewood Nursing Home, staffing shortages forced the temporary closure of 50 beds in 2021.

Grafton County Nursing Home has a few dozen beds it can’t fill. It’s not because patients aren’t interested; it's because the beds can’t be staffed.

Craig Labore, the home's administrator, said prior to the COVID-19 pandemic, nearly all of their beds were occupied. Now around one-third are unused. Without enough staff, in late May, the facility put a pause on new admissions.

“We're still on pause right now” Labore said, “We are having some discussions about trying to resume. But it's not going to be anywhere near the volume that we're receiving applications for. The waitlist grows.”

Labore’s facility isn’t an outlier, according to a new survey commissioned by the New Hampshire Health Care Association, which represents dozens of New Hampshire nursing homes. Of the 37 facilities that responded to the survey, more than half reported pausing patient admission due to lack of available staff in the past two years.

For some, the pause was a few weeks here and there, but for others it was months long.

“It's something we hear from families, that they are beginning to see challenges with access issues for finding care for their loved one,” Labore said.

At the same time some facilities are reducing patient volumes, running a nursing home is also getting more expensive, according to the survey.

Lately, inflation has been one culprit. Earlier this spring, Labore’s distributor for cleaning products said he wouldn’t deliver to Grafton County, citing rising fuel costs.

But Labore said these types of issues pale in comparison to the cost of increasing reliance on travel nurses and other contract staff, which are more expensive than hiring local staff directly.

“We’re using less billable hours compared to the previous year, but our costs have gone up,” he said.

At the same time, many workers in the industry report low wages that are competitive with other less demanding jobs in food service or retail. For them, working for a healthcare staffing agency can result in better pay.

Earlier coverage: As COVID surges, N.H.'s health care system is left shaken (2021)

Nursing homes in New Hampshire are losing money on patient care, about 75 dollars per patient per day in 2021 on average. That’s up from 25 dollars in 2019, according to the survey commissioned by the New Hampshire Health Care Association. The survey did not take into account the addition of COVID-19 relief funds, which some facilities told NHPR they have used to help offset these types of operational losses.

Unlike states including Nebraskaand Maine, no nursing homes have permanently closed recently in New Hampshire, according to Brendan Williams, president and CEO of the association.

But Williams says dramatic cuts to patient volume, which for some facilities have included entire wings or floors, are their own “quiet catastrophe.” It’s the quietness that has him worried.

“People tend to wait for complete disaster before we react,” he said.

Still, Williams is hopeful lawmakers in Concord will enact policy changes to bolster the industry.

Williams would like to see New Hampshire regulate the prices set by healthcare staffing agencies as has been done in Minnesota and Massachusetts, where staffing agencies face regulatory “wage caps.”

At a minimum, he wants to see more transparency from staffing agencies.

“We need to know what it is they're charging facilities and what proportion of what they're charging facilities actually goes to the caregivers,” he said.

Williams would also like to see the state raise Medicaid reimbursement rates to better support facilities as costs continue to rise.

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