Illinois lawmakers two years ago passed landmark legislation aimed at increasing nursing home staffing, including funneling more than $700 million annually into Medicaid-funded facilities.
But ask nursing home residents if those efforts have helped, and most will say it’s still business as usual, according to Susan Real, CEO of the East Central Illinois Area Agency on Aging, which includes Danville.
“They're looking at this in real time saying, ‘Well, there's still staff challenges that are affecting my life,’” she said. “They conclude that there's very little improvement.”
PERKS AND INCENTIVES
House Bill 254 came after the COVID pandemic devastated the state’s nursing homes, which already faced dire shortages before the outbreak. At the time, Illinois had nearly half of the 100 most understaffed facilities in the nation.
That led legislators to take an innovative approach to solve the problem: reward nursing homes for increasing staff levels and provide additional money to raise wages for certified nursing assistants.
The state approved $360 million to go to nursing homes that met certain staffing targets. Those targets were determined by what’s known as the Staff Time and Resource Intensity Verification, or STRIVE study, conducted by the federal Centers for Medicare and Medicaid Services.
Incentive payments start when a facility reaches 70% of its STRIVE target and increase incrementally with each full percentage point increase that a facility attains.
Another $85 million was approved to subsidize wage hikes for CNAs based on their years of experience, starting with a $1.50 per-hour bump for those with one year of experience. Pay incentives increase annually to a maximum of $6.50 per hour for those with at least six years of experience.
The bill also approved another $202 million in combined state and federal funds to raise the base per-day reimbursem*nt rate the state pays nursing homes by $7. Another $4 per day is added for facilities serving an above-average percentage of Medicaid patients.
GOOD NEWS, BAD NEWS
Fast forward to today, and the incentive package and funding boost has indeed led to more staffing in nursing homes.
The state witnessed an 11% increase in nursing home staffing ratios, outpacing improvements in other states, according to a review conducted in December by the Illinois Department of Healthcare and Family Services. The most significant improvements came at facilities with severe staffing issues and high Medicaid populations.
The number of facilities falling below the 70% STRIVE target fell dramatically from 154 at the start of 2022 to just 53 in the second quarter of 2023, marking a two-thirds decrease. That was largely due to an overall increase of nearly 14% in nursing staff hours, the review found.
Now, instead of having nearly half the nation’s most understaffed nursing homes, there are only 18, according to Matt Hartman, president and CEO of the Illinois Health Care Association, which helped draft the law.
But the good news stops there. Even with the infusion of dollars, Illinois still ranks in the bottom 10 states with the worst senior-care staffing, according to Seniorly, an online resource for people seeking long-term care. The state ranks even lower for the ratio of nursing home providers per occupied bed.
That’s no surprise to Angie Baker, the ombudsman for East Central Illinois Area Agency on Aging who serves as an advocate for nursing home residents.
“Staffing is still our number one issue at facilities,” she said. “We've got a lot of good people working with and for residents, but staffing levels haven’t stabilized.”
To meet the need, many facilities turn to high-cost nursing agencies to provide enough workers to keep the doors open. That usually leads to constant turnover of nursing providers that can impact residents’ care, argued Baker.
“It's better than nothing, but it certainly isn’t ideal from the residents’ perspective,” she said. “You're still going to get a warm body in the facility, but they don't know the residents.”
Lack of nurses contributed in part to two facilities closing in Champaign County in the last few years, noted Real with the east-central agency, creating worries about the lack of Medicaid-funded beds available in the area.
'NO MAGIC BULLET'
Hartman said although the initial dollars approved two years ago helped bolster the industry, more money is needed in order to keep the incentive programs and pay bumps funded.
Staffing is the biggest cost to facilities, he said. As it stands, there’s still a $500 million gap between overall costs versus how much Medicaid reimburses facilities. Meanwhile, state agencies and industry groups continue to tweak the new funding model, he noted, to generate the best outcomes for residents.
Hartman said he recognizes that Illinois doesn’t have the millions of dollars on hand that are needed to fully fund nursing homes, but steps need to be taken now to budget and plan for more funding in the future.
“We will work with them to incrementally improve it, but we'd like to see more sooner than later,” he said.
Providing more funding can’t be the only fix, though. Other major obstacles making it hard in Illinois to find a sufficient number of workers also need to change, Hartman argued.
That includes a massively understaffed state licensing agency that sometimes takes over a year to approve and issue licenses to professional nurses, he explained. That’s led to many moving out of state or onto other jobs.
Many community colleges have stopped offering nursing programs due to state regulations capping CNA classes to eight students, Hartman noted. Colleges can't afford to employ a full-time registered nurse to teach just eight people because tuition won't cover it.
“We need to create some relief in a lot of places,” he said. “There's no magic bullet for this. There are a lot of things that need to happen.”
